The pattern of recurrence in initial pure ductal carcinoma-in-situ of the breast: 19 years experience of King Chulalongkorn Memorial Hospital, Thailand

Abstract

Background: The rate of recurrence after treatment for pure DCIS has been recognized range from 5-20%. Approximately half of these patients are invasive and less than 1% is distant metastasis. The aims of our study was to identify pattern of recurrence, clinico-pathological makers of recurrence in King Chulalongkorn Memorial Hospital. Method(s): One hundred and seventy-four patients who diagnosed with pure DCIS between 1998 and 2016 at King Chulalongkorn Memorial Hospital were reviewed ret-rospectively. The clinical and pathologic characteristics of DCIS patients including pattern of locoregional recurrence and distant metastasis were analyzed. Result(s): In initial analysis, 17 from 174 patients (9.8%) with initially pure DCIS were diagnosed with recurrent disease. 15 out of 17 (88.2%) patients were loco-regional recurrence. Distant metastasis was rarely reported in 2 out of 17 patients (11.8%). For recurrent subgroup, the median age was 47.5 years (33-66) and 50% had tumor size more than 1 centimeter. 75% had histologic grade I-II, none of patients had DCIS with comedonecrosis, 92% had DCIS with positive estrogen receptor and 61% had negative margin, but approximately 30% had closed margin. In term of treatment, 58.8% underwent wide excision, 21.1% received postoperative radiation, 28.6% received 5 years tamoxifen for prevention. The median time of overall recurrence was 103 months (11-205). Only one patient had died of disease. Disease free survival and overall survival will be further analyzed. Conclusion(s): Pattern of recurrence after diagnosis of pure DCIS is mostly loco-regional recurrence and rarely distant metastasis. Further study of clinicopathological predictors is essential for early prevention and improved the treatment outcome of pure DCIS patients.