Meijnen Philip, Oldenburg Hester S A, Peterse Johannes L, Bartelink Harry, Rutgers Emiel J Th
Department of Surgery, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
Ann Surg Oncol. 2008 Jan;15(1):235-43. doi: 10.1245/s10434-007-9659-2. Epub 2007 Nov 7.
The effect of treatment of patients diagnosed with ductal carcinoma in situ (DCIS) of the breast was evaluated, and factors associated with local recurrence were assessed.
The study involved 504 patients treated by means of wide local excision alone (WLE) (n = 91), wide local excision and radiotherapy (WLE+RT) (n = 119), or mastectomy (n = 294) at the Netherlands Cancer Institute between 1986 and 2005. Clinical, pathological, and follow-up data were evaluated.
The median time to follow-up was 6.7 years. The 8-year overall local recurrence rate was 12% after breast-conserving treatment (BCT) [15.6% after WLE and 8.8% after WLE+RT (P = 0.161)] and 0.9% after mastectomy (P < 0.0001). In total, 18 (66.7%) invasive local recurrences and 9 (33.3%) DCIS local recurrences occurred. The 8-year distant metastasis rate was 4% after BCT [4.3% after WLE and 4.2% after WLE+RT (P = 0.983)] and 0.9% after mastectomy (P = 0.048). Median tumor extent was 10, 15, and 35 mm for patients treated with WLE, WLE+RT, and mastectomy, respectively. Margins were involved in 6.4% of all patients. Factors associated with local recurrence were age younger than 40 years (HR 8.66), surgical margin involvement (HR 5.75), WLE (HR 26.77), and WLE+RT (HR 7.42).
BCT of DCIS bears the risk of residual disease progressing into invasive local recurrence and distant metastasis. A re-excision or mastectomy is therefore desired in all patients with unclear margins. Mastectomy treatment is associated with optimal local control and might be considered for patients younger than 40 years who are at high risk of local recurrence.
评估了乳腺导管原位癌（DCIS）患者的治疗效果，并评估了与局部复发相关的因素。
该研究纳入了1986年至2005年期间在荷兰癌症研究所接受单纯局部广泛切除（WLE）（n = 91）、局部广泛切除加放疗（WLE+RT）（n = 119）或乳房切除术（n = 294）治疗的504例患者。对临床、病理和随访数据进行了评估。
中位随访时间为6.7年。保乳治疗（BCT）后8年的总体局部复发率为12%[WLE后为15.6%，WLE+RT后为8.8%（P = 0.161）]，乳房切除术后为0.9%（P < 0.0001）。总共发生了18例（66.7%）浸润性局部复发和9例（33.3%）DCIS局部复发。BCT后8年远处转移率为4%[WLE后为4.3%，WLE+RT后为4.2%（P = 0.983）]，乳房切除术后为0.9%（P = 0.048）。接受WLE、WLE+RT和乳房切除术的患者肿瘤中位大小分别为10、15和35 mm。所有患者中有6.4%切缘阳性。与局部复发相关的因素包括年龄小于40岁（HR 8.66）、手术切缘阳性（HR 5.75）、WLE（HR 26.77）和WLE+RT（HR 7.42）。
DCIS的BCT存在残留疾病进展为浸润性局部复发和远处转移的风险。因此，所有切缘不明的患者都需要再次切除或进行乳房切除术。乳房切除术与最佳的局部控制相关，对于局部复发高危的40岁以下患者可考虑采用。
