Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Breast Cancer Res Treat. 2021 Apr;186(3):617-624. doi: 10.1007/s10549-021-06129-3. Epub 2021 Mar 6.
Local recurrence after treatment of ductal carcinoma in situ (DCIS) with breast-conserving surgery (BCS) is more common than after mastectomy, but it is unclear if patterns of invasive recurrence vary by initial surgical therapy. Among patients with invasive recurrence after treatment for DCIS, we compared patterns of first recurrence between those originally treated with BCS vs. mastectomy.
From 2000 to 2016, women with an invasive recurrence occurring ≥ 6 months after initial treatment for DCIS were retrospectively identified. Clinicopathologic features and adjuvant treatment of the initial DCIS, as well as characteristics of first invasive recurrences, were compared between patients who had undergone BCS vs. mastectomy.
452 patients with an invasive recurrence after surgery for DCIS were identified: 367 patients (81%) had initially undergone BCS and 85 patients (19%) mastectomy. Patients originally treated with mastectomy were younger and were more likely to have had high grade, necrosis, and multifocal or multicentric DCIS (p < 0.001) compared with the BCS group. A higher proportion of invasive recurrences were local after BCS (93%; 343/367), whereas 88% (75/85) of recurrences after mastectomy were regional or distant (p < 0.001). The median time to first invasive recurrence was not different between surgical groups (BCS: 6.4 years vs. mastectomy: 5.5 years; p = 0.12).
Among women who experienced a first invasive recurrence after treatment for DCIS, those who had originally undergone mastectomy more commonly presented with advanced disease compared to those treated with BCS, likely related to the absence of the breast and the higher risk profile of their initial DCIS.
与保乳手术（BCS）相比，乳腺导管原位癌（DCIS）治疗后的局部复发更为常见，但初始手术治疗的侵袭性复发模式是否不同尚不清楚。在治疗 DCIS 后的侵袭性复发患者中，我们比较了最初接受 BCS 与乳房切除术治疗的患者首次复发的模式。
回顾性地从 2000 年至 2016 年期间，确定了初始治疗 DCIS 后≥6 个月发生侵袭性复发的女性患者。比较了接受 BCS 与乳房切除术的患者之间，初始 DCIS 的临床病理特征和辅助治疗以及首次侵袭性复发的特征。
共确定了 452 例 DCIS 手术后发生侵袭性复发的患者：367 例（81%）最初接受了 BCS，85 例（19%）接受了乳房切除术。与 BCS 组相比，接受乳房切除术的患者年龄更小，且更有可能患有高级别、坏死、多灶或多中心 DCIS（p<0.001）。BCS 组中，局部复发的比例更高（93%，343/367），而乳房切除术组中，区域或远处复发的比例更高（88%，75/85）（p<0.001）。两组的首次侵袭性复发的中位时间无差异（BCS：6.4 年 vs. 乳房切除术：5.5 年；p=0.12）。
在接受 DCIS 治疗后发生首次侵袭性复发的女性中，与接受 BCS 治疗的患者相比，最初接受乳房切除术的患者更常出现晚期疾病，这可能与乳房缺失以及其初始 DCIS 的更高风险特征有关。
