Ottesen G L, Graversen H P, Blichert-Toft M, Christensen I J, Andersen J A
Department of Forensic Pathology, University of Copenhagen, Denmark.
Breast Cancer Res Treat. 2000 Aug;62(3):197-210. doi: 10.1023/a:1006453915590.
In a Danish nationwide prospective study of in situ carcinoma of the breast, a total of 275 women, treated with excision alone, were registered from 1982 to 1989. The series included 142 cases of ductal carcinoma in situ (DCIS), 100 cases of lobular carcinoma in situ (LCIS), 26 cases of DCIS+LCIS, and seven cases of atypical hyperplasia (AH). Within a median follow-up of 120 months, a crude recurrence rate of 28% (76 cases) was found, of which 53% (40 cases) recurred as invasive carcinomas (IC) and 47% (36 cases) as CIS. CIS recurrences appeared after median 18 months, compared to median 42 months for IC recurrences. No statistical difference was found with respect to development of IC between the three groups of DCIS, DCIS+LCIS, and LCIS. The majority of recurrences were ipsilateral, also for LCIS. Forty four of 49 recurrences following DCIS, and seven of nine recurrences following DCIS+LCIS occurred as local recurrences. Histopathologically, in DCIS a strong association was found between large nuclear size and comedonecrosis. Univariate analysis showed a significant association to recurrence for nuclear size, comedonecrosis, and size of the original lesion. Multivariate analysis showed that only comedonecrosis and size of lesion were independent predictors of recurrence, however, specimen margins were not included in the analysis, as this parameter could not be adequately evaluated in the present series. Nuclear size of original DCIS lesion was related to histologic grade of the IC recurrence. The recurrence rate for DCIS of small nuclear size increased from 6% at five years of follow-up to 16% at 10 years, possibly due to a slower growth rate and a continued but delayed risk. Similarities were found between LCIS and DCIS of small nuclear size, both showing a continued risk and comparable rate of recurrence. Further, progression to IC of similar, highly differentiated type was seen, indicating a linkage between biological behavior of the two histological types.
在一项丹麦全国性的乳腺原位癌前瞻性研究中，1982年至1989年期间共登记了275例仅接受切除术治疗的女性。该系列包括142例导管原位癌（DCIS）、100例小叶原位癌（LCIS）、26例DCIS+LCIS以及7例非典型增生（AH）。在中位随访120个月时，发现粗复发率为28%（76例），其中53%（40例）复发为浸润性癌（IC），47%（36例）复发为原位癌（CIS）。CIS复发的中位时间为18个月，而IC复发的中位时间为42个月。DCIS、DCIS+LCIS和LCIS三组之间在IC发生方面未发现统计学差异。大多数复发为同侧，LCIS也是如此。DCIS后的49例复发中有44例，DCIS+LCIS后的9例复发中有7例为局部复发。组织病理学上，在DCIS中发现细胞核大小与粉刺样坏死之间存在强关联。单因素分析显示细胞核大小、粉刺样坏死和原发灶大小与复发有显著关联。多因素分析表明，只有粉刺样坏死和病灶大小是复发的独立预测因素，然而，分析中未包括标本切缘，因为在本系列中无法充分评估该参数。原发DCIS病灶的细胞核大小与IC复发的组织学分级有关。细胞核小的DCIS在随访5年时的复发率从6%增加到10年时的16%，这可能是由于生长速度较慢以及持续但延迟的风险。在细胞核小的LCIS和DCIS之间发现了相似之处，两者都显示出持续的风险和相当的复发率。此外，还观察到进展为相似的高分化类型的IC，表明这两种组织学类型的生物学行为之间存在联系。
