Division of Surgical Oncology, Department of Surgery, University of Wisconsin, 600 Highland Ave, Madison, WI, 53792, USA.
Department of Population Health Sciences and Carbone Cancer Center, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA.
Breast Cancer Res Treat. 2021 Sep;189(2):463-470. doi: 10.1007/s10549-021-06278-5. Epub 2021 Jun 15.
Controversy remains regarding the optimal margin width for patients with ductal carcinoma in situ (DCIS) who undergo breast conserving surgery (BCS).
Women with a primary DCIS diagnosis were enrolled in a statewide population-based cohort from 1997 to 2006. Patients were surveyed every two years with follow-up data available through 2016. Surgical pathology reports were collected for 559 participants following breast conserving surgery. Multivariable Cox proportional hazard models evaluated relationships between locoregional recurrence (LRR) and margin width in the presence or absence of adjuvant radiation therapy while controlling for age, menopausal status and duration of endocrine therapy use.
The majority of women in this study were over 50yo (74%), 34% had high grade disease, and 77% underwent radiation. The overall LRR rate was 12%. A LRR occurred in 46 women who had radiation (11%) and 23 women who did not undergo radiation (19%). Univariate analysis identified smaller margin width, younger age, premenopausal status, no radiotherapy, and shorter endocrine therapy use associated with LRR. Multivariable models demonstrated that close margins (< 2 mm) were associated with an increased risk of recurrence when compared to margins ≥ 2 mm in width whether women received radiation (HR 1.98 CI 0.87-4.54) or not (HR 1.32 CI 0.27-6.49), but confidence intervals were wide.
In this study, patients with DCIS and close margins were less likely to experience recurrence after routine re-excision to margins greater than 2 mm.
对于接受保乳手术（BCS）的导管原位癌（DCIS）患者，最佳切缘宽度仍存在争议。
1997 年至 2006 年，在全州范围内的人群中招募了患有原发性 DCIS 诊断的女性患者。每两年对患者进行一次调查，随访数据可获得至 2016 年。对 559 名接受保乳手术后的患者进行了外科病理报告的收集。在存在或不存在辅助放疗的情况下，多变量 Cox 比例风险模型评估了局部区域复发（LRR）与切缘宽度之间的关系，同时控制了年龄、绝经状态和内分泌治疗使用时间。
本研究中的大多数女性年龄在 50 岁以上（74%），34%的患者疾病分级较高，77%的患者接受了放疗。总体 LRR 率为 12%。在接受放疗的 46 名女性（11%）和未接受放疗的 23 名女性（19%）中发生了 LRR。单变量分析确定了较小的切缘宽度、较年轻的年龄、绝经前状态、未接受放疗和较短的内分泌治疗时间与 LRR 相关。多变量模型表明，与宽度≥2mm 的切缘相比，近距离（<2mm）切缘与接受或不接受放疗的女性的复发风险增加相关（HR 1.98 CI 0.87-4.54 和 HR 1.32 CI 0.27-6.49），但置信区间较宽。
在这项研究中，DCIS 患者在常规再次切除至大于 2mm 的切缘后，复发的可能性较小。
