多灶微浸润与保乳手术后导管原位癌女性浸润性局部复发风险增加相关。
Multiple foci of microinvasion is associated with an increased risk of invasive local recurrence in women with ductal carcinoma in situ treated with breast-conserving surgery.
机构信息
Department of Radiation Oncology, Toronto, ON, Canada.
ICES, Toronto, ON, Canada.
出版信息
Breast Cancer Res Treat. 2019 Nov;178(1):169-176. doi: 10.1007/s10549-019-05364-z. Epub 2019 Jul 19.
PURPOSE
The impact of Ductal Carcinoma in Situ (DCIS) with multiple foci of microinvasion (MI) (≤ 1 mm) on the risks of local recurrence (LR) and invasive LR is unknown, leading to uncertainty if DCIS with multiple foci of MI requires more aggressive treatment. We report a population-based analysis of the impact of multiple foci of MI, confirmed by pathology review, on the 15-year risks of LR and invasive LR treated with breast-conserving surgery (BCS) ± radiotherapy (RT).
METHODS
Cohort includes all women diagnosed with DCIS ± MI from 1994 to 2003 treated with BCS ± RT. Cox proportional hazards model was used to evaluate the impact of multiple foci of MI on the risks of LR and invasive LR, adjusting for covariates. The 15-year local and invasive local recurrence-free survival rates were calculated using the Kaplan-Meier method with differences compared by log-rank test.
RESULTS
The cohort includes 2988 women treated by BCS; 2721 had pure DCIS (51% received RT), 267 had DCIS with one or more foci of MI (58% had RT). Median follow-up was 13 years. Median age at diagnosis was 58 years. On multivariable analyses, the presence of multiple foci of MI was associated with an increased risk of invasive LR (HR = 1.59, 95% CI 1.01-2.49, p = 0.04) but not DCIS LR (HR = 0.89, 95% CI 0.46, 1.76, p = 0.7). The 15-year invasive LRFS risks for cases with pure DCIS, with 1 focus or multiple foci of MI were 85.7%, 85.6%, 74.7% following treatment by BCS alone, 87.2%, 89.9%, and 77% for those treated with BCS + RT without boost and 89.2%, 91.3%, and 95% for women treated with BCS + RT and boost.
CONCLUSIONS
The presence of multiple foci of MI in DCIS is associated with higher 15-year risks of invasive LR after breast-conserving therapy compared to women with pure DCIS but treatment with whole breast and boost RT can mitigate this risk.
目的
导管原位癌（DCIS）伴微浸润灶（MI）多发（≤1mm）对局部复发（LR）和浸润性 LR 风险的影响尚不清楚，因此对于 MI 多发的 DCIS 是否需要更积极的治疗存在不确定性。我们报告了一项基于人群的分析，研究了经病理证实的 MI 多发对保乳手术（BCS）±放疗（RT）治疗后 15 年 LR 和浸润性 LR 风险的影响。
方法
该队列纳入了 1994 年至 2003 年间诊断为 DCIS±MI 并接受 BCS±RT 治疗的所有女性。采用 Cox 比例风险模型评估 MI 多发对 LR 和浸润性 LR 风险的影响，并进行了协变量调整。采用 Kaplan-Meier 法计算 15 年局部和局部浸润无复发生存率，并采用对数秩检验比较差异。
结果
该队列包括 2988 例接受 BCS 治疗的女性；2721 例为单纯 DCIS（51%接受 RT），267 例为 DCIS 伴一个或多个 MI 灶（58%接受 RT）。中位随访时间为 13 年。中位诊断年龄为 58 岁。多变量分析显示，MI 多发与浸润性 LR 风险增加相关（HR=1.59，95%CI 1.01-2.49，p=0.04），但与 DCIS LR 无关（HR=0.89，95%CI 0.46-1.76，p=0.7）。单纯 BCS 治疗后，单纯 DCIS、1 个 MI 灶或多个 MI 灶的 15 年浸润性 LRFS 风险分别为 85.7%、85.6%、74.7%；未行局部加量 RT 的 BCS+RT 治疗组分别为 87.2%、89.9%和 77%；行局部加量 RT 的 BCS+RT 治疗组分别为 89.2%、91.3%和 95%。
结论
与单纯 DCIS 相比，DCIS 伴 MI 多发与保乳治疗后 15 年浸润性 LR 风险增加相关，但全乳和加量 RT 治疗可降低这种风险。
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