Meattini Icro, Saieva Calogero, Bastiani Paolo, Martella Francesca, Francolini Giulio, Lo Russo Monica, Paoletti Lisa, Doria Morena, Desideri Isacco, Terziani Francesca, De Luca Cardillo Carla, Bendinelli Benedetta, Ciabatti Cinzia, Muntoni Cristina, Tinacci Galliano, Nori Jacopo, Smith Herd, Brancato Beniamino, Galli Lorenzo, Sanchez Luis Jose, Casella Donato, Bernini Marco, Orzalesi Lorenzo, Carta Giulio Alberto, Bianchi Simonetta, Rossi Francesca, Livi Lorenzo
Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Italy.
Cancer Risk Factors and Lifestyle Epidemiology Unit, Cancer Research and Prevention Institute (ISPO), Italy.
Breast. 2017 Jun;33:139-144. doi: 10.1016/j.breast.2017.03.017. Epub 2017 Apr 4.
Ductal carcinoma in situ (DCIS) is a heterogeneous disease, for which the best adjuvant treatment is still uncertain. Many attempts of risk-groups stratification have been made over time, developing prognostic scores to predict risk of local recurrence (LR) on the basis of features such as age, final surgical margins (FSM) status, grade, and tumor size. The aim of our analysis was to evaluate the patterns of recurrence from a two large-institutional retrospective series.
We collected data on 457 patients treated with BCS and adjuvant RT between 1990 and 2012. Final analysis was performed on 278 patients, due to missing data about hormonal status (HS). Patients were treated at the Radiation Oncology Unit of the University of Florence (n = 195), and S. Maria Annunziata Hospital (n = 83) (Florence, Italy).
At a median follow up time of 10.8 years (range 3-25), we observed 20 LR (7.2%). The 5-year and 10-year LR rates were 4.9% and 10.2%, respectively. At Cox regression univariate analysis, estrogen receptor (ER) positive status (p = 0.001), HS positive (p = 0.003), and FSM <1 mm (p = 0.0001) significantly impacted on LR. At Cox regression multivariate analysis positive ER status maintained a protective role (p = 0.003), and FSM status <1 mm its negative impact (p = 0.0001) on LR rate.
Our experience confirmed the wide heterogeneity of DCIS. Inadequate FSM and negative ER status negatively influenced LR rates. Tumor biology should be integrated in adjuvant treatment decision-making process.
导管原位癌（DCIS）是一种异质性疾病，其最佳辅助治疗方案仍不明确。长期以来，人们进行了许多风险分层的尝试，根据年龄、最终手术切缘（FSM）状态、分级和肿瘤大小等特征制定预后评分，以预测局部复发（LR）风险。我们分析的目的是评估两个大型机构回顾性系列研究中的复发模式。
我们收集了1990年至2012年间接受保乳手术（BCS）和辅助放疗的457例患者的数据。由于激素状态（HS）数据缺失，最终对278例患者进行了分析。患者分别在佛罗伦萨大学放射肿瘤学科室（n = 195）和圣玛丽亚安农齐亚塔医院（n = 83）（意大利佛罗伦萨）接受治疗。
中位随访时间为10.8年（范围3 - 25年），我们观察到20例局部复发（7.2%）。5年和10年局部复发率分别为4.9%和10.2%。在Cox回归单因素分析中，雌激素受体（ER）阳性状态（p = 0.001）、HS阳性（p = 0.003）和FSM < 1 mm（p = 0.0001）对局部复发有显著影响。在Cox回归多因素分析中，ER阳性状态对局部复发率仍具有保护作用（p = 0.003），而FSM状态< 1 mm对局部复发率有负面影响（p = 0.0001）。
我们的经验证实了DCIS具有广泛的异质性。FSM不足和ER阴性状态对局部复发率有负面影响。肿瘤生物学特性应纳入辅助治疗决策过程。
