[乳腺导管原位癌。882例病例分析]

[Ductal carcinoma in situ of the breast. Analysis of 882 cases].

作者信息

Cutuli B, Fay R, Cohen-Solal-Le Nir C, De Lafontan B, Mignotte H, Servent V, Giard S, Auvray H, Charra-Brunaud C, Gonzague-Casabianca L, Quetin P

机构信息

Polyclinique de Courlancy, Reims (51).

出版信息

Presse Med. 2004 Jan 31;33(2):83-9. doi: 10.1016/s0755-4982(04)98490-4.

DOI:10.1016/s0755-4982(04)98490-4

PMID:15026697

Abstract

OBJECTIVE

This study assesses the results of "current clinical practice" among 882 women treated in nine French Cancer Centers from 1985 to 1995 for pure ductal carcinoma in situ (DCIS) of the breast.

METHOD

Median age was 53 years (range 21-87); 177 (20%) patients underwent mastectomy (M), 190 (22%) conservative surgery alone (CS) and 515 (58%) conservative surgery with radiotherapy (CS + RT).

RESULTS

The crude 7-year local relapse (LR) rates were 2%, 31% and 13% among the M, CS and CS+RT subgroups (p<0.0001). All four LR after M were invasive as well as 31 (52%) out of 59 and 40 (61%) out of 66 in the CS and CS+RT groups. Distant metastases occurred in 1%, 3% and 1% of the three treatment groups. No LR factors were found in the M group. Among women treated with CS, the 7-year LR rates were 36%, 31% and 30% among women aged 40 or less, 41 to 60 and 61 or more (NS). For women treated by CS+RT, the LR rates in these age subgroups were 33%, 13% and 8%, respectively (p<0.0001). Patients with negative, positive or uncertain margins had 7-year LR rates of 26%, 56% and 29% respectively if treated with CS (p=0.02) and 11%, 23% and 9% if treated with CS+RT (p=0.0008). RT reduced LR rates by 65% in all histological subgroups, but more particularly in comedocarcinoma and mixed cribriform/papillary subgroups. The 7-year rate of contralateral breast cancer was 7%, identical in all subgroups.

CONCLUSION

Mastectomy remains the safest treatment for women with DCIS, with a 98% 7-year control rate. After conservative surgery, RT reduces very significantly LR rates, according to the NSABP B-17 and EORTC 10853 randomized trial results. The RT benefit is present in all clinical/histological subgroups, but its magnitude varies. Young age (<40 years) and incomplete excision are the most important LR risk factors.

摘要

目的

本研究评估了1985年至1995年间在法国九个癌症中心接受治疗的882例单纯乳腺导管原位癌（DCIS）女性的“当前临床实践”结果。

方法

中位年龄为53岁（范围21 - 87岁）；177例（20%）患者接受了乳房切除术（M），190例（22%）仅接受了保乳手术（CS），515例（58%）接受了保乳手术加放疗（CS + RT）。

结果

M、CS和CS + RT亚组的7年粗局部复发（LR）率分别为2%、31%和13%（p<0.0001）。M组的所有4例LR均为浸润性，CS组的59例中有31例（52%）以及CS + RT组的66例中有40例（61%）为浸润性。三个治疗组的远处转移发生率分别为1%、3%和1%。M组未发现LR因素。在接受CS治疗的女性中，年龄在40岁及以下、41至60岁和61岁及以上的女性7年LR率分别为36%、31%和30%（无显著性差异）。对于接受CS + RT治疗的女性，这些年龄亚组的LR率分别为33%、13%和8%（p<0.0001）。切缘阴性、阳性或不确定的患者，若接受CS治疗，7年LR率分别为26%、56%和29%（p = 0.02）；若接受CS + RT治疗，LR率分别为11%、23%和9%（p = 0.0008）。放疗在所有组织学亚组中使LR率降低了65%，但在粉刺癌和筛状/乳头状混合亚组中降低得尤为明显。对侧乳腺癌的7年发生率为7%，在所有亚组中相同。