The impact of extensive intraductal component (EIC) on the genomic risk of recurrence in early hormone receptor positive breast cancer.

Background: Early invasive ductal carcinoma (IDC) breast cancer often presents with a coexisting ductal carcinoma in situ (DCIS) component, while about 5 % of cases present with an extensive (>25 %) intraductal component (EIC). The impact of EIC on the genomic risk of recurrence is unclear.
Methods: Patients with early hormone receptor-positive HER2neu-negative (HR + HER2-) IDC breast cancer and a known OncotypeDX Breast Recurrence Score® (RS) who underwent breast surgery at our institute were included. Using a rule-based text-analysis algorithm, we analyzed pathological reports and categorized patients into three groups: EIC, non-extensive DCIS (DCIS-L), and pure-IDC (NO-DCIS). Genomic risk was determined using OncotypeDX RS.
Results: A total of 33 (4.6 %) EIC cases, 377 (57.2 %) DCIS-L cases and 307 (42.8 %) NO-DCIS cases were identified. Patients in the EIC group were younger and had lower tumor grades than other groups. The distribution of genomic risk varied between the groups, with EIC tumors significantly less likely to have a high RS (>25) compared to DCIS-L and No-DCIS tumors (3 % vs 20 % and 20 %, respectively; p = 0.03). When adjusted to age, tumor size, grade and LNs involvement, both DCIS-L and NO-DCIS groups were significantly correlated with a higher probability of high RS compared to the EIC group (OR 12.3 and OR 13.1, respectively; p < 0.02). Moreover, patients with EIC had a lower likelihood for adjuvant chemotherapy recommendation.
Conclusions: In early HR + HER2- IDC, an EIC correlates with a reduced genomic recurrence risk. The impact on genomic risk seems to be influenced by the extent, not merely the presence, of DCIS.
Competing Interests: Declaration of competing interest Y.Bar reports consulting fees from Eli lilly, Roche, Stemline and Gilead and travel fees from Gilead. A.Sonnenblick reports consulting fees from Eli lilly, Teva, Pfizer, Novartis, Roche, Gilead, MSD, Astra-Zenca, Progenetics and Rhenium; Travel fees from Neopharm, Celgene, Medison, Roche and MSD and grant support from Novartis and Roche, all outside the submitted work. I.Wolf reports research grants from MSD, BMS, Roche and Novartis; S. Strulov Shachar reports consulting fees from: Pfizer, Novartis, Roche, Medison, MSD, AstraZeneca, Eli Lilly, ProGenetics, Gilead and Stemline and travel fees from Pfizer, Roche, Gilead and AstraZeneca, all outside the submitted work. The rest of the authors declare that they have no conflict of interest.
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