Abstract
The value of DNA-flow cytometry and clinico-pathological prognostic factors for the prediction of local recurrences after breast-conserving therapy (BCT) were evaluated in a retrospective study. Thirty-one patients with a local recurrence were compared with 31 matched patients without a local recurrence. Morphology and DNA-indices of the local recurrences and their corresponding primary tumours were compared. Ductal carcinoma in situ was present significantly more often in the group with a primary recurring tumour, than in the matched group (P less than 0.001), and the same holds for lobular carcinoma (n = 5). Half of the tumours that recurred had macroscopically positive surgical margins compared to about one-fourth of the matched group. Fifty-six per cent of the DNA-aneuploid stemlines in cases with local recurrence were present in the corresponding primary tumour as well (confidence limits 45%-75%), an indication that the majority of local recurrences are true recurrences and not independently developed tumours. The lack of similarity of DNA stemlines between some primary DNA-aneuploid tumours and their local recurrences indicates that these tumours had developed independently. The percentage of DNA-aneuploid cases in the group with local recurrence (89%) did not differ significantly from that in the matched group (70%). However, the findings suggest a selective recurrence of DNA-diploid stemlines. This might indicate increased resistance of DNA-diploid tumour cells to radiotherapy as compared with the resistance level in DNA-aneuploid cells.
Full text
PDFSelected References
These references are in PubMed. This may not be the complete list of references from this article.
- Baird R. M., Worth A., Hislop G. Recurrence after lumpectomy for comedo-type intraductal carcinoma of the breast. Am J Surg. 1990 May;159(5):479–481. doi: 10.1016/s0002-9610(05)81250-4. [DOI] [PubMed] [Google Scholar]
- Barr L. C., Brunt A. M., Goodman A. G., Phillips R. H., Ellis H. Uncontrolled local recurrence after treatment of breast cancer with breast conservation. Cancer. 1989 Sep 15;64(6):1203–1207. doi: 10.1002/1097-0142(19890915)64:6<1203::aid-cncr2820640607>3.0.co;2-g. [DOI] [PubMed] [Google Scholar]
- Beerman H., Kluin P. M., Hermans J., van de Velde C. J., Cornelisse C. J. Prognostic significance of DNA-ploidy in a series of 690 primary breast cancer patients. Int J Cancer. 1990 Jan 15;45(1):34–39. doi: 10.1002/ijc.2910450108. [DOI] [PubMed] [Google Scholar]
- Beerman H., Smit V. T., Kluin P. M., Bonsing B. A., Hermans J., Cornelisse C. J. Flow cytometric analysis of DNA stemline heterogeneity in primary and metastatic breast cancer. Cytometry. 1991;12(2):147–154. doi: 10.1002/cyto.990120208. [DOI] [PubMed] [Google Scholar]
- Cady B. New diagnostic, staging, and therapeutic aspects of early breast cancer. Cancer. 1990 Feb 1;65(3 Suppl):634–647. doi: 10.1002/1097-0142(19900201)65:3+<634::aid-cncr2820651306>3.0.co;2-x. [DOI] [PubMed] [Google Scholar]
- Calle R., Vilcoq J. R., Zafrani B., Vielh P., Fourquet A. Local control and survival of breast cancer treated by limited surgery followed by irradiation. Int J Radiat Oncol Biol Phys. 1986 Jun;12(6):873–878. doi: 10.1016/0360-3016(86)90379-2. [DOI] [PubMed] [Google Scholar]
- Carpenter R., Gibbs N., Matthews J., Cooke T. Importance of cellular DNA content in pre-malignant breast disease and pre-invasive carcinoma of the female breast. Br J Surg. 1987 Oct;74(10):905–906. doi: 10.1002/bjs.1800741011. [DOI] [PubMed] [Google Scholar]
- Clark G. M., Dressler L. G., Owens M. A., Pounds G., Oldaker T., McGuire W. L. Prediction of relapse or survival in patients with node-negative breast cancer by DNA flow cytometry. N Engl J Med. 1989 Mar 9;320(10):627–633. doi: 10.1056/NEJM198903093201003. [DOI] [PubMed] [Google Scholar]
- Clarke D. H., Lê M. G., Sarrazin D., Lacombe M. J., Fontaine F., Travagli J. P., May-Levin F., Contesso G., Arriagada R. Analysis of local-regional relapses in patients with early breast cancers treated by excision and radiotherapy: experience of the Institut Gustave-Roussy. Int J Radiat Oncol Biol Phys. 1985 Jan;11(1):137–145. doi: 10.1016/0360-3016(85)90372-4. [DOI] [PubMed] [Google Scholar]
- Cornelisse C. J., van de Velde C. J., Caspers R. J., Moolenaar A. J., Hermans J. DNA ploidy and survival in breast cancer patients. Cytometry. 1987 Mar;8(2):225–234. doi: 10.1002/cyto.990080217. [DOI] [PubMed] [Google Scholar]
- Eberlein T. J., Connolly J. L., Schnitt S. J., Recht A., Osteen R. T., Harris J. R. Predictors of local recurrence following conservative breast surgery and radiation therapy. The influence of tumor size. Arch Surg. 1990 Jun;125(6):771–777. doi: 10.1001/archsurg.1990.01410180097016. [DOI] [PubMed] [Google Scholar]
- Fisher B., Redmond C., Poisson R., Margolese R., Wolmark N., Wickerham L., Fisher E., Deutsch M., Caplan R., Pilch Y. Eight-year results of a randomized clinical trial comparing total mastectomy and lumpectomy with or without irradiation in the treatment of breast cancer. N Engl J Med. 1989 Mar 30;320(13):822–828. doi: 10.1056/NEJM198903303201302. [DOI] [PubMed] [Google Scholar]
- Fisher E. R., Sass R., Fisher B., Gregorio R., Brown R., Wickerham L. Pathologic findings from the National Surgical Adjuvant Breast Project (protocol 6). II. Relation of local breast recurrence to multicentricity. Cancer. 1986 May 1;57(9):1717–1724. doi: 10.1002/1097-0142(19860501)57:9<1717::aid-cncr2820570902>3.0.co;2-h. [DOI] [PubMed] [Google Scholar]
- Harris J. R., Connolly J. L., Schnitt S. J., Cady B., Love S., Osteen R. T., Patterson W. B., Shirley R., Hellman S., Cohen R. B. The use of pathologic features in selecting the extent of surgical resection necessary for breast cancer patients treated by primary radiation therapy. Ann Surg. 1985 Feb;201(2):164–169. doi: 10.1097/00000658-198502000-00005. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Hedley D. W., Friedlander M. L., Taylor I. W., Rugg C. A., Musgrove E. A. Method for analysis of cellular DNA content of paraffin-embedded pathological material using flow cytometry. J Histochem Cytochem. 1983 Nov;31(11):1333–1335. doi: 10.1177/31.11.6619538. [DOI] [PubMed] [Google Scholar]
- Holland R., Connolly J. L., Gelman R., Mravunac M., Hendriks J. H., Verbeek A. L., Schnitt S. J., Silver B., Boyages J., Harris J. R. The presence of an extensive intraductal component following a limited excision correlates with prominent residual disease in the remainder of the breast. J Clin Oncol. 1990 Jan;8(1):113–118. doi: 10.1200/JCO.1990.8.1.113. [DOI] [PubMed] [Google Scholar]
- Kallioniemi O. P., Blanco G., Alavaikko M., Hietanen T., Mattila J., Lauslahti K., Koivula T. Tumour DNA ploidy as an independent prognostic factor in breast cancer. Br J Cancer. 1987 Nov;56(5):637–642. doi: 10.1038/bjc.1987.258. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Kurtz J. M., Jacquemier J., Amalric R., Brandone H., Ayme Y., Hans D., Bressac C., Roth J., Spitalier J. M. Risk factors for breast recurrence in premenopausal and postmenopausal patients with ductal cancers treated by conservation therapy. Cancer. 1990 Apr 15;65(8):1867–1878. doi: 10.1002/1097-0142(19900415)65:8<1867::aid-cncr2820650833>3.0.co;2-i. [DOI] [PubMed] [Google Scholar]
- Kurtz J. M., Jacquemier J., Amalric R., Brandone H., Ayme Y., Hans D., Bressac C., Spitalier J. M. Why are local recurrences after breast-conserving therapy more frequent in younger patients? J Clin Oncol. 1990 Apr;8(4):591–598. doi: 10.1200/JCO.1990.8.4.591. [DOI] [PubMed] [Google Scholar]
- Lagios M. D., Margolin F. R., Westdahl P. R., Rose M. R. Mammographically detected duct carcinoma in situ. Frequency of local recurrence following tylectomy and prognostic effect of nuclear grade on local recurrence. Cancer. 1989 Feb 15;63(4):618–624. doi: 10.1002/1097-0142(19890215)63:4<618::aid-cncr2820630403>3.0.co;2-j. [DOI] [PubMed] [Google Scholar]
- Lindley R., Bulman A., Parsons P., Phillips R., Henry K., Ellis H. Histologic features predictive of an increased risk of early local recurrence after treatment of breast cancer by local tumor excision and radical radiotherapy. Surgery. 1989 Jan;105(1):13–20. [PubMed] [Google Scholar]
- Locker A. P., Horrocks C., Gilmour A. S., Ellis I. O., Dowle C. S., Elston C. W., Blamey R. W. Flow cytometric and histological analysis of ductal carcinoma in situ of the breast. Br J Surg. 1990 May;77(5):564–567. doi: 10.1002/bjs.1800770533. [DOI] [PubMed] [Google Scholar]
- Mate T. P., Carter D., Fischer D. B., Hartman P. V., McKhann C., Merino M., Prosnitz L. R., Weissberg J. B. A clinical and histopathologic analysis of the results of conservation surgery and radiation therapy in stage I and II breast carcinoma. Cancer. 1986 Nov 1;58(9):1995–2002. doi: 10.1002/1097-0142(19861101)58:9<1995::aid-cncr2820580907>3.0.co;2-1. [DOI] [PubMed] [Google Scholar]
- Schnitt S. J., Connolly J. L., Recht A., Silver B., Harris J. R. Influence of infiltrating lobular histology on local tumor control in breast cancer patients treated with conservative surgery and radiotherapy. Cancer. 1989 Jul 15;64(2):448–454. doi: 10.1002/1097-0142(19890715)64:2<448::aid-cncr2820640218>3.0.co;2-7. [DOI] [PubMed] [Google Scholar]
- Schwartz G. F., Patchefsky A. S., Feig S. A., Shaber G. S., Schwartz A. B. Clinically occult breast cancer. Multicentricity and implications for treatment. Ann Surg. 1980 Jan;191(1):8–12. doi: 10.1097/00000658-198001000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Smit V. T., Fleuren G. J., van Houwelingen J. C., Zegveld S. T., Kuipers-Dijkshoorn N. J., Cornelisse C. J. Flow cytometric DNA-ploidy analysis of synchronously occurring multiple malignant tumors of the female genital tract. Cancer. 1990 Oct 15;66(8):1843–1849. [PubMed] [Google Scholar]
- Van Limbergen E., Van der Schueren E., Van den Bogaert W., Van Wing J. Local control of operable breast cancer after radiotherapy alone. Eur J Cancer. 1990;26(6):674–679. doi: 10.1016/0277-5379(90)90115-a. [DOI] [PubMed] [Google Scholar]
- Vindeløv L. L., Christensen I. J., Jensen G., Nissen N. I. Limits of detection of nuclear DNA abnormalities by flow cytometric DNA analysis. Results obtained by a set of methods for sample-storage, staining and internal standardization. Cytometry. 1983 Mar;3(5):332–339. doi: 10.1002/cyto.990030505. [DOI] [PubMed] [Google Scholar]
- du Toit R. S., Locker A. P., Ellis I. O., Elston C. W., Nicholson R. I., Blamey R. W. Invasive lobular carcinomas of the breast--the prognosis of histopathological subtypes. Br J Cancer. 1989 Oct;60(4):605–609. doi: 10.1038/bjc.1989.323. [DOI] [PMC free article] [PubMed] [Google Scholar]
- van de Vijver M. J., Peterse J. L., Mooi W. J., Wisman P., Lomans J., Dalesio O., Nusse R. Neu-protein overexpression in breast cancer. Association with comedo-type ductal carcinoma in situ and limited prognostic value in stage II breast cancer. N Engl J Med. 1988 Nov 10;319(19):1239–1245. doi: 10.1056/NEJM198811103191902. [DOI] [PubMed] [Google Scholar]