Department of Surgery, McGill University, Montreal, QC, Canada.
Department of Surgery, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Ave, Boston, MA, USA.
Ann Surg Oncol. 2017 Sep;24(9):2509-2517. doi: 10.1245/s10434-017-5867-6. Epub 2017 Apr 28.
A diagnosis of lobular carcinoma in situ (LCIS) is associated with an increased risk of developing breast cancer, although little data exist on long-term patient outcomes, including those who develop subsequent breast malignancies.
The Surveillance, Epidemiology, and End Results (SEER) database was used to identify women with a histological diagnosis of LCIS between 1983 and 2014. The incidence and clinicopathologic features of subsequent malignancies were then examined, and the Kaplan-Meier method and multivariable Cox PH regression used to obtain breast cancer-specific survival (BCSS) estimates and associated hazard ratios.
Overall, 19,462 women swith a mean age at LCIS diagnosis of 53.7 years, and a 10- and 20-year cumulative incidence of subsequent breast malignancy of 11.3% [95% confidence interval (CI) 10.7-11.9%] and 19.8% (95% CI 18.8-20.9) met the eligibility criteria. At a median follow-up of 8.1 years (range 0-30.9) a total of 1837 primary breast cancers were diagnosed, of which 55.2% were diagnosed in the ipsilateral breast. Most breast cancers were of low/intermediate grade, hormone receptor-positive, and diagnosed in early stages. Of subsequent malignancies, invasive ductal carcinoma (IDC) distributed equally across both breasts, whereas invasive lobular carcinoma (ILC) was more likely to present in the ipsilateral breast (69.0% ILC vs. 49.2% IDC; p < 0.001). On multivariable analysis, type of surgical treatment for LCIS had no affect on long-term survival (p = 0.44). The 10- and 20-year BCSS for women with LCIS was 98.9 and 96.3%, respectively.
Women with LCIS who are diagnosed with a subsequent primary breast cancer are often diagnosed in early stages and have excellent BCSS.
诊断为乳腺小叶原位癌（LCIS）与发生乳腺癌的风险增加相关，尽管关于长期患者结局的数据很少，包括那些发展为后续乳腺癌的患者。
使用监测、流行病学和最终结果（SEER）数据库，确定了 1983 年至 2014 年间患有 LCIS 组织学诊断的女性。然后检查了随后发生的恶性肿瘤的发病率和临床病理特征，并使用 Kaplan-Meier 方法和多变量 Cox PH 回归来获得乳腺癌特异性生存（BCSS）估计值和相关风险比。
总体而言，19462 名女性的平均年龄为 53.7 岁，10 年和 20 年的后续乳腺癌恶性肿瘤累积发生率分别为 11.3%（95%置信区间 [95%CI] 10.7-11.9%）和 19.8%（95%CI 18.8-20.9%），符合入选标准。在中位随访 8.1 年（范围 0-30.9）期间，共诊断出 1837 例原发性乳腺癌，其中 55.2%为同侧乳房诊断。大多数乳腺癌为低/中级别，激素受体阳性，且处于早期诊断阶段。在随后的恶性肿瘤中，浸润性导管癌（IDC）均匀分布于双侧乳房，而浸润性小叶癌（ILC）更可能出现在同侧乳房（69.0%的 ILC 与 49.2%的 IDC；p<0.001）。多变量分析显示，LCIS 的手术治疗类型对长期生存没有影响（p=0.44）。LCIS 女性的 10 年和 20 年 BCSS 分别为 98.9%和 96.3%。
诊断为 LCIS 并随后发生原发性乳腺癌的女性通常处于早期诊断阶段，具有极好的 BCSS。
