Chen Cong, Huang Shumin, Huang Aihua, Jia Yunlu, Wang Ji, Zhang Zeqin, Mao Misha, Wang Linbo, Zhou Jichun
Department of Surgical Oncology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China,
Biomedical Research Center and Key Laboratory of Biotherapy of Zhejiang Province, Hangzhou, China,
Onco Targets Ther. 2018 Dec 13;11:9071-9080. doi: 10.2147/OTT.S186228. eCollection 2018.
Ductal carcinoma in situ with microinvasion (DCISM) represents ~1% of all breast cancer cases. Risk factors for lymph node (LN) metastasis and appropriate adjuvant therapy for DCISM are still widely debated.
We retrieved DCISM data from the National Cancer Institute's Surveillance, Epidemiology, and End Results registry database (1998-2013). Chi-squared tests and logistic regression models were applied to investigate the potential risks of LN metastasis. Univariate and multivariate Cox proportional hazards regressions were performed to estimate the prognostic factors of DCISM. Survival outcomes were estimated using the Kaplan-Meier method. A 1:1 propensity score matching was used to minimize potential bias.
Overall, 6,219 patients with DCISM met our inclusion criteria. Younger age and higher grade disease were identified as risk factors for LN metastasis. In the multivariable analysis, LN metastasis and chemotherapy were prognostic factors for worse overall survival and breast cancer-specific survival. Furthermore, propensity score matching and subgroup analysis showed that chemotherapy may not be effective for DCISM patients.
Younger patients with high-grade disease tend to have LN involved in DCISM. Adjuvant chemotherapy might not be necessary for patients with DCISM.
伴有微浸润的导管原位癌（DCISM）占所有乳腺癌病例的约1%。淋巴结（LN）转移的危险因素以及DCISM合适的辅助治疗仍存在广泛争议。
我们从美国国家癌症研究所的监测、流行病学和最终结果登记数据库（1998 - 2013年）中检索DCISM数据。应用卡方检验和逻辑回归模型来研究LN转移的潜在风险。进行单因素和多因素Cox比例风险回归以估计DCISM的预后因素。使用Kaplan - Meier方法估计生存结果。采用1:1倾向评分匹配以尽量减少潜在偏差。
总体而言，6219例DCISM患者符合我们的纳入标准。年龄较小和疾病分级较高被确定为LN转移的危险因素。在多变量分析中，LN转移和化疗是总体生存和乳腺癌特异性生存较差的预后因素。此外，倾向评分匹配和亚组分析表明化疗对DCISM患者可能无效。
年龄较小且疾病分级较高的DCISM患者倾向于发生LN转移。DCISM患者可能无需辅助化疗。
