Si J, Quan C L, Mo M, Guo R, Su Y H, Yang B L, Chen J J, Shao Z M, Wu J
Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.
Zhonghua Wai Ke Za Zhi. 2019 Sep 1;57(9):681-685. doi: 10.3760/cma.j.issn.0529-5915.2019.09.007.
To examine the influence factors on axillary evaluation in ductal carcinoma in situ (DCIS) patients, and the prognosis of different choices of axillary evaluation in a single-center retrospective study. Totally 1 557 DCIS patients admitted in Department of Breast Surgery, Fudan University Shanghai Cancer Center from January 2006 to November 2016 were retrospectively enrolled. All patients were female. The median age was 49 years (range: 21 to 85 years). Surgical methods included modified radical mastectomy, simple mastectomy (with or without axillary evaluation) and breast conservation surgery (with or without axillary evaluation). Axillary evaluation included axillary lymph node dissection (ALND) and sentinel lymph node biopsy (SLNB). tests, χ(2) test and Logistic regression analysis was used to analyze influence factors on axillary evaluation, respectively. Kaplan-Meier curve and Log-rank analysis were used to evaluate recurrence-free survival (RFS) and loco-regional recurrence-free survival (LRRFS) in patients with different surgical methods. Among the 1 557 DCIS patients, there were 1 226 cases received axillary evaluation, while 331 cases not received axillary evaluation. Patients were separated into 3 groups by different axillary evaluation choices: SLNB group (957 cases, 61.46%), ALND group (197 cases, 12.65%) and no evaluation group (403 cases, 25.88%). The patients in SLNB group increased significantly (0.000), from 3.85% (60/1 557) in 2006 to 75.19% (1 170/1 557) in 2016. The independent influence factors of receiving axillary evaluation were high nuclear grade (3.191, 95: 1.722 to 5.912, 0.001) and tumor size>15 mm (1.698, 95: 1.120 to 2.573, 0.012). Also, patients received breast conservation surgery were more likely to refuse axillary evaluation (0.155, 95: 0.103 to 0.233, 0.000). There were no significant differences in RFS and LRRFS in patients with different axillary evaluation choices. The investigation in trends and influence factors of different axillary evaluation choices provided basis on surgical precision medicine in DCIS patients. Patients received SLNB increased significantly. The independent influence factors of axillary evaluation were nuclear grade, tumor size and surgical methods. There was no significant differences in prognosis among the groups receiving different axillary evaluations.
在一项单中心回顾性研究中，探讨导管原位癌（DCIS）患者腋窝评估的影响因素，以及不同腋窝评估选择的预后情况。回顾性纳入2006年1月至2016年11月在复旦大学附属肿瘤医院乳腺外科收治的1557例DCIS患者。所有患者均为女性，中位年龄49岁（范围：21至85岁）。手术方式包括改良根治术、单纯乳房切除术（有或无腋窝评估）和保乳手术（有或无腋窝评估）。腋窝评估包括腋窝淋巴结清扫（ALND）和前哨淋巴结活检（SLNB）。分别采用检验、χ²检验和Logistic回归分析来分析腋窝评估的影响因素。采用Kaplan-Meier曲线和Log-rank分析评估不同手术方式患者的无复发生存期（RFS）和局部区域无复发生存期（LRRFS）。在1557例DCIS患者中，1226例接受了腋窝评估，331例未接受腋窝评估。根据不同的腋窝评估选择将患者分为3组：SLNB组（957例，61.46%）、ALND组（197例，12.65%）和未评估组（403例，25.88%）。SLNB组患者比例显著增加（P = 0.000），从2006年的3.85%（60/1557）增至2016年的75.19%（1170/1557）。接受腋窝评估的独立影响因素为高核分级（3.191，95%CI：1.722至5.912，P = 0.001）和肿瘤大小>15 mm（1.
