Vapiwala Neha, Harris Eleanor, Hwang Wei-Ting, Solin Lawrence J
Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Cancer J. 2006 Jan-Feb;12(1):25-32. doi: 10.1097/00130404-200601000-00006.
The importance of negative final resection margins for optimal local control has been established for women with ductal carcinoma in situ (intraductal carcinoma) undergoing breast conservation treatment. This study evaluated long-term outcome after breast conservation treatment and whether reexcision or the presence of residual tumor in the reexcision specimen predicted for local recurrence in patients with ductal carcinoma in situ with negative margins.
The study cohort consisted of 192 women with ductal carcinoma in situ treated with breast conservation treatment at the University of Pennsylvania from 1978 to 2000. Analysis was performed for unilateral, mammographically detected, intraductal breast carcinomas. Study endpoints of interest included rates of local recurrence, overall survival, and cause-specific survival. The median follow-up was 6.2 years (mean, 7 years; range, 0.1-21.4 years).
The 10-year overall survival and 10-year cause-specific survival rates were 87% and 99%, respectively. There were 11 local failures (6%) in the treated breast, with a 10-year actuarial local failure rate of 10% and a median time to local failure of 7.4 years (mean, 6.6 years; range, 1.6-10.2 years). Among the subset of 124 patients with negative final resection margins, there was no statistically significant difference in the 8-year actuarial local recurrence rates among patients who underwent single excision (7%), reexcision with residual tumor (8%), or reexcision with no residual tumor (0%).
The use of breast conservation treatment in patients with ductal carcinoma in situ remains an effective and durable treatment approach. The need for reexcision to achieve negative margins and the presence of residual ductal carcinoma in situ in the reexcision specimen do not negatively impact local recurrence rates in the current study. These findings suggest that requiring more than one surgery to obtain clear resection margins is not an adverse prognostic factor for local failure.
对于接受保乳治疗的导管原位癌（导管内癌）女性患者，阴性切缘对实现最佳局部控制的重要性已得到确立。本研究评估了保乳治疗后的长期结局，以及再次切除或再次切除标本中存在残留肿瘤是否可预测切缘阴性的导管原位癌患者的局部复发情况。
研究队列包括1978年至2000年在宾夕法尼亚大学接受保乳治疗的192例导管原位癌女性患者。对单侧、乳腺钼靶检测到的导管内乳腺癌进行分析。感兴趣的研究终点包括局部复发率、总生存率和特定病因生存率。中位随访时间为6.2年（平均7年；范围0.1 - 21.4年）。
10年总生存率和10年特定病因生存率分别为87%和99%。治疗的乳房中有11例局部失败（6%），10年精算局部失败率为10%，局部失败的中位时间为7.4年（平均6.6年；范围1.6 - 10.2年）。在124例最终切缘阴性的患者亚组中，接受单次切除（7%）、切除后有残留肿瘤的再次切除（8%）或切除后无残留肿瘤的再次切除（0%）的患者，8年精算局部复发率无统计学显著差异。
对导管原位癌患者使用保乳治疗仍然是一种有效且持久的治疗方法。在本研究中，为达到阴性切缘而进行再次切除的必要性以及再次切除标本中存在残留导管原位癌，对局部复发率没有负面影响。这些发现表明，需要不止一次手术来获得切缘阴性并非局部失败的不良预后因素。
