Mamtani Anita, Van Zee Kimberly J
Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
Curr Breast Cancer Rep. 2020 Jun;12(2):98-106. doi: 10.1007/s12609-020-00360-5. Epub 2020 Feb 24.
Standard options for the treatment of ductal carcinoma in situ (DCIS) include breast-conserving surgery (BCS) alone; BCS with radiotherapy or endocrine therapy, or both; and mastectomy. Survival is excellent with all options, but rates of local recurrence (LR) vary, as do quality-of-life measures. Here we discuss treatment outcomes, risk factors for LR, and tools for risk estimation.
After BCS, radiotherapy reduces the risk of LR by half, and endocrine therapy reduces the risk by a third. Young age, inadequate margins, and greater volume of disease are associated with higher risk of LR after BCS, while young age, high grade, and microinvasion are associated with higher risk of locoregional recurrence after mastectomy. Clinical tools, including the Memorial Sloan Kettering Cancer Center (MSKCC) DCIS nomogram, provide LR risk estimates after BCS that appear more accurate than current genomic assays. The safety of active surveillance for seemingly low-risk patients remains uncertain.
Estimation of LR risk, utilizing a multitude of clinicopathologic and treatment factors, can help a woman balance that risk with her values and priorities, and allow her to choose the optimal treatment option for her.
导管原位癌（DCIS）的标准治疗方案包括单纯保乳手术（BCS）；BCS联合放疗或内分泌治疗，或两者联合；以及乳房切除术。所有治疗方案的生存率都很高，但局部复发（LR）率各不相同，生活质量指标也是如此。在此，我们讨论治疗结果、LR的危险因素以及风险评估工具。
BCS术后，放疗可将LR风险降低一半，内分泌治疗可将风险降低三分之一。年龄较小、切缘不充分以及病变范围较大与BCS术后较高的LR风险相关，而年龄较小、高级别以及微浸润与乳房切除术后较高的局部区域复发风险相关。包括纪念斯隆凯特琳癌症中心（MSKCC）DCIS列线图在内的临床工具，可提供BCS术后的LR风险估计，其准确性似乎高于当前的基因组检测。对于看似低风险患者进行主动监测的安全性仍不确定。
利用多种临床病理和治疗因素来估计LR风险，可帮助女性在该风险与自身价值观和优先事项之间取得平衡，并使其能够为自己选择最佳治疗方案。
