Vicini Frank A, Recht Abram
Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI 48073, USA.
J Clin Oncol. 2002 Jun 1;20(11):2736-44. doi: 10.1200/JCO.2002.07.137.
Patients younger than 35 to 45 years old at the time of diagnosis of invasive breast cancer have been found to have a worse prognosis than older patients in many studies. However, the impact of patient age at diagnosis on the outcome of treatment with either lumpectomy and radiation therapy (RT) or mastectomy for patients with ductal carcinoma-in-situ (DCIS) of the breast has not been extensively analyzed.
Articles addressing the effect of patient age at diagnosis on the outcome of treatment of DCIS with lumpectomy and RT or mastectomy were identified through the MEDLINE and CancerLit databases and reference lists of relevant articles. Studies were reviewed to determine the impact of patient age at diagnosis on clinical and pathologic features of DCIS, the influence of age on outcome after lumpectomy and RT, and the impact of age on outcome after mastectomy.
DCIS in younger patients more frequently contains adverse prognostic pathologic factors and extends over a greater distance in the breast than in older patients. In series with adequate follow-up, younger patients treated with lumpectomy and RT had a significantly higher rate of local recurrence than older patients, especially for invasive local recurrences. Some studies have suggested that careful attention to margin status and excising larger volumes of tissue can reduce this difference substantially. No available data show that younger patients have better long-term cancer-free survival rates if treated by mastectomy rather than lumpectomy and RT.
Successful treatment of younger patients with DCIS with lumpectomy and RT requires careful attention to patient evaluation, selection, and surgical technique. When this is done, age at diagnosis should not be a contraindication to breast-conserving therapy.
在许多研究中发现，浸润性乳腺癌诊断时年龄小于35至45岁的患者比老年患者预后更差。然而，对于乳腺导管原位癌（DCIS）患者，诊断时的患者年龄对保乳手术加放疗（RT）或乳房切除术治疗结果的影响尚未得到广泛分析。
通过MEDLINE和CancerLit数据库以及相关文章的参考文献列表，确定了关于诊断时患者年龄对DCIS保乳手术加放疗或乳房切除术治疗结果影响的文章。对研究进行综述，以确定诊断时患者年龄对DCIS临床和病理特征的影响、年龄对保乳手术加放疗后结果的影响以及年龄对乳房切除术后结果的影响。
与老年患者相比，年轻患者的DCIS更常包含不良预后病理因素，且在乳腺中的延伸范围更大。在有充分随访的系列研究中，接受保乳手术加放疗的年轻患者局部复发率明显高于老年患者，尤其是浸润性局部复发。一些研究表明，仔细关注切缘状态并切除更大体积的组织可大幅降低这种差异。没有现有数据表明，与保乳手术加放疗相比，年轻患者接受乳房切除术能获得更好的长期无癌生存率。
对年轻DCIS患者成功进行保乳手术加放疗需要仔细关注患者评估、选择和手术技术。当做到这一点时，诊断时的年龄不应成为保乳治疗的禁忌证。
