Department of Breast Surgery, The First Hospital of China Medical University, Shenyang, Liaoning, China.
PeerJ. 2022 Aug 31;10:e13966. doi: 10.7717/peerj.13966. eCollection 2022.
Ductal carcinoma (DCIS) has become a non-negligible part of breast cancers owing to the greatly increased incidence. While its natural history was not fully elucidated, which is the reason for current controversies in clinical treatment. Exploration of this issue from a clinical perspective is meaningful.
Medical records of 389 patients diagnosed with DCIS or DCIS with invasive ductal carcinoma (IDC) were reviewed. All of them received appropriate medical care in our center. All 324 patients in training cohort were divided into invasion and non-invasion groups based on pathology. Differences in DCIS immunohistochemical markers and hematological indicators between them were analyzed. In the invasion group, differences between DCIS and matched IDC were compared to explore changes in the tumor heterogeneity during invasion. Conclusions are validated in the validation cohort of 65 patients.
Patients in invasion and non-invasion groups were balanced in baseline characteristics and no statistically significant differences were noticed for DCIS immunohistochemical markers. For hematological indicators, high expression of platelet >291.50) (odds ratio, 2.46; CI [1.35-4.46]; = 0.003) and SII (>347.20) (odds ratio, 2.54; CI [1.56-4.12]; < 0.001) were established as independent predictors for invasion by logistic analysis and were validated in the validation cohort. Ki-67 of IDC was significantly higher than that of matched DCIS ( < 0.001). HER2 expression and histological grade of DCIS were separately linearly related to those of IDC.
The change in hematological indicators is an independent predictor for invasion and can be incorporated into the treatment decision-making process for DCIS. Invasion tumor cells exhibit a stronger proliferative capacity compared with the ones. There are linear relationships in HER2 expression and histological grades between DCIS and matched IDC. DCIS subclones with different histological grades will develop into invasive carcinomas separately.
由于发病率的大幅增加，导管癌（DCIS）已成为乳腺癌中不可忽视的一部分。尽管其自然史尚未完全阐明，这也是目前临床治疗存在争议的原因。从临床角度探讨这个问题是有意义的。
回顾了 389 例诊断为 DCIS 或 DCIS 伴浸润性导管癌（IDC）的患者的病历。他们都在我们中心接受了适当的医疗护理。在训练队列中，所有 324 例患者根据病理分为浸润组和非浸润组。分析了两组间 DCIS 免疫组化标志物和血液学指标的差异。在浸润组中，比较了 DCIS 与匹配的 IDC 之间的差异，以探讨肿瘤异质性在浸润过程中的变化。在验证队列的 65 例患者中验证了结论。
浸润组和非浸润组患者在基线特征上平衡，DCIS 免疫组化标志物无统计学差异。对于血液学指标，血小板高表达（>291.50）（比值比，2.46；CI[1.35-4.46]；=0.003）和 SII（>347.20）（比值比，2.54；CI[1.56-4.12]；<0.001）被确立为独立的浸润预测因子，通过逻辑回归分析验证，并在验证队列中得到验证。IDC 的 Ki-67 明显高于匹配的 DCIS（<0.001）。DCIS 的 HER2 表达和组织学分级分别与 IDC 的呈线性相关。
血液学指标的变化是浸润的独立预测因子，可以纳入 DCIS 的治疗决策过程。侵袭性肿瘤细胞的增殖能力明显强于非侵袭性肿瘤细胞。DCIS 和匹配的 IDC 之间的 HER2 表达和组织学分级呈线性关系。具有不同组织学分级的 DCIS 亚克隆将分别发展为浸润性癌。
