Rutter Charles E, Park Henry S, Killelea Brigid K, Evans Suzanne B
Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT, USA,
Ann Surg Oncol. 2015 Jul;22(7):2378-86. doi: 10.1245/s10434-014-4334-x. Epub 2015 Jan 7.
Ductal carcinoma-in situ (DCIS) is a preinvasive form of breast cancer associated with excellent outcomes after either mastectomy or breast conservation therapy. Previous studies have demonstrated declining rates of mastectomy. However, it is unclear how this pattern has changed in recent years.
Women with DCIS were identified within the National Cancer Data Base. Patients treated with lumpectomy with or without radiotherapy were compared to women treated with mastectomy on the basis of demographic, clinicopathologic, and reporting facility details using χ (2) tests and multivariable logistic regression modeling to identify factors that may influence surgical choice. Changes in the proportion of women receiving contralateral prophylactic mastectomy (CPM) were assessed in a similar fashion.
We identified 212,936 women diagnosed with DCIS between 1998 and 2011. Lumpectomy was performed in 68 % (144,681) of patients. Mastectomy rates initially declined from 1998 (36 %) through 2004 (28 %), before increasing again through 2011 (33 %). Younger patient age, greater medical comorbidity, more extensive disease, higher tumor grade, treatment at an academic facility, and greater distance from the reporting facility were associated with heightened use of mastectomy (all p < 0.001). CPM also increased over time, particularly among younger patients, on multivariate analysis (p < 0.001).
Mastectomy utilization appears to be rising between 2004 and 2011, particularly among younger patients and those with higher-risk histopathologic features. CPM is increasing in a similar fashion. Further research is needed to understand the drivers of this change.
导管原位癌（DCIS）是一种乳腺癌的浸润前形式，在乳房切除术或保乳治疗后预后良好。既往研究显示乳房切除术的比例呈下降趋势。然而，近年来这种模式如何变化尚不清楚。
在国家癌症数据库中识别出患有DCIS的女性。根据人口统计学、临床病理和报告机构的详细信息，使用χ²检验和多变量逻辑回归模型，将接受保乳手术（无论是否接受放疗）的患者与接受乳房切除术的女性进行比较，以确定可能影响手术选择的因素。以类似方式评估接受对侧预防性乳房切除术（CPM）的女性比例的变化。
我们识别出1998年至2011年间被诊断为DCIS的212,936名女性。68%（144,681）的患者接受了保乳手术。乳房切除术的比例最初从1998年（36%）下降至2004年（28%），随后在2011年再次上升（33%）。患者年龄较轻、合并症较多、疾病范围更广、肿瘤分级更高、在学术机构接受治疗以及距离报告机构更远与更高的乳房切除术使用率相关（所有p<0.001）。多变量分析显示，CPM也随时间增加，尤其是在年轻患者中（p<0.001）。
2004年至2011年间乳房切除术的使用率似乎在上升，尤其是在年轻患者和具有高风险组织病理学特征的患者中。CPM也以类似方式增加。需要进一步研究以了解这种变化的驱动因素。
