Giardiello Daniele, Kramer Iris, Hooning Maartje J, Hauptmann Michael, Lips Esther H, Sawyer Elinor, Thompson Alastair M, de Munck Linda, Siesling Sabine, Wesseling Jelle, Steyerberg Ewout W, Schmidt Marjanka K
Division of Molecular Pathology, The Netherlands Cancer Institute, Amsterdam, the Netherlands.
Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands.
NPJ Breast Cancer. 2020 Nov 3;6(1):60. doi: 10.1038/s41523-020-00202-8.
We aimed to assess contralateral breast cancer (CBC) risk in patients with ductal carcinoma in situ (DCIS) compared with invasive breast cancer (BC). Women diagnosed with DCIS (N = 28,003) or stage I-III BC (N = 275,836) between 1989 and 2017 were identified from the nationwide Netherlands Cancer Registry. Cumulative incidences were estimated, accounting for competing risks, and hazard ratios (HRs) for metachronous invasive CBC. To evaluate effects of adjuvant systemic therapy and screening, separate analyses were performed for stage I BC without adjuvant systemic therapy and by mode of first BC detection. Multivariable models including clinico-pathological and treatment data were created to assess CBC risk prediction performance in DCIS patients. The 10-year cumulative incidence of invasive CBC was 4.8% for DCIS patients (CBC = 1334). Invasive CBC risk was higher in DCIS patients compared with invasive BC overall (HR = 1.10, 95% confidence interval (CI) = 1.04-1.17), and lower compared with stage I BC without adjuvant systemic therapy (HR = 0.87; 95% CI = 0.82-0.92). In patients diagnosed ≥2011, the HR for invasive CBC was 1.38 (95% CI = 1.35-1.68) after screen-detected DCIS compared with screen-detected invasive BC, and was 2.14 (95% CI = 1.46-3.13) when not screen-detected. The C-index was 0.52 (95% CI = 0.50-0.54) for invasive CBC prediction in DCIS patients. In conclusion, CBC risks are low overall. DCIS patients had a slightly higher risk of invasive CBC compared with invasive BC, likely explained by the risk-reducing effect of (neo)adjuvant systemic therapy among BC patients. For support of clinical decision making more information is needed to differentiate CBC risks among DCIS patients.
我们旨在评估导管原位癌（DCIS）患者与浸润性乳腺癌（BC）患者相比的对侧乳腺癌（CBC）风险。从荷兰全国癌症登记处识别出1989年至2017年间被诊断为DCIS（N = 28,003）或I - III期BC（N = 275,836）的女性。估计累积发病率，并考虑竞争风险以及异时性浸润性CBC的风险比（HRs）。为了评估辅助性全身治疗和筛查的效果，对未接受辅助性全身治疗的I期BC以及首次发现BC的方式进行了单独分析。创建了包含临床病理和治疗数据的多变量模型，以评估DCIS患者中CBC风险预测的性能。DCIS患者中浸润性CBC的10年累积发病率为4.8%（CBC = 1334）。与总体浸润性BC相比，DCIS患者发生浸润性CBC的风险更高（HR = 1.10，95%置信区间（CI）= 1.04 - 1.17），而与未接受辅助性全身治疗的I期BC相比风险更低（HR = 0.87；95% CI = 0.82 - 0.92）。在2011年及以后诊断的患者中，筛查发现的DCIS后发生浸润性CBC的HR与筛查发现的浸润性BC相比为1.38（95% CI = 1.35 - 1.68），未筛查发现时为2.14（95% CI = 1.46 - 3.13）。DCIS患者浸润性CBC预测的C指数为0.52（95% CI = 0.50 - 0.54）。总之，CBC总体风险较低。与浸润性BC相比，DCIS患者发生浸润性CBC的风险略高，这可能是由于BC患者中（新）辅助性全身治疗的风险降低作用所致。为了支持临床决策，需要更多信息来区分DCIS患者中的CBC风险。
