Halasz Sasha R, O'Keefe Thomas, Wallace Anne M, Blair Sarah L
Department of Surgery, University of California San Diego, 9300 Campus Point Drive, #7220, La Jolla, CA, 92037, USA.
Division of Breast Surgery and The Comprehensive Breast Health Center, University of California San Diego, Mailbox 0819, 3855 Health Sciences Dr, La Jolla, CA, 92037, USA.
Breast Cancer Res Treat. 2021 Apr;186(2):551-559. doi: 10.1007/s10549-020-06014-5. Epub 2020 Nov 12.
To use the National Cancer Database to assess treatment patterns in very young women with ductal carcinoma in situ (DCIS) given their propensity for higher risk features and increased risk of recurrence.
We used the NCDB to identify female patients who underwent surgery for a first cancer diagnosis of DCIS within three different age groups: ≤30, 31-50, and >50. Demographic information, tumor characteristics, and initial treatment patterns were characterized and compared. Univariable and multivariable logistic regression of individuals with hormone-receptor-positive disease who underwent breast-conserving surgery (BCS) was conducted to assess for group differences in adjuvant endocrine therapy utilization. Survival analysis was conducted via Kaplan-Meier method and Cox regression.
We identified 236,832 patients meeting inclusion criteria. Individuals in the youngest group were more likely to be a minority, had better Charlson-Deyo scores, lived further from their treatment facility, and were less often insured. This group also had more unfavorable tumor features and were more likely to undergo bilateral mastectomy. In subgroup analysis of patients with hormone-receptor-positive disease who underwent BCS, the youngest group was significantly less likely to have received endocrine therapy. There was also a trend toward worse overall survival in the youngest group.
We report differences in demographics, tumor characteristics, and treatment of very young women with DCIS. Given the known reduction in recurrence with use of adjuvant endocrine therapy, there may be room for increasing therapy rates or otherwise altering guidelines for treatment of young women with hormone-receptor-positive DCIS who undergo BCS.
利用国家癌症数据库评估非常年轻的导管原位癌（DCIS）女性患者的治疗模式，因为她们具有更高风险特征的倾向和复发风险增加的情况。
我们使用国家癌症数据库识别在三个不同年龄组（≤30岁、31 - 50岁和>50岁）内首次诊断为DCIS并接受手术的女性患者。对人口统计学信息、肿瘤特征和初始治疗模式进行了描述和比较。对接受保乳手术（BCS）的激素受体阳性疾病患者进行单变量和多变量逻辑回归，以评估辅助内分泌治疗使用方面的组间差异。通过Kaplan-Meier方法和Cox回归进行生存分析。
我们确定了236,832名符合纳入标准的患者。最年轻组的个体更可能是少数族裔，Charlson-Deyo评分更好，居住距离治疗机构更远，且参保率更低。该组还具有更多不利的肿瘤特征，更可能接受双侧乳房切除术。在接受BCS的激素受体阳性疾病患者的亚组分析中，最年轻组接受内分泌治疗的可能性显著更低。最年轻组的总体生存也有更差的趋势。
我们报告了非常年轻的DCIS女性患者在人口统计学、肿瘤特征和治疗方面的差异。鉴于已知辅助内分泌治疗可降低复发率，对于接受BCS的激素受体阳性DCIS年轻女性，可能有提高治疗率或改变治疗指南的空间。
