Division of Breast Surgery and The Comprehensive Breast Health Center, University of California San Diego, 0819, 3855 Health Sciences Dr, La Jolla, CA, 92037, USA.
Division of Biomedical Informatics, Department of Medicine, Moores Cancer Center, University of California San Diego, 3855 Health Sciences Dr, La Jolla, CA, 92037, USA.
Int J Clin Oncol. 2022 Jan;27(1):121-130. doi: 10.1007/s10147-021-02036-1. Epub 2021 Oct 7.
Trials for DCIS have not explored whether outcomes for patients with large disease burden requiring mastectomy are comparable to those of patients with lumpectomy-amenable disease. We aim to identify whether patients with DCIS larger than 5 cm and diffuse-type DCIS differ in breast cancer mortality (BCM) from patients with disease less than 5 cm.
Patients diagnosed with DCIS in the SEER program were assessed to identify factors prognostic of breast-cancer-specific survival using competing risks regression.
44,849 patients met criteria for the cumulative incidence estimate. On competing risks cumulative incidence approximation, the 10-year estimate for BCM for each group was 1.3%, 1.3%, 2.3%, and 5.1%, respectively, and the difference among groups was significant (p = 0.017). On competing risks regression of patients with known covariates, both diffuse-type disease and disease larger than 5 cm (hazard ratio [HR] = 6.2 and 1.7, p = 0.013 and p = 0.042, respectively) were associated with increased risk of BCM. After matching, DCIS > 5 cm and diffuse disease were associated with increased BCM relative to disease < 5 cm (HR = 1.69, p = 0.04). Among patients undergoing mastectomy for disease larger than 5 cm or diffuse disease, the 10-year cumulative incidence for BCM was 0.5% among patients undergoing bilateral mastectomy and 2.4% for patients undergoing unilateral mastectomy.
Patients with large and diffuse DCIS represent uncommon but poorly studied DCIS subgroups with worse prognoses than patients with disease smaller than 5 cm. Further studies are needed to elucidate the appropriate treatment for these patients.
针对 DCIS 的临床试验尚未探索需要接受乳房切除术的疾病负担较大的患者与可接受保乳术治疗的患者的结局是否可比。我们旨在确定直径大于 5cm 的 DCIS 患者和弥漫型 DCIS 患者的乳腺癌死亡率（BCM）是否与直径小于 5cm 的疾病患者有所不同。
在 SEER 计划中诊断为 DCIS 的患者，使用竞争风险回归来评估预测乳腺癌特异性生存的因素。
44849 名患者符合累积发生率估计标准。在竞争风险累积发生率逼近法中，每组的 10 年 BCM 估计值分别为 1.3%、1.3%、2.3%和 5.1%，组间差异具有统计学意义（p=0.017）。在已知协变量的患者竞争风险回归中，弥漫型疾病和直径大于 5cm 的疾病（风险比 [HR]分别为 6.2 和 1.7，p=0.013 和 p=0.042）均与 BCM 风险增加相关。在匹配后，与直径小于 5cm 的疾病相比，直径大于 5cm 的 DCIS 和弥漫性疾病与 BCM 增加相关（HR=1.69，p=0.04）。对于因直径大于 5cm 或弥漫性疾病而行乳房切除术的患者，行双侧乳房切除术的患者 10 年 BCM 累积发生率为 0.5%，而行单侧乳房切除术的患者为 2.4%。
直径大且弥漫的 DCIS 患者代表预后较差的罕见但研究不足的 DCIS 亚组，与直径小于 5cm 的疾病患者相比，其预后更差。需要进一步研究以阐明这些患者的适当治疗方法。
