Harris E E, Schultz D J, Peters C A, Solin L J
Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA 19104, USA.
Int J Radiat Oncol Biol Phys. 2000 Nov 1;48(4):933-41. doi: 10.1016/s0360-3016(00)00726-4.
The purpose of this study was to evaluate the relationship between a family history of breast or ovarian cancer and outcome after breast-conserving surgery and radiation in women presenting with an initial diagnosis of ductal carcinoma in situ (DCIS) of the breast.
A total of 146 consecutive women with a pathologic diagnosis of ductal carcinoma in situ as their first diagnosis of any breast cancer were identified; 28 (19%) had a positive family history of breast or ovarian cancer in a first-degree relative, 27 (19%) had a positive family history in a second-degree relative, and 91 (62%) had no family history. Pathologic, clinical, and treatment factors, and clinical outcomes for each family history group were compared. Cosmesis and complications were recorded at each follow-up. Patients were treated between 1978 and 1995, and the median follow-up was 7.1 years.
Patients with a positive family history in a first- or second-degree relative each had an 8% incidence of local failure at 10 years, while the negative family history group demonstrated a 16% local failure rate (p = 0.33). Overall survival at 10 years for patients with a positive family history in a first- or second-degree relative was 100% and for those with a negative family history was 91% (p = 0.08). The negative family history group had a higher median age that may account for the difference in overall survival. Cause-specific survival (CSS) was 97%, 100%, and 99%, respectively, at 10 years (p = 0.25). There were no differences in the cosmetic results or complication rates between women with a positive or negative family history.
We have shown that a family history of breast and/or ovarian cancer is not associated with an adverse outcome for women treated with breast conservation therapy for DCIS. Local recurrence, cause-specific survival, overall survival, cosmesis, and complication rates were comparable to that of similarly treated women with negative family histories. Therefore, a positive family history is not a contraindication for breast conservation therapy in women with DCIS.
本研究旨在评估初诊为乳腺导管原位癌（DCIS）的女性患者中，乳腺癌或卵巢癌家族史与保乳手术及放疗后结局之间的关系。
共纳入146例经病理诊断为导管原位癌且为首次诊断为任何乳腺癌的连续女性患者；28例（19%）一级亲属中有乳腺癌或卵巢癌家族史阳性，27例（19%）二级亲属中有家族史阳性，91例（62%）无家族史。比较了各家族史组的病理、临床和治疗因素以及临床结局。每次随访时记录美容效果和并发症情况。患者于1978年至1995年接受治疗，中位随访时间为7.1年。
一级或二级亲属中有家族史阳性的患者10年局部复发率均为8%，而无家族史组局部复发率为16%（p = 0.33）。一级或二级亲属中有家族史阳性的患者10年总生存率为100%，无家族史患者为91%（p = 0.08）。无家族史组中位年龄较高，这可能是总生存率存在差异的原因。10年病因特异性生存率（CSS）分别为97%、100%和99%（p = 0.25）。家族史阳性或阴性女性的美容效果或并发症发生率无差异。
我们已表明，乳腺癌和/或卵巢癌家族史与接受DCIS保乳治疗的女性的不良结局无关。局部复发、病因特异性生存率、总生存率、美容效果和并发症发生率与家族史阴性的类似治疗女性相当。因此，家族史阳性并非DCIS女性保乳治疗的禁忌证。
