Abstract S5-04: A large prospectively-designed study of the DCIS score: Predicting recurrence risk after local excision for ductal carcinoma in situ patients with and without irradiation
Notice bibliographique
Résumé
Abstract Background: DCIS patients need better tools to align the aggressiveness of treatment with the aggressiveness of their disease. The DCIS Score (DS) was validated as a predictor of ipsilateral breast recurrence (IBR; DCIS or invasive) in 327 E5194 patients treated by breast-conserving surgery (BCS) without radiation (RT) (Solin,2013). This Ontario population based DCIS study of 3335 women with DCIS from 1994 to 2003 (Rakovitch,2013) was conducted to test the DCIS Score as a predictor of recurrence risk in patients treated with BCS alone and in patients treated with BCS+RT. Methods: REMARK guidelines were followed. Breast pathologists centrally reviewed all H&E slides. The Oncotype DX DCIS Score was obtained by standardized quantitative RT-PCR using fixed paraffin embedded tumor. The pre-specified primary objective was to determine the relationship (hazard ratio (HR)/50 units) between the risk of an IBR and the continuous DS (using Cox models) in patients treated with BCS alone with ER+ tumors and clear margins (CM, no ink on tumor). Results: Tumor blocks were collected for 1569 patients (47% of parent cohort); 718 received BCS without RT (N=571 with CM) and 846 received BCS+RT (N=689 with CM). Median follow-up was 9.4 years. Among 1260 pts with CM, 100 pts treated with BCS alone had an IBR (DCIS, N=44; invasive, N=57); 86 pts treated with BCS+RT had an IBR (DCIS, N=32; invasive, N=55). In the primary analysis, among 571 patients treated by BCS alone with CM the continuous DS was significantly associated with IBR in ER+ patients (HR 2.26; 95%CI 1.41,3.59; P=0.001) and in all patients (HR 2.15; 95%CI 1.43,3.22; P=<0.001). The DS was also associated with invasive IBR (HR 1.78; 95%CI 1.03,3.05; P=0.04); similar but non-significant results were noted in the ER+ subgroup (P=0.08). Among 689 pts with CM treated by BCS+RT, the DS was associated with IBR (HR 2.78; 95%CI 1.77,4.41; P=<0.001). There was no interaction between the DS and RT (P=0.40). In multivariable analysis for IBR in CM cases, the HR/50 units for the DCIS Score among patients treated with BCS alone was 1.80(95%CI 1.17,2.74; P=0.008) and 2.86(95%CI 1.79,4.62, P=<0.001) for those treated with BCS+RT adjusting for multifocality, tumor size and age. Conclusions: DCIS Score quantifies recurrence risk for DCIS patients treated by BCS with or without RT. Integrating the DCIS Score with established risk factors, such as multifocality, age, and tumor size, can help identify DCIS patients treated with BCS alone with low 10 year risk (<10%) of recurrence and those who still have high 10 year risk of recurrence despite RT who may be candidates for more aggressive treatment. BCS Alone, CMBCS with RT, CMDCIS Score Risk Group10-Yr Kaplan-Meier IBR Rate (95%CI)10-Yr Kaplan-Meier IBR Rate (95%CI) All patients (N=571)Unifocal DCIS (N=457)All patients (N=689)Multifocal DCIS (N=177)Low (<39)12.7% (9.5%,16.9%) N=3559.7% (6.8%,13.8%) N=2987.5% (4.9%,11.2%) N=3329.8% (4.6%,20.1%) N=91Int (39-54)33.0% (23.6%,44.8%) N=9527.1% (17.7%,40.2%) N=7213.6% (8.6%,21.2%) N=15520.6% (10.3%,38.7%) N=37High (>55)27.8% (20.0%,37.8%) N=12127.0% (18.2%,38.9%) N=8720.5% (15.1%,27.5%) N=20233.3% (21.9%,48.5%) N=49Log rank P-value<0.001<0.001<0.001<0.001 Citation Format: Eileen Rakovitch, Sharon Nofech-Mozes, Wedad Hanna, Frederick L Baehner, Refik Saskin, Steven M Butler, Alan Tuck, Sandip Sengupta, Leela Elavathil, Prashant A Jani, Michel Bonin, Martin C Chang, Elzbieta Slodkowska, Joseph M Anderson, Farid Jamshidian, Diana B Cherbavaz, Steven Shak, Lawerence Paszat. A large prospectively-designed study of the DCIS score: Predicting recurrence risk after local excision for ductal carcinoma in situ patients with and without irradiation [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr S5-04.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,001 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».