Jones Caroline E, Richman Joshua, Jackson Bradford E, Wallace Audrey S, Krontiras Helen, Urist Marshall M, Bland Kirby I, Parker Catherine C
Department of Surgery, The University of Alabama at Birmingham, Birmingham, Alabama.
Center for Outcomes Research, JPS Health Network, Fort Worth, Texas.
J Surg Res. 2018 Nov;231:36-42. doi: 10.1016/j.jss.2018.05.007. Epub 2018 Jun 1.
Mastectomy remains an effective treatment for ductal carcinoma in situ (DCIS) but whether further therapy is warranted for close or positive margins is controversial. We aim to characterize the treatment practices of DCIS throughout the United States in patients who undergo mastectomy with close or positive margins to better understand the use of postmastectomy radiation therapy (PMRT).
Using the 2004-2013 National Cancer Database, we identified all female patients with a diagnosis of DCIS who underwent mastectomy. Distributional characteristics were summarized for overall and margin-stratified samples. Characteristic differences were assessed by region and receipt of radiation. Chi-square and independent sample t-tests were used to assess differences for categorical and continuous variables, respectively.
In 21,591 patients who met inclusion criteria, 470 patients with close/positive margins were identified. Sixteen percent of patients with close/positive margins received PMRT compared to 1.5% with negative margins (P < 0.01). There was no difference in PMRT and patient race, insurance status, treatment facility, or endocrine therapy. Patients with close/positive margins who received PMRT were more likely to be in an urban setting from the Midwest (24.6%) and Northeast (21.8%) compared to the West (11.0%) and South (10.7%) (P < 0.01).
Use of PMRT for DCIS following mastectomy with close/positive margins differs across the country. Regional variations in treatment patterns reinforce a need to determine whether PMRT improves survival to establish treatment guidelines.
乳房切除术仍然是治疗导管原位癌（DCIS）的有效方法，但对于切缘接近或阳性的患者是否需要进一步治疗存在争议。我们旨在描述全美国接受乳房切除术且切缘接近或阳性的DCIS患者的治疗情况，以更好地了解乳房切除术后放疗（PMRT）的使用情况。
利用2004 - 2013年国家癌症数据库，我们确定了所有诊断为DCIS并接受乳房切除术的女性患者。对总体样本和按切缘分层的样本进行分布特征总结。通过地区和放疗接受情况评估特征差异。分别使用卡方检验和独立样本t检验来评估分类变量和连续变量的差异。
在21,591例符合纳入标准的患者中，确定了470例切缘接近/阳性的患者。切缘接近/阳性的患者中有16%接受了PMRT，而切缘阴性的患者中这一比例为1.5%（P < 0.01）。PMRT与患者种族、保险状况、治疗机构或内分泌治疗之间没有差异。接受PMRT的切缘接近/阳性患者相比西部（11.0%）和南部（10.7%），更有可能来自中西部（24.6%）和东北部（21.8%）的城市地区（P < 0.01）。
乳房切除术后切缘接近/阳性的DCIS患者使用PMRT的情况在全国存在差异。治疗模式的地区差异强化了确定PMRT是否能提高生存率以制定治疗指南的必要性。
