Mieke Van Bockstal1, Kathleen Lambein2, Ann Smeets3, Laurence Slembrouck4, Patrick Neven5, Ines Nevelsteen3, Caroline Weltens6, Erik Van Limbergen6, Marie-Rose Christiaens3, Chantal Van Ongeval7, Hans Wildiers8, Louis Libbrecht9, Giuseppe Floris10. 1. Department of Pathology, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands; Laboratory of Experimental Cancer Research, Department of Radiation Oncology and Experimental Cancer Research, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium. Electronic address: m.vanbockstal@erasmusmc.nl. 2. Department of Pathology, AZ St Lucas Hospital Ghent, Groenebriel 1, 9000 Ghent, Belgium; Department of Surgical Oncology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium. 3. Department of Surgical Oncology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium. 4. Department of Oncology, KUL University of Leuven, Herestraat 49, 3000 Leuven, Belgium. 5. Department of Oncology, KUL University of Leuven, Herestraat 49, 3000 Leuven, Belgium; Department of Gynecology and Obstetrics, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium. 6. Department of Radiotherapy Oncology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium. 7. Department of Radiology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium. 8. Department of Medical Oncology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium. 9. Department of Pathology, University Clinics St Luc, Hippokrateslaan 10, 1200 Sint-Lambrechts-Woluwe, Belgium. 10. Department of Pathology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium; Department of Imaging and Pathology, Laboratory of Translational Cell & Tissue Research, KUL University of Leuven, Herestraat 49, 3000 Leuven, Belgium.
Abstract
BACKGROUND: Ductal carcinoma in situ (DCIS) of the breast constitutes a heterogeneous group of non-obligate precursors for invasive breast cancer. To date, adequate risk stratification is lacking, which is presumed to result in overtreatment. We previously identified myxoid stromal architecture as a potential prognosticator for loco-regional recurrence. In the present study, we investigated the prognostic potential of stromal characteristics. METHODS: Hematoxylin and eosin stained slides from 211 DCIS patients were reviewed. The following histological features were dichotomously assessed: nuclear grade, DCIS architecture, presence of necrosis, intraductal calcifications, stromal inflammation and myxoid stromal architecture. Loco-regional recurrences constituted the primary endpoint. RESULTS: Cox regression analysis showed that high nuclear grade, myxoid stromal architecture and moderate to extensive stromal inflammation were significantly associated with decreased recurrence-free survival, independent of radiotherapy. Based on these features, a combined risk score (CRS) was calculated, ranging from zero to three. A high CRS of three was associated with significantly shorter recurrence-free survival. Nineteen patients had a CRS of three, of which three relapsed (15.7%), whereas only one out of 113 patients with a CRS of zero relapsed (0.9%). CONCLUSIONS: We were able to validate our previously reported findings regarding the prognostic potential of myxoid periductal stroma in an independent DCIS patient cohort. A CRS based on nuclear grade, myxoid stromal architecture and stromal inflammation might facilitate discrimination of low risk from high risk patients. Consequently, the CRS may tailor adjuvant therapy. Future research should investigate whether radiotherapy can be safely omitted in patients with a low CRS.
BACKGROUND:Ductal carcinoma in situ (DCIS) of the breast constitutes a heterogeneous group of non-obligate precursors for invasive breast cancer. To date, adequate risk stratification is lacking, which is presumed to result in overtreatment. We previously identified myxoid stromal architecture as a potential prognosticator for loco-regional recurrence. In the present study, we investigated the prognostic potential of stromal characteristics. METHODS:Hematoxylin and eosin stained slides from 211 DCIS patients were reviewed. The following histological features were dichotomously assessed: nuclear grade, DCIS architecture, presence of necrosis, intraductal calcifications, stromal inflammation and myxoid stromal architecture. Loco-regional recurrences constituted the primary endpoint. RESULTS: Cox regression analysis showed that high nuclear grade, myxoid stromal architecture and moderate to extensive stromal inflammation were significantly associated with decreased recurrence-free survival, independent of radiotherapy. Based on these features, a combined risk score (CRS) was calculated, ranging from zero to three. A high CRS of three was associated with significantly shorter recurrence-free survival. Nineteen patients had a CRS of three, of which three relapsed (15.7%), whereas only one out of 113 patients with a CRS of zero relapsed (0.9%). CONCLUSIONS: We were able to validate our previously reported findings regarding the prognostic potential of myxoid periductal stroma in an independent DCIS patient cohort. A CRS based on nuclear grade, myxoid stromal architecture and stromal inflammation might facilitate discrimination of low risk from high risk patients. Consequently, the CRS may tailor adjuvant therapy. Future research should investigate whether radiotherapy can be safely omitted in patients with a low CRS.
Authors: Serdar Altinay; Laurent Arnould; Noella Bletard; Cecile Colpaert; Franceska Dedeurwaerdere; Benjamin Dessauvagie; Valérie Duwel; Giuseppe Floris; Stephen Fox; Clara Gerosa; Shabnam Jaffer; Eline Kurpershoek; Magali Lacroix-Triki; Andoni Laka; Kathleen Lambein; Gaëtan Marie MacGrogan; Caterina Marchió; Dolores Martin Martinez; Sharon Nofech-Mozes; Dieter Peeters; Alberto Ravarino; Emily Reisenbichler; Erika Resetkova; Souzan Sanati; Anne-Marie Schelfhout; Vera Schelfhout; Abeer M Shaaban; Renata Sinke; Claudia Maria Stanciu-Pop; Claudia Stobbe; Carolien H M van Deurzen; Koen Van de Vijver; Anne-Sophie Van Rompuy; Stephanie Verschuere; Anne Vincent-Salomon; Hannah Wen; Hélène Dano; Caroline Bouzin; Christine Galant; Mieke R Van Bockstal Journal: Mod Pathol Date: 2019-09-18 Impact factor: 7.842
Authors: Mieke R Van Bockstal; Marie C Agahozo; Linetta B Koppert; Carolien H M van Deurzen Journal: Int J Cancer Date: 2019-05-08 Impact factor: 7.396
Authors: Jan Kukačka; Stephan Metz; Christoph Dehner; Alexander Muckenhuber; Korbinian Paul-Yuan; Angelos Karlas; Eva Maria Fallenberg; Ernst Rummeny; Dominik Jüstel; Vasilis Ntziachristos Journal: Photoacoustics Date: 2022-03-02