保乳手术治疗乳腺导管原位癌患者的临床病理特征的预后意义。

Prognostic Significance of Clinicopathologic Features in Patients With Breast Ductal Carcinoma-in-Situ Who Received Breast-Conserving Surgery.

机构信息

Department of Oncology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Graduate Institute of Oncology, National Taiwan University College of Medicine and, Taipei, Taiwan; Cancer Research Center, National Taiwan University College of Medicine and, Taipei, Taiwan; National Taiwan University Cancer Center, National Taiwan University College of Medicine and, Taipei, Taiwan.

Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.

出版信息

Clin Breast Cancer. 2018 Dec;18(6):441-450.e2. doi: 10.1016/j.clbc.2018.04.002. Epub 2018 Apr 10.

DOI:10.1016/j.clbc.2018.04.002

PMID:29709458

Abstract

PURPOSE

To identify whether a certain group of breast ductal carcinoma-in-situ (DCIS) patients can be treated with breast-conserving surgery (BCS) alone; to analyze the clinicopathologic features of DCIS and tamoxifen administration in patients treated with BCS who developed ipsilateral breast tumor recurrence (IBTR).

PATIENTS AND METHODS

Data for 375 women with breast DCIS who underwent BCS at our institute between June 2003 and October 2010 were analyzed. The patients were divided into different categories according to the recurrence risk predicted using the California/Van Nuys Prognostic Index (USC/VNPI) score (4-6, 7-9, and 10-12), Eastern Cooperative Oncology Group (ECOG) E5194 criteria, or combined risk features with USC/VNPI score and ECOG E5194 criteria. The IBTR and disease-free survival (DFS) rates were calculated by the Kaplan-Meier method. The prognostic effects of age, tumor size, tumor grade, margin width, estrogen receptor status, USC/VNPI score, low-risk characteristics, and tamoxifen use were evaluated by log-rank tests.

RESULTS

Of the patients, 168 were treated with breast irradiation after BCS and 207 were not. The patients who were treated with radiotherapy (RT) tended to be younger (< 40 years), to have higher USC/VNPI scores (7-9), and to meet the ECOG E5194 non-cohort 1 criteria. The 7-year risk of IBTR was 6.2% (n = 11) in the patients who received irradiation and 9.0% (n = 22) in those who did not. DFS rates were better in the patients who underwent RT than in those who did not (93.3% vs. 88.5%, P = .056). Among the patients who underwent BCS alone, age ≥ 40 years, margin width > 10 mm, USC/VNPI scores 4-6, ECOG E5194 cohort 1 criteria, estrogen receptor-positive status, and tamoxifen use predicted lower IBTR and better DFS rates. In the multivariate analysis, combined low-risk characteristics (USC/VNPI scores 4-6 and meeting the ECOG E5194 cohort 1 criteria) were identified as an independent prognostic factor of lower IBTR (P = .028) and better DFS (P = .005).

CONCLUSION

RT reduces the risk of IBTR after BCS for DCIS of the breast. Patients with combined low-risk characteristics (USC/VNPI scores 4-6 and meeting the ECOG E5194 cohort 1 criteria) may be adequately treated with BCS alone.

摘要

目的

确定某一组乳腺导管原位癌（DCIS）患者是否可以单独接受保乳手术（BCS）治疗；分析接受 BCS 治疗且同侧乳房肿瘤复发（IBTR）的 DCIS 患者的临床病理特征和他莫昔芬治疗情况。

方法

分析了 2003 年 6 月至 2010 年 10 月在我院接受 BCS 的 375 例乳腺 DCIS 患者的数据。根据加利福尼亚/范努伊斯预后指数（USC/VNPI）评分（4-6、7-9 和 10-12）、东部肿瘤协作组（ECOG）E5194 标准或 USC/VNPI 评分和 ECOG E5194 标准联合风险特征，将患者分为不同类别。采用 Kaplan-Meier 法计算 IBTR 和无病生存率（DFS）。通过对数秩检验评估年龄、肿瘤大小、肿瘤分级、切缘宽度、雌激素受体状态、USC/VNPI 评分、低危特征和他莫昔芬使用对预后的影响。

结果

168 例患者在 BCS 后接受乳房照射治疗，207 例患者未接受照射治疗。接受放疗（RT）的患者倾向于更年轻（<40 岁）、USC/VNPI 评分较高（7-9）且符合 ECOG E5194 非队列 1 标准。接受放疗的患者 7 年 IBTR 风险为 6.2%（n=11），未接受放疗的患者为 9.0%（n=22）。接受 RT 的患者 DFS 率优于未接受 RT 的患者（93.3% vs. 88.5%，P=0.056）。在仅接受 BCS 的患者中，年龄≥40 岁、切缘宽度>10mm、USC/VNPI 评分 4-6、ECOG E5194 队列 1 标准、雌激素受体阳性状态和他莫昔芬使用预测 IBTR 发生率较低和 DFS 率较高。多变量分析显示，联合低危特征（USC/VNPI 评分 4-6 且符合 ECOG E5194 队列 1 标准）是 IBTR 发生率较低（P=0.028）和 DFS 率较高（P=0.005）的独立预后因素。