Department of Oncology, Shengjing Hospital of China Medical University, Shenyang, China.
Department of Nursing, Shengjing Hospital of China Medical University, Shenyang, China.
Elife. 2023 Feb 6;12:e83045. doi: 10.7554/eLife.83045.
More than half of Chinese patients with hormone receptor positive (HR+) ductal carcinoma in situ (DCIS) are treated with mastectomy, and usually subjected to postoperative endocrine therapy (ET). Given that long-term ET can cause severe adverse effects it is important to determine the beneficial effect and safety of post-mastectomy ET on the disease-free survival (DFS) and adverse events in patients with HR+ DCIS.
To explore beneficial effect and safety of post-mastectomy ET in patients with HR+ DCIS, we performed a multicenter, population-based study. This retrospective study analyzed the DFS and adverse events in 1037 HR+ DCIS Chinese patients with or without post-mastectomy ET from eight breast centers between 2006 and 2016. The median follow-up time period was 86 months.
There were 791 DCIS patients receiving ET (ET group). Those patients were followed up for a median of 86 months (range, 60-177 months). There were 23 cases with tumor recurrence or distant metastasis. There were similar 5-year DFS rates and DFS between the ET and non-ET groups, even for those with high-risk factors. Conversely, 37.04% of patients suffered from adverse events after ET, which were significantly higher than those in the non-ET group.
ET after mastectomy did not benefit patients with HR+ DCIS for their DFS, rather increased adverse events in those patients. Therefore, ET after mastectomy may not be recommended for patients with HR+ DCIS, even for those with high-risk factors, such as multifocal, microinvasive, and higher T stage.
This study was supported by grants from Outstanding Scientific Fund of Shengjing Hospital (201803) and Outstanding Young Scholars of Liaoning Province (2019-YQ-10).
超过一半的激素受体阳性（HR+）导管原位癌（DCIS）中国患者接受乳房切除术治疗，且通常接受术后内分泌治疗（ET）。鉴于长期 ET 可能会引起严重的不良反应，因此确定 HR+ DCIS 患者术后 ET 在无病生存（DFS）和不良事件方面的有益效果和安全性非常重要。
为了探讨 HR+ DCIS 患者术后 ET 的有益效果和安全性，我们进行了一项多中心、基于人群的研究。这项回顾性研究分析了 2006 年至 2016 年间 8 家乳腺中心的 1037 例 HR+ DCIS 中国患者（有或无术后 ET）的 DFS 和不良事件。中位随访时间为 86 个月。
有 791 例 DCIS 患者接受了 ET（ET 组）。这些患者的中位随访时间为 86 个月（范围，60-177 个月）。有 23 例出现肿瘤复发或远处转移。ET 组和非 ET 组的 5 年 DFS 率和 DFS 相似，即使是高危因素的患者也是如此。相反，ET 组有 37.04%的患者出现不良事件，明显高于非 ET 组。
乳房切除术后 ET 对 HR+ DCIS 患者的 DFS 无益，反而增加了这些患者的不良事件。因此，即使对于具有多灶性、微浸润和更高 T 分期等高危因素的 HR+ DCIS 患者，也不推荐乳房切除术后 ET。
本研究得到盛京医院杰出科学基金（201803）和辽宁省杰出青年学者项目（2019-YQ-10）的资助。
