Liu Ying, Schloemann Derek T, Lian Min, Colditz Graham A
Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, 660 South Euclid Ave, Campus Box 8100, St. Louis, MO, 63110, USA,
Breast Cancer Res Treat. 2015 May;151(1):199-208. doi: 10.1007/s10549-015-3389-0. Epub 2015 Apr 19.
The purpose of this study was to examine influencing factors and outcomes of accelerated partial breast irradiation through brachytherapy (APBIb) versus whole breast irradiation (WBI) for ductal carcinoma in situ (DCIS). From the Surveillance Epidemiology and End Results program of the US National Cancer Institute, we identified 40,749 women who were diagnosed with first primary DCIS between 2002 and 2011 and treated with breast-conserving surgery and radiotherapy. A multi-level logistic regression analysis was performed to estimate odds ratios of APBIb use. Hazard ratios (HRs) of developing ipsilateral breast tumors (IBTs) and contralateral breast tumors (CBTs) were analyzed in 1962 patients with APBIb and 7203 propensity score-matched patients with WBI, using Cox proportional hazards regression. Overall, 2212 (4.5 %) of 40,749 women (the whole cohort) received APBIb. Factors associated with the increased use of APBIb included older age, non-Hispanic white race/ethnicity, smaller tumor size, hormone receptor positivity, comedo subtypes, and urban residence. During the 46-month follow-up, 74 (0.8 %) and 131 (1.4 %) of 9165 propensity score-matched patients developed IBTs and CBTs, respectively. Compared with WBI, APBIb was associated with a significantly increased risk of IBTs (HR 1.74; 95 % CI 1.06-2.85) but not CBTs (OR 0.91; 95 % CI 0.59-1.41). This population-based study suggests that APBIb use for DCIS was influenced by patient and tumor characteristics as well as urbanization of residence. We observed a moderately increased IBT risk associated with APBIb versus WBI, suggesting that APBIb should be used with caution for DCIS before data from randomized controlled trials with long-term follow-ups are available.
本研究旨在探讨通过近距离放射疗法进行的加速部分乳腺照射（APBIb）与全乳照射（WBI）治疗导管原位癌（DCIS）的影响因素和结果。我们从美国国立癌症研究所的监测、流行病学和最终结果计划中，识别出40749名在2002年至2011年间被诊断为原发性DCIS并接受保乳手术和放射治疗的女性。进行了多层次逻辑回归分析以估计使用APBIb的比值比。在1962例接受APBIb治疗的患者和7203例倾向评分匹配的接受WBI治疗的患者中，使用Cox比例风险回归分析了发生同侧乳腺肿瘤（IBT）和对侧乳腺肿瘤（CBT）的风险比（HR）。总体而言，40749名女性（整个队列）中有2212名（4.5%）接受了APBIb。与APBIb使用增加相关的因素包括年龄较大、非西班牙裔白人种族/族裔、肿瘤较小、激素受体阳性、粉刺型以及城市居住。在46个月的随访期间，9165例倾向评分匹配的患者中，分别有74例（0.8%）和131例（1.4%）发生了IBT和CBT。与WBI相比，APBIb与IBT风险显著增加相关（HR 1.74；95%CI 1.06 - 2.85），但与CBT无关（OR 0.91；95%CI 0.59 - 1.41）。这项基于人群的研究表明，DCIS使用APBIb受到患者和肿瘤特征以及居住城市化的影响。我们观察到与WBI相比，APBIb与IBT风险适度增加相关，这表明在获得长期随访的随机对照试验数据之前，DCIS使用APBIb应谨慎。
