What question did this study set out to answer?

This research explores how estrogen receptor and HER2 status, along with calcification and surgical modality, affect recurrence risks in ductal carcinoma in situ.

June 6, 2026Open Access

Prognostic Implications of Calcification and Surgery Type by Estrogen Receptor and HER2 Status in Ductal Carcinoma In Situ: Single-Center Study

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This research explores how estrogen receptor and HER2 status, along with calcification and surgical modality, affect recurrence risks in ductal carcinoma in situ.
Conducted a retrospective analysis of 365 patients who underwent surgery for DCIS between 1997 and 2020.
Evaluated ipsilateral and contralateral breast tumor recurrence as primary and secondary endpoints, respectively.
Utilized multivariable Cox models and propensity score matching to assess the impact of surgical type and margin status on outcomes.
In multivariable analysis, mastectomy (HR 0.021, p=0.014) and margin status (≥2 mm: HR 0.192, p=0.013) were independent predictors for ipsilateral recurrence.
Calcification was linked to improved contralateral recurrence outcomes (HR 0.103, p=0.013), especially in the ER-positive group (p=0.010).
Propensity score matching validated that mastectomy significantly reduced ipsilateral recurrence risk (p=0.038) but showed no significant impact on contralateral risk (p=0.246).

Resumen

Ductal carcinoma in situ (DCIS) presents a challenge in risk stratification, raising concerns regarding both undertreatment and overtreatment.This study investigated the relationships among estrogen receptor (ER) status, human epidermal growth factor receptor 2 (HER2) status, clinicopathological features, and recurrence in DCIS, with a particular focus on the prognostic roles of calcification and surgical modality. MethodsA retrospective analysis was conducted in 365 patients who underwent surgery for DCIS at OOO between 1997 and 2020.Ipsilateral breast tumor recurrence (IBTR) and contralateral breast tumor recurrence (CBTR) were evaluated as the primary and secondary endpoints, respectively.Multivariable Cox models were implemented, incorporating radiotherapy, endocrine therapy, and margin status.1:1 propensity score matching (PSM) was performed to adjust for selection bias between breast-conserving surgery and mastectomy. ResultsER-negative and HER2-positive DCIS were associated with older age, more frequent calcification, and higher nuclear grade (all p<0.001).In the multivariable analysis for IBTR, surgical modality (mastectomy: HR 0.021, p=0.014) and margin status (≥2 mm: HR 0.192, p=0.013) were the only independent predictors.Conversely, the presence of calcification was independently associated with more favorable outcomes for CBTR (HR 0.103, p=0.013).Subgroup analysis revealed that calcification was significantly associated with improved CBTR-free survival, particularly in the ER-positive cohort (p=0.010).PSM analysis confirmed that mastectomy significantly reduced IBTR risk (p=0.038)but was not significantly associated with CBTR risk (p=0.246). ConclusionCalcification and surgical modality demonstrated divergent prognostic implications for IBTR and CBTR according to molecular subtype.Although calcification is traditionally considered a high-risk feature prevalent in aggressive subtypes, its presence was associated with favorable contralateral events in ERpositive DCIS.These findings emphasize the importance of integrating molecular markers with clinical features to support more personalized approaches to DCIS management.

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