O'Keefe Thomas J, Harismendy Olivier, Wallace Anne M
Division of Breast Surgery and the Comprehensive Breast Health Center, University of California San Diego, La Jolla, CA, USA.
Moores Cancer Center and Division of Biomedical Informatics, Department of Medicine, University of California San Diego, La Jolla, CA, USA.
Gland Surg. 2022 Feb;11(2):307-318. doi: 10.21037/gs-21-599.
Ductal carcinoma in situ (DCIS) is a group of preinvasive breast neoplasms. Studies have shown excellent survival among patients with lumpectomy-amenable disease. Patients requiring mastectomy have been less well characterized. We aim to characterize this cohort and identify whether growth distribution pattern is associated with sentinel lymph node involvement at time of surgery or subsequent development of metastatic disease.
Patients were identified using local cancer registry data and were chart reviewed using electronic medical records. Growth pattern was classified as unifocal, multifocal, or diffuse. Chi-squared, Analysis of Variance (ANOVA), and Kaplan-Meier analyses were performed.
Two hundred and twenty-six patients were identified with median age at diagnosis 49 and follow up 7.1 years. 42 had unifocal, 51 had multifocal and 20 had diffuse lesions. 3/20 patients with diffuse type lesions developed subsequent distant metastatic disease, while none of the patients with unifocal or multifocal lesions did. 1/20 patients with diffuse and 2/51 with multifocal disease had sentinel lymph node involvement (SLNI) at surgery. Tumor extent was not associated with sentinel lymph node involvement or distant metastatic disease (P=0.2, Kaplan-Meier analysis) but growth pattern was (P=0.01). It was also associated on Kaplan-Meier with development of distant metastatic disease alone (P=0.01).
Patients with diffuse growth pattern DCIS were more likely to have SLNI or development of distant metastatic disease. Our findings suggest that patients with diffuse type lesions are at greater risk of metastatic disease and therefore breast cancer death from DCIS. Optimal therapy for these patients will need further elucidation.
导管原位癌（DCIS）是一组乳腺浸润前肿瘤。研究表明，适合行肿块切除术的患者生存率良好。而需要行乳房切除术的患者特征尚不明确。我们旨在描述这一队列的特征，并确定生长分布模式是否与手术时前哨淋巴结受累或随后转移性疾病的发生有关。
利用当地癌症登记数据确定患者，并通过电子病历对其病历进行回顾。生长模式分为单灶性、多灶性或弥漫性。进行了卡方检验、方差分析（ANOVA）和Kaplan-Meier分析。
共确定了226例患者，诊断时的中位年龄为49岁，随访7.1年。42例为单灶性病变，51例为多灶性病变，20例为弥漫性病变。20例弥漫性病变患者中有3例随后发生远处转移性疾病，而单灶性或多灶性病变患者均未发生。20例弥漫性病变患者中有1例、51例多灶性病变患者中有2例在手术时出现前哨淋巴结受累（SLNI）。肿瘤范围与前哨淋巴结受累或远处转移性疾病无关（P=0.2，Kaplan-Meier分析），但生长模式有关（P=0.01）。在Kaplan-Meier分析中，它也仅与远处转移性疾病的发生有关（P=0.01）。
弥漫性生长模式的DCIS患者更有可能出现前哨淋巴结受累或远处转移性疾病。我们的研究结果表明，弥漫性病变患者发生转移性疾病的风险更高，因此因DCIS导致乳腺癌死亡的风险也更高。这些患者的最佳治疗方法需要进一步阐明。
