Radiation Therapy Program, BC Cancer Agency-Vancouver Island Centre, Victoria, BC, Canada.
Ann Surg Oncol. 2011 Jan;18(1):119-24. doi: 10.1245/s10434-010-1214-x. Epub 2010 Jul 20.
To identify prognostic indicators of local recurrence (LR) in patients with ductal carcinoma in situ (DCIS) of the breast treated with breast conserving surgery (BCS) alone.
A retrospective study was conducted of all women with pure DCIS, diagnosed 1985-1999, referred for tertiary oncologic opinion in British Columbia, treated with BCS without adjuvant radiotherapy. Kaplan-Meier local control (LC) and breast cancer specific survival (BCSS) estimates for the entire group were plotted. Stratified analyses identified subgroups with high Kaplan-Meier 10-year LR. Cox multivariate modeling was used to assess predictors of LR. Kaplan-Meier BCSS rates were compared between two cohorts: those who experienced LR and those who did not have LR.
A total of 460 women comprised the study cohort. Median follow-up was 9.4 years. The 15-year LC and BCSS rates were 82% and 97%, respectively. Stratified analyses of LR identified comedo histology, high nuclear grade, tumor size >4 cm or indeterminate size, and positive margins to be associated with significantly higher LR risk, with 10-year LR risks approximating 15-30%. The 10-year BCSS rates for the LR group were 94% compared with 99% for the NoLR group. On Cox regression modeling, high nuclear grade, the presence of comedocarcinoma, and positive margins were significant factors for higher risk of LR.
Women with DCIS treated with BCS alone had higher LR risk, and those with a LR were more likely to die of breast cancer. Optimal local treatment is mandatory to minimize the risk of breast cancer death for women with this curable disease.
为了确定接受保乳手术（BCS）治疗的乳腺导管原位癌（DCIS）患者局部复发（LR）的预后指标。
对所有 1985-1999 年在不列颠哥伦比亚省被转诊至三级肿瘤专科接受治疗的、接受单纯 BCS 治疗且未接受辅助放疗的乳腺纯 DCIS 女性患者进行回顾性研究。对整个组别的 Kaplan-Meier 局部控制（LC）和乳腺癌特异性生存（BCSS）进行了评估。分层分析确定了 Kaplan-Meier 10 年 LR 较高的亚组。使用 Cox 多变量模型评估 LR 的预测因子。比较了发生 LR 和未发生 LR 的两组之间的 Kaplan-Meier BCSS 率。
共有 460 名女性入组该研究队列。中位随访时间为 9.4 年。15 年的 LC 和 BCSS 率分别为 82%和 97%。LR 的分层分析确定了粉刺样组织学、高核分级、肿瘤大小>4cm 或不确定大小、以及阳性切缘与显著较高的 LR 风险相关，10 年 LR 风险接近 15%-30%。LR 组的 10 年 BCSS 率为 94%，而无 LR 组为 99%。在 Cox 回归模型中，高核分级、粉刺癌和阳性切缘是 LR 风险较高的显著因素。
接受单纯 BCS 治疗的 DCIS 女性患者 LR 风险较高，且发生 LR 的患者更有可能死于乳腺癌。为了降低这种可治愈疾病患者死于乳腺癌的风险，必须采用最佳的局部治疗方法。
