Schouten van der Velden Arjan P, van Vugt Roel, Van Dijck Jos A A M, Leer Jan Willem H, Wobbes Theo
Department of Surgical Oncology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Int J Radiat Oncol Biol Phys. 2007 Nov 1;69(3):703-10. doi: 10.1016/j.ijrobp.2007.03.062. Epub 2007 Jun 4.
Outcomes after different treatment strategies for ductal carcinoma in situ (DCIS) of the breast were analyzed for a geographically defined population in the East Netherlands.
A total of 798 patients with a first diagnosis of DCIS between January 1989 and December 2003 were included and their medical records were reviewed. Survival rates for ipsilateral recurrences were calculated by the Kaplan-Meier method and a multivariate Cox proportional hazards regression model was used to evaluate the prognostic significance of different variables.
The 5-year recurrence-free survival was 75% for breast conserving surgery (BCS) alone (237 patients) compared with 91% for BCS followed by radiation therapy (RT; 153 patients) and 99% for mastectomy (408 patients, p < 0.01). Independent risk factors for local recurrences were treatment strategy, symptomatically detected DCIS, and presence of comedo necrosis. Margin status reached statistical significance only for patients treated by BCS (hazard ratio, 2.0; 95% confidence interval, 1.1-4.0) whereas significance of other prognostic variables did not change.
In a defined population outside a trial setting, RT after BCS for DCIS lowered recurrence rates. Besides the use of RT, a microscopically complete excision of DCIS is essential. This is especially true for patients with symptomatically detected DCIS and with tumors that contain comedo necrosis, as these groups are at particular high risk for recurrent disease.
分析荷兰东部某一地理区域内，针对乳腺导管原位癌（DCIS）采用不同治疗策略后的治疗结果。
纳入1989年1月至2003年12月期间首次诊断为DCIS的798例患者，并对其病历进行回顾。采用Kaplan-Meier法计算同侧复发的生存率，并使用多变量Cox比例风险回归模型评估不同变量的预后意义。
单纯保乳手术（BCS）组（237例患者）的5年无复发生存率为75%，而BCS后加放疗（RT；153例患者）组为91%，乳房切除术组（408例患者）为99%（p<0.01）。局部复发的独立危险因素为治疗策略、有症状检出的DCIS以及粉刺样坏死的存在。仅对于接受BCS治疗的患者，切缘状态具有统计学意义（风险比，2.0；95%置信区间，1.1 - 4.0），而其他预后变量的意义未改变。
在非试验环境下的特定人群中，DCIS患者BCS后加RT可降低复发率。除了使用RT外，对DCIS进行显微镜下完整切除至关重要。对于有症状检出的DCIS患者以及含有粉刺样坏死的肿瘤患者尤其如此，因为这些人群复发疾病的风险特别高。
