Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China.
J Cancer Res Clin Oncol. 2019 Jul;145(7):1877-1886. doi: 10.1007/s00432-019-02930-2. Epub 2019 May 14.
Ductal carcinoma in situ (DCIS) is widely recognized as the precursor of invasive ductal carcinoma (IDC). We aimed to analyze the clinicopathological characteristics and clinical outcomes of coexisting DCIS component in IDC and its clinical significance according to molecular subtypes.
Data from 3001 patients with IDC (79.4%) and IDC/DCIS (20.6%) who underwent surgery from January 2009 to June 2016 were retrospectively assessed. The clinical outcomes of IDC with coexistent DCIS in different molecular subtypes were evaluated.
IDC/DCIS patients were more likely to be younger (P < 0.001), had low tumor grade (P = 0.001), had less lymph node involvement (P = 0.038) and received more mastectomy (P = 0.002) than IDC patients. In the comparison of molecular subtype prevalence, IDC/DCIS patients were more frequently presented with luminal B/HER2 positive (12.5% vs 11.0%, P < 0.001) and HER2 positive subtypes (20.9% vs 9.8%, P < 0.001). The 5-year disease-free survival (DFS, 90.9% vs 87.5%, P = 0.021) and 5-year overall survival (OS 96.1% vs 94.0%, P = 0.018) were significantly improved in IDC/DCIS patients compared to IDC patients. In multivariate analysis, the presence of coexisting DCIS (P = 0.048), tumor size (P < 0.001), lymph node status (P < 0.001), lymphovascular invasion (P = 0.007) and molecular subtypes (P < 0.001) were independent prognostic factors for DFS. Furthermore, coexistence of DCIS component in IDC significantly improved DFS in HER2 positive (94.8% vs 78.5%, P = 0.003), but had no association in luminal and triple negative subtypes.
IDC with coexisting DCIS was associated with improved prognosis. Patients with IDC/DCIS presented with more HER2 positive expression and might improve DFS in HER2 positive breast cancer.
导管原位癌（DCIS）被广泛认为是浸润性导管癌（IDC）的前驱病变。本研究旨在根据分子亚型分析 IDC 中同时存在的 DCIS 成分的临床病理特征和临床结局及其临床意义。
回顾性分析 2009 年 1 月至 2016 年 6 月间接受手术治疗的 3001 例 IDC（79.4%）和 IDC/DCIS（20.6%）患者的数据。评估不同分子亚型中同时存在 DCIS 的 IDC 的临床结局。
IDC/DCIS 患者较 IDC 患者更年轻（P < 0.001），肿瘤分级较低（P = 0.001），淋巴结受累较少（P = 0.038），接受乳房切除术的比例较高（P = 0.002）。在分子亚型流行率的比较中，IDC/DCIS 患者更常表现为管腔 B/HER2 阳性（12.5% vs 11.0%，P < 0.001）和 HER2 阳性亚型（20.9% vs 9.8%，P < 0.001）。与 IDC 患者相比，IDC/DCIS 患者的 5 年无病生存率（DFS，90.9% vs 87.5%，P = 0.021）和 5 年总生存率（OS，96.1% vs 94.0%，P = 0.018）显著提高。多因素分析显示，同时存在 DCIS（P = 0.048）、肿瘤大小（P < 0.001）、淋巴结状态（P < 0.001）、脉管侵犯（P = 0.007）和分子亚型（P < 0.001）是 DFS 的独立预后因素。此外，IDC 中同时存在 DCIS 成分显著提高了 HER2 阳性患者的 DFS（94.8% vs 78.5%，P = 0.003），但在管腔和三阴性亚组中无相关性。
同时存在 DCIS 的 IDC 与改善的预后相关。IDC/DCIS 患者表现出更多的 HER2 阳性表达，可能改善 HER2 阳性乳腺癌患者的 DFS。
