Chen Hongliang, Bai Fang, Wang Maoli, Zhang Mingdi, Zhang Peng, Wu Kejin
Department of Breast Surgery, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, China.
Ann Transl Med. 2019 Sep;7(18):484. doi: 10.21037/atm.2019.08.16.
To evaluate the prognostic significance of co-existence ductal carcinoma in situ (DCIS) in invasive ductal breast cancer (IDC) compared with pure IDC.
The Surveillance, Epidemiology, and End Results (SEER) database was searched to identify unilateral IDC cases between 2004 and 2015, which were grouped into pure IDC and IDC with DCIS component (IDC-DCIS). Comparisons of the distribution of clinical-pathological characteristics the two groups were performed using Pearson's chi-square. Breast cancer-specific survival (BCSS) and overall survival (OS) were estimated using the Kaplan-Meier method and compared across RS groups using the log-rank statistic. Cox models were fitted to assess the factors independently associated with survival. A 1:1 matched case-control analysis was conducted with each clinical-pathological characteristic matched completely.
A total of 98,097 pure IDC cases (39.6%) and 149,477 IDC-DCIS cases (60.4%) were enrolled. IDC-DCIS patients were presented with less aggressive characteristics such as lower proportion of histologic grade III (34.2% 42.2%, P<0.001), ER negative (16.8% 26.1%, P<0.001) and PR negative (26.5% 35.7%, P<0.001) disease and higher proportion of T1 cases (68.7% 58.2%, P<0.001) compared with pure IDC patients. Co-existence DCIS was an independent prognostic factor for BCSS and OS in the whole cohort. According to the multivariate analysis, it was an independent favorable prognostic factor among ER positive cases, but an independent negative prognostic factor among ER negative cases based on the matched cohort.
Co-existence DCIS showed quite different prognostic significance among ER positive and negative disease.
评估浸润性导管癌（IDC）中并存导管原位癌（DCIS）与单纯IDC相比的预后意义。
检索监测、流行病学和最终结果（SEER）数据库，以确定2004年至2015年间的单侧IDC病例，将其分为单纯IDC和伴有DCIS成分的IDC（IDC-DCIS）。使用Pearson卡方检验对两组临床病理特征分布进行比较。采用Kaplan-Meier法估计乳腺癌特异性生存（BCSS）和总生存（OS），并使用对数秩检验在不同风险组之间进行比较。拟合Cox模型以评估与生存独立相关的因素。进行1:1匹配的病例对照分析，使每个临床病理特征完全匹配。
共纳入98097例单纯IDC病例（39.6%）和149477例IDC-DCIS病例（60.4%）。与单纯IDC患者相比，IDC-DCIS患者具有侵袭性较低的特征，如组织学III级比例较低（34.2%对42.2%，P<0.001）、雌激素受体（ER）阴性（16.8%对26.1%，P<0.001）和孕激素受体（PR）阴性（26.5%对35.7%，P<0.001）疾病，以及T1病例比例较高（68.7%对58.2%，P<0.001）。并存DCIS是整个队列中BCSS和OS的独立预后因素。根据多变量分析，在ER阳性病例中它是独立的有利预后因素，但在基于匹配队列的ER阴性病例中是独立的不良预后因素。
并存DCIS在ER阳性和阴性疾病中显示出截然不同的预后意义。
