Division of Breast Imaging, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street (WAC 240), Boston, MA 02114, USA.
Division of Surgical Oncology, Department of Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
Clin Imaging. 2022 Feb;82:179-192. doi: 10.1016/j.clinimag.2021.11.018. Epub 2021 Nov 20.
PURPOSE: Patients who have ductal carcinoma in situ (DCIS) are undergoing bilateral mastectomy at increasing rates. One of the reasons is to minimize contralateral breast cancer (CBC) risk. The purpose of this study is to determine the rate of and risk factors associated with CBC in women treated for DCIS. METHODS: A retrospective study was performed of women with DCIS at surgery from 2007 to 2014 who had at least five-year follow-up. Patient attributes, imaging findings, histopathology results, and surgical and long-term outcomes were collected. Features associated with a CBC were assessed with multivariable logistic regression models. RESULTS: 613 women (mean 56 years, range 30-87) with DCIS underwent breast-conserving surgery (BCS) (n = 426), unilateral mastectomy (n = 101), or bilateral mastectomy (n = 86), with mean follow-up of 7.9 years. Of the 527 women who had BCS or unilateral mastectomy, 7.4% (n = 39) developed a CBC (DCIS in 12 and invasive cancer in 27). 4.1% (5/122) of women treated with adjuvant endocrine therapy developed a CBC, compared to 8.4% (34/405) who were not treated (p = .11). Features associated with CBC risk were younger age at menarche (adjusted odds ratio [aOR] of 0.76, p = .03) and low nuclear grade of DCIS (aOR of 5.43 for grade 1 versus 3, p = .01). CONCLUSION: In women treated for DCIS, the overall rate of CBC was low at 7.4%. Younger age at menarche and low nuclear grade of DCIS had significant associations with higher CBC risk.
目的：患有导管原位癌（DCIS）的患者正在以越来越高的比例接受双侧乳房切除术。原因之一是为了最大限度地降低对侧乳腺癌（CBC）的风险。本研究的目的是确定在接受 DCIS 治疗的女性中 CBC 的发生率和相关风险因素。
方法：对 2007 年至 2014 年接受手术治疗的 DCIS 女性患者进行回顾性研究，这些患者的随访时间至少为 5 年。收集患者特征、影像学表现、组织病理学结果以及手术和长期结果。使用多变量逻辑回归模型评估与 CBC 相关的特征。
结果：613 名（平均年龄 56 岁，范围 30-87 岁）患有 DCIS 的女性接受了保乳手术（BCS）（n=426）、单侧乳房切除术（n=101）或双侧乳房切除术（n=86），平均随访时间为 7.9 年。在接受 BCS 或单侧乳房切除术的 527 名女性中，7.4%（n=39）发生了 CBC（DCIS 12 例，浸润性癌 27 例）。接受辅助内分泌治疗的 122 名女性中有 4.1%（5/122）发生了 CBC，而未接受治疗的 405 名女性中有 8.4%（34/405）发生了 CBC（p=0.11）。与 CBC 风险相关的特征是初潮年龄较小（调整后的优势比 [aOR]为 0.76，p=0.03）和 DCIS 的核分级较低（核分级 1 与 3 相比，aOR 为 5.43，p=0.01）。
结论：在接受 DCIS 治疗的女性中，CBC 的总体发生率较低，为 7.4%。初潮年龄较小和 DCIS 的核分级较低与 CBC 风险显著相关。
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