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Breast Cancer Res Treat. 2018 Jun;169(2):311-322. doi: 10.1007/s10549-018-4681-6. Epub 2018 Jan 30.

Tamoxifen therapy improves overall survival in luminal A subtype of ductal carcinoma in situ: a study based on nationwide Korean Breast Cancer Registry database.

Author information

1
Department of Surgery, Seoul National University Boramae Medical Center, 39, Boramae-Gil, Dongjak-Gu, Seoul, 156-707, Republic of Korea. kiterius@snu.ac.kr.
2
Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
3
Department of Surgery, Chonbuk National University Medical School, Jeonju, Republic of Korea.
4
Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea.
5
Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea.
6
Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea.
7
Department of Surgery, Gachon University, Gil Hospital, Incheon, Republic of Korea.
8
Department of Surgery, Seoul National University Boramae Medical Center, 39, Boramae-Gil, Dongjak-Gu, Seoul, 156-707, Republic of Korea.
9
Department of Biostatistics, Seoul National University Boramae Medical Center, Seoul, Republic of Korea.
10
Department of Pathology, Seoul National University Boramae Medical Center, Seoul, Republic of Korea.

Abstract

PURPOSE:

To determine the prognostic role of tamoxifen therapy for patients with ductal carcinoma in situ (DCIS) according to molecular subtypes.

METHODS:

Data of 14,944 patients with DCIS were analyzed. Molecular subtypes were classified into four categories based on expression of estrogen receptor (ER)/progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2). Kaplan-Meier estimator was used for overall survival analysis while Cox proportional hazards model was used for univariate and multivariate analyses.

RESULTS:

Luminal A subtype (ER/PR+, HER2-) showed higher (P = .009) survival rate than triple-negative (TN) subtype. Tamoxifen therapy group showed superior (P < .001) survival than no-tamoxifen therapy group. It had survival benefit only for luminal A subtype (P = .001). Tamoxifen therapy resulted in higher survival rate in subgroups with positive ER (P = .006), positive PR (P = .009), and negative HER2 (P < .001). In luminal A subtype, tamoxifen therapy showed lower hazard ratio (HR) compared to no-tamoxifen therapy (HR, 0.420; 95% CI 0.250-0.705; P = .001). Tamoxifen therapy was a significant independent factor by multivariate analysis (HR, 0.538; 95% CI 0.306-0.946; P = .031) as well as univariate analysis.

CONCLUSION:

Tamoxifen therapy group showed superior prognosis than the no-tamoxifen therapy group. Its prognostic influence was only effective for luminal A subtype. Patients with luminal A subtype showed higher survival rate than those with TN subtype. Active tamoxifen therapy is recommended for DCIS patients with luminal A subtype, and routine tests for ER, PR, and HER2 should be considered for DCIS.

KEYWORDS:

Breast neoplasms; Molecular subtype; Prognosis; Survival analysis; Tamoxifen therapy

PMID:
29383628
DOI:
10.1007/s10549-018-4681-6
[Indexed for MEDLINE]

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