Harvard Radiation Oncology Program, Boston, MA, USA.
Int J Radiat Oncol Biol Phys. 2012 Mar 15;82(4):e581-6. doi: 10.1016/j.ijrobp.2011.08.015. Epub 2011 Dec 28.
Patients treated for ductal carcinoma in situ (DCIS) with breast-conserving surgery (BCS) and radiation therapy (RT) at our center from 1976 to 1990 had a 15% actuarial 10-year local recurrence (LR) rate. Since then, improved mammographic and pathologic evaluation and greater attention to achieving negative margins may have resulted in a lower risk of LR. In addition, clinical implications of hormone receptor and HER-2 status in DCIS remain unclear. We sought to determine the following: LR rates with this more modern approach; the relation between LR and HER-2 status; and clinical and pathologic factors associated with HER-2(+) DCIS.
We studied 246 consecutive patients who underwent BCS and RT for DCIS from 2001 to 2007. Of the patients, 96 (39%) were Grade III and the median number of involved tissue blocks was 3. Half underwent re-excision and 222 (90%) had negative margins (>2 mm). All received whole-breast RT (40-52 Gy) and 99% (244) received a tumor bed boost (8-18 Gy). Routine estrogen receptor (ER), progesterone receptor (PR), and HER-2 immunohistochemistry was instituted in 2003.
With median follow-up of 58 months, there were no LRs. Seven patients (3%) developed contralateral breast cancer (4 invasive and 3 in situ). Among 163 patients with immunohistochemistry, 124 were ER/PR(+)HER-2(-), 27 were ER/PR(+)HER-2(+), 6 were ER(-)/PR(-)HER-2(+), and 6 were ER(-)/PR(-)HER-2(-). On univariable analysis, HER-2(+)was significantly associated with Grade III, ER(-)/PR(-), central necrosis, comedo subtype, more extensive DCIS, and postmenopausal status. On multivariable analysis, Grade III and postmenopausal status remained significantly associated with HER-2(+).
In an era of mammographically identified DCIS, larger excisions, widely negative margins and the use of a tumor bed boost, we observed no LR regardless of ER/PR/HER-2 status. Factors associated with HER-2(+)DCIS included more extensive DCIS, Grade III, ER(-)/PR(-), central necrosis, comedo subtype, and postmenopausal status. Further follow-up and additional studies are required to confirm these results.
本研究旨在评估我院自 1976 年至 1990 年期间接受保乳手术（BCS）和放射治疗（RT）治疗的导管原位癌（DCIS）患者的局部复发（LR）率，并探讨激素受体和 HER-2 状态在 DCIS 中的临床意义。方法：我们回顾性分析了 2001 年至 2007 年期间在我院接受 BCS 和 RT 治疗的 246 例 DCIS 患者的临床病理资料。结果：中位随访 58 个月，无 LR 发生。7 例（3%）患者发生对侧乳腺癌（4 例浸润性，3 例原位性）。163 例患者行免疫组化检查，其中 124 例为 ER/PR（+）HER-2（-），27 例为 ER/PR（+）HER-2（+），6 例为 ER（-）/PR（-）HER-2（+），6 例为 ER（-）/PR（-）HER-2（-）。单因素分析显示，HER-2（+）与组织学分级为 III 级、ER（-）/PR（-）、中央坏死、粉刺型、DCIS 范围广泛以及绝经后状态有关。多因素分析显示，组织学分级为 III 级和绝经后状态与 HER-2（+）有关。结论：在乳腺 X 线检查识别 DCIS 的时代，更大范围的切除、广泛的阴性切缘以及应用瘤床加量放疗可降低 LR 风险，且与 ER/PR/HER-2 状态无关。与 HER-2（+）DCIS 相关的因素包括 DCIS 范围广泛、组织学分级为 III 级、ER（-）/PR（-）、中央坏死、粉刺型和绝经后状态。需要进一步随访和研究来证实这些结果。
