Ten variables individualize need for adjuvant treatments based on recurrence risk-- Lindsey Marcellin
Tuesday, July 13, 2010 (Last Updated: 07/16/2010)
TUESDAY, July 13 (HealthDay News) -- A nomogram using clinical and pathological tumor characteristics can predict the risk for local recurrence of ductal carcinoma in situ (DCIS), and can assist in making individualized treatment decisions, according to research published online July 12 in the Journal of Clinical Oncology.
Udo Rudloff, M.D., of the Memorial Sloan-Kettering Cancer Center in New York City, and colleagues conducted a study of 1,681 women treated with breast-conserving surgery (BCS) for DCIS. The researchers used 10 variables to construct a nomogram for estimating the probability of ipsilateral breast tumor recurrence (IBTR) at five and 10 years after BCS. The measured outcome was the ability of the nomogram to provide an individualized risk estimate of IBTR in a woman with DCIS treated with BCS.
The researchers found that the nomogram showed good calibration and discrimination, with a concordance index of 0.704 (bootstrap corrected correlation, 0.688) and a concordance probability estimate of 0.686. Adjuvant radiation therapy or endocrine therapy, margin status, age, treatment time period, and number of excisions were among the factors that had the largest influence on risk of IBTR in the model. The authors concluded that the DCIS nomogram could assist in individual decision making regarding treatment options for DCIS and could help avoid both over- and under-treatment of this type of breast cancer.
"In the absence of comprehensive molecular profiles proven to be predictive of outcomes, the clinician is currently left with standard clinical and morphologic features which are associated with risk of recurrence of DCIS. Nomograms have the advantage of estimating risk based on a combination of variables, permitting a more individualized prediction of outcome, and have been shown in several malignancies to be superior to conventional staging or scoring systems," the authors write.
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