Division of Cancer and Stem Cells, School of Medicine, University of Nottingham Biodiscovery Institute, The University of Nottingham, Nottingham, UK.
Histopathology Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt.
Br J Cancer. 2020 Nov;123(10):1513-1520. doi: 10.1038/s41416-020-1023-3. Epub 2020 Aug 10.
Oestrogen receptor (ER) in invasive breast cancer (BC) predicts response to endocrine therapy (ET) and provides prognostic value. In this study, we investigated the value of ER expression in ductal carcinoma in situ (DCIS) in terms of outcome and the impact on ET decision.
In total, 643 pure DCIS, diagnosed at Nottingham University Hospitals, were assessed for ER. Clinicopathological data were correlated against ER status, together with assessment of recurrence rate.
ER positivity was observed in 74% (475/643) of cases. ER positivity was associated with clinicopathological variables of good prognosis; however, outcome analysis revealed that ER status was not associated with local recurrence. In the intermediate- and high-grade ER-positive DCIS, 58% (11/19) and 63% (15/24) of the recurrences were invasive, respectively, comprising 7% and 6% of all ER-positive DCIS, respectively. Invasive recurrence in low-grade DCIS was infrequent (2%), and none of these patients died of BC. The ER status of the recurrent invasive tumours matched the primary DCIS ER status (94% in ipsilateral and 90% of contralateral recurrence).
The strong correlation between DCIS and invasive recurrence ER status and the clinical impact of ET justify discussion of the use of ET in ER-positive DCIS treated by breast-conserving surgery. The excellent outcome of low-grade DCIS, which was almost always ER-positive, does not, in the opinion of authors, justify the use of risk-reducing ET. Therefore, the decision on ET for DCIS should be personalised and consider grade, ER status and other characteristics.
在浸润性乳腺癌（BC）中，雌激素受体（ER）可预测内分泌治疗（ET）的反应，并提供预后价值。在这项研究中，我们研究了 ER 表达在导管原位癌（DCIS）中的价值，包括其对结局的影响和对 ET 决策的影响。
共评估了诺丁汉大学医院诊断的 643 例纯 DCIS 中的 ER 情况。将临床病理数据与 ER 状态相关联，并评估复发率。
74%（475/643）的病例中存在 ER 阳性。ER 阳性与预后良好的临床病理变量相关；然而，结局分析显示 ER 状态与局部复发无关。在中高级别 ER 阳性 DCIS 中，分别有 58%（11/19）和 63%（15/24）的复发是浸润性的，分别占所有 ER 阳性 DCIS 的 7%和 6%。低级别 DCIS 的浸润性复发很少见（2%），且这些患者均未死于 BC。复发的浸润性肿瘤的 ER 状态与原发性 DCIS 的 ER 状态相匹配（同侧为 94%，对侧为 90%）。
DCIS 和浸润性复发 ER 状态之间的强相关性以及 ET 的临床影响证明了在保乳手术后接受 ET 的 ER 阳性 DCIS 中讨论使用 ET 的合理性。作者认为，低级别 DCIS 的出色结局（几乎总是 ER 阳性）不需要使用降低风险的 ET。因此，对 DCIS 的 ET 决策应该个体化，并考虑分级、ER 状态和其他特征。
