Department of Surgery, Elisabeth-Tweesteden Hospital, Hilvarenbeekseweg 60, 5022 GC, Tilburg, The Netherlands.
School for Oncology and Developmental Biology, Research Institute GROW, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands.
Breast Cancer Res Treat. 2021 May;187(1):245-254. doi: 10.1007/s10549-020-06055-w. Epub 2021 Jan 1.
To spare DCIS patients from overtreatment, treatment de-escalated over the years. This study evaluates the influence of these developments on the patterns of care in the treatment of DCIS with particular interest in the use of breast conserving surgery (BCS), radiotherapy following BCS and the use and type of axillary staging.
In this large population-based cohort study all women, aged 50-74 years diagnosed with DCIS from January 1989 until January 2019, were analyzed per two-year cohort.
A total of 30,417 women were diagnosed with DCIS. The proportion of patients undergoing BCS increased from 47.7% in 1995-1996 to 72.7% in 2017-2018 (p < 0.001). Adjuvant radiotherapy following BCS increased from 28.9% (1995-1996) to 89.6% (2011-2012) and subsequently decreased to 74.9% (2017-2018; p < 0.001). Since its introduction, the use of sentinel lymph node biopsy (SLNB) increased to 63.1% in 2013-2014 and subsequently decreased to 52.8% in 2017-2018 (p < 0.001). Axillary surgery is already omitted in 55.8% of the patients undergoing BCS nowadays. The five-year invasive relapse-free survival (iRFS) for BCS with adjuvant radiotherapy in the period 1989-2010, was 98.7% [CI 98.4% - 99.0%], compared to 95.0% [CI 94.1% -95.8%] for BCS only (p < 0.001). In 2011-2018, this was 99.3% [CI 99.1% - 99.5%] and 98.8% [CI 98.2% - 99.4%] respectively (p = 0.01).
This study shows a shift toward less extensive treatment. DCIS is increasingly treated with BCS and less often followed by additional radiotherapy. The absence of radiotherapy still results in excellent iRFS. Axillary surgery is increasingly omitted in DCIS patients.
为了避免 DCIS 患者过度治疗，多年来治疗已经有所缓和。本研究评估了这些发展对 DCIS 治疗模式的影响，特别关注保乳手术（BCS）的使用、BCS 后的放疗以及腋窝分期的使用和类型。
在这项基于人群的大型队列研究中，所有年龄在 50-74 岁之间的 1989 年 1 月至 2019 年 1 月期间被诊断为 DCIS 的女性均按每两年一组进行分析。
共有 30417 名女性被诊断为 DCIS。接受 BCS 的患者比例从 1995-1996 年的 47.7%增加到 2017-2018 年的 72.7%（p<0.001）。BCS 后的辅助放疗从 28.9%（1995-1996 年）增加到 89.6%（2011-2012 年），随后下降到 74.9%（2017-2018 年；p<0.001）。自引入以来，前哨淋巴结活检（SLNB）的使用率从 2013-2014 年的 63.1%增加到 2017-2018 年的 52.8%（p<0.001）。目前，接受 BCS 的患者中有 55.8%已经省略了腋窝手术。在 1989-2010 年期间，接受辅助放疗的 BCS 的五年无侵袭性复发存活率（iRFS）为 98.7%[98.4%-99.0%]，而仅接受 BCS 的为 95.0%[94.1%-95.8%]（p<0.001）。在 2011-2018 年期间，这分别为 99.3%[99.1%-99.5%]和 98.8%[98.2%-99.4%]（p=0.01）。
本研究表明治疗方式向非广泛治疗转变。DCIS 越来越多地采用 BCS 治疗，且后续追加放疗的情况越来越少。不进行放疗仍能产生极好的 iRFS。在 DCIS 患者中，腋窝手术越来越多地被省略。
