Postoperative radiotherapy for ductal carcinoma in situ: survival prediction and clinical decision support using a nomogram-based approach

Sep 30, 2026

Uploaded by Eliana

Postoperative radiotherapy after breast-conserving surgery for ductal carcinoma in situ remains clinically debated. A SEER-based analysis of 50,580 DCIS patients assessed associations between postoperative RT and survival endpoints, identifying age, partial mastectomy, tumor size, estrogen receptor status, and nuclear grade as factors linked to receiving RT. RT improved overall survival, disease-specific survival, and disease-free survival across most subgroups, with Cox regression highlighting age, tumor size, ER status, and nuclear grade as independent predictors. Nomograms and an online tool supported individualized DSS and DFS prediction to assist decision-making.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages10

Reading Time25 min

AccessFree to download

Background

Treatment options and controversy of postoperative radiotherapy

Data source and patient selection

Associations with postoperative RT

Survival outcomes across subgroups

Prognostic modeling

Cox regression predictors

Nomogram construction and validation

Discrimination and calibration

Online decision-support tool

[www. nature.com/scientificreports](www. nature.com/scientificreports) OPEN Postoperative radiotherapy for ductal carcinoma in situ: survival prediction and clinical decision support using a nomogram-based approach Yajie Wang1,4, Jiashu Zhang1,2,4, Yanrong Wu1 & Yiran Liang1,3􀀍 Whether postoperative radiotherapy (RT) is required for ductal carcinoma in situ (DCIS) after breastconserving surgery (BCS) remains controversial. In this study, we aimed to analyze the association between postoperative RT and survival outcomes in DCIS patients and develop nomograms to predict these outcomes. Using data on 50,580 DCIS patients obtained from the surveillance, epidemiology, and end results (SEER) database, the Chi-squared tests revealed that DCIS patients with younger age, partial mastectomy, larger tumor size, negative estrogen receptor (ER) status, and higher nuclear grade, were more likely to receive postoperative RT. Additionally, Postoperative RT could improve the overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS) across most patient subgroups, although no significant association was observed in DSS among older patients or those with smaller tumor size. Univariate and multivariate Cox regression analyses identified that age, tumor size, ER status, and nuclear grade were independent predictors for DSS and DFS. Based on these findings, we further constructed a nomogram, which demonstrated strong discriminative ability and good calibration as validated by C-index and calibration curve. A predictive online tool was created to visualize personalized DSS and DFS prediction for DCIS patients with different treatment regimens ([https://nordaraail.github.io/breast-calculator/](https://nordaraail.github.io/breast-calculator/)). Our study suggests that postoperative RT is associated with improved survival in most DCIS patients. The nomograms showed good performance in predicting the DSS and DFS of DCIS patients, and our online tool well visualized the DSS and DFS prediction to support clinical decision-making. Keywords Ductal carcinoma in situ, Prognosis, Radiotherapy, SEER database, Nomogram Ductal carcinoma in situ (DCIS) is a non-invasive form of breast cancer characterized by the proliferation of malignant epithelial cells confined within the ductal basement membrane, without invasion into the surroundingstroma1. It represents a heterogeneous condition, ranging from indolent, low-grade lesions with minimal risk of progression to high-grade lesions that may harbor or rapidly evolve into invasive breast cancer. Historically, DCIS is usually diagnosed by surgical removal of a suspicious breast mass, and comprises only 1–2% of all breast cancers2. However, with the widespread adoption of screening mammography, the incidence of DCIS has risen dramatically over the past 30 years. In 2023, approximately 55,720 new cases of DCIS were diagnosed in the United States, accounting for about 20% of all newly detected breast cancers3. Evidence from histopathological studies supports the notion that DCIS is a precursor lesion to invasive breast cancer (IBC)4, with a continuum of molecular and morphological changes observed during progression. The histological feature of DCIS is the proliferation of malignant epithelial cells surrounded by an intact basement membrane (BM) of the ducts5. The transition from DCIS to invasive disease involves the breakdown of the basement membrane and loss of surrounding myoepithelial cells, allowing tumor cells to infiltrate adjacent tissues6. Despite this understanding, 1Department of Breast Surgery, General Surgery, Qilu Hospital of Shandong University, Wenhua Xi Road No. 107, Jinan 250012, Shandong, China. 2Department of Breast Surgery, General Surgery, Affiliated Hospital of Jining Medical University, Jining 272000, Shandong, China. 3Department of Breast Surgery, General Surgery, The Affiliated Taian City Central Hospital of Qingdao University, Taian 271000, Shandong, Ch

FAQs

Why is postoperative radiotherapy for DCIS after breast-conserving surgery controversial?

Evidence and clinical trials show benefits in reducing recurrence, but the decision is weighed against radiotherapy-related toxicities and the varying risk of progression among patients.

What patient factors were associated with receiving postoperative radiotherapy?

Younger age, partial mastectomy, larger tumor size, negative estrogen receptor status, and higher nuclear grade were more likely to receive postoperative RT.

How were the nomograms and the online tool used in the study?

The study built nomograms based on independent predictors and validated them with discrimination and calibration metrics, then provided an online tool to visualize personalized DSS and DFS predictions for different treatment regimens.

Sep 30, 2026

Uploaded by Eliana