Coromilas Ellie J, Wright Jason D, Huang Yongmei, Feldman Sheldon, Neugut Alfred I, Hillyer Grace Clarke, Chen Ling, Hershman Dawn L
Departments of Medicine, Gynecology, and Surgery, and the Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, 161 Ft Washington, New York, NY, 10032, USA.
Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
Breast Cancer Res Treat. 2016 Jul;158(2):373-84. doi: 10.1007/s10549-016-3890-0. Epub 2016 Jun 30.
Axillary evaluation in women with ductal carcinoma in situ (DCIS) is increasing; however, this may introduce additional morbidity with unclear benefit. Our objective was to examine the morbidity and mortality associated with axillary evaluation in DCIS. We conducted a retrospective cohort study of 10,504 women aged 65-90 years with DCIS who underwent breast conserving surgery between 2002 and 2012 using SEER-Medicare database. Patients were categorized by receipt of axillary evaluation with either sentinel lymph node biopsy (SLNB) or axillary node dissection (ALND). We determined the incidence of lymphedema treatment as defined by diagnostic and procedural codes, as well as 10-year breast cancer-specific and all-cause mortality. 18.3 % of those treated with BCS and 69.4 % of those treated with mastectomy had an axillary evaluation. One year after treatment, 8.2 % of women who had an axillary evaluation developed lymphedema, compared to 5.9 % of those who did not. In a multivariable Cox proportional hazard model, the incidence of lymphedema was higher among those who underwent axillary evaluation (HR 1.22, 95 % CI 1.04-1.45). Overall 10-year breast cancer-specific survival was similar between both groups (HR 0.83, 95 % CI 0.40-1.74). Only 44 (0.40 %) women died of breast cancer; receipt of axillary evaluation did not alter overall survival. Axillary evaluation is commonly performed in women with DCIS, especially those undergoing mastectomy. However, women who receive an axillary evaluation have higher rates of lymphedema, without breast cancer-specific or overall survival benefit. Efforts should be made to determine the population of women with DCIS who benefit from this procedure.
原位导管癌（DCIS）女性患者的腋窝评估正在增加；然而，这可能会带来额外的发病率，而益处却不明确。我们的目的是研究DCIS腋窝评估相关的发病率和死亡率。我们使用监测、流行病学和最终结果（SEER）-医疗保险数据库，对2002年至2012年间接受保乳手术的10504名65至90岁DCIS女性进行了一项回顾性队列研究。患者根据是否接受前哨淋巴结活检（SLNB）或腋窝淋巴结清扫（ALND）进行腋窝评估进行分类。我们根据诊断和程序编码确定了淋巴水肿治疗的发生率，以及10年乳腺癌特异性死亡率和全因死亡率。接受保乳手术治疗的患者中有18.3%以及接受乳房切除术治疗的患者中有69.4%进行了腋窝评估。治疗后一年，进行腋窝评估的女性中有8.2%发生了淋巴水肿，而未进行腋窝评估的女性中这一比例为5.9%。在多变量Cox比例风险模型中，接受腋窝评估的患者淋巴水肿发生率更高（风险比1.22，95%置信区间1.04-1.45）。两组的总体10年乳腺癌特异性生存率相似（风险比0.83，95%置信区间0.40-1.74）。只有44名（0.40%）女性死于乳腺癌；接受腋窝评估并未改变总体生存率。DCIS女性通常会进行腋窝评估，尤其是那些接受乳房切除术的女性。然而，接受腋窝评估的女性淋巴水肿发生率更高，且未获得乳腺癌特异性或总体生存益处。应努力确定能从该手术中获益的DCIS女性人群。
