Joo Ji Hyeon, Kim Wontaek, Nam Jiho, Kim Donghyun, Kim Hyun Yul, Jung Youn Joo, Choo Ki Seok, Nam Kyung Jin, Nam Su Bong, Kim Jae-Joon, Ki Yongkan
Department of Radiation Oncology, Pusan National University School of Medicine, Yangsan, Republic of Korea.
Department of Radiation Oncology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea.
Gland Surg. 2024 Feb 29;13(2):131-143. doi: 10.21037/gs-23-433. Epub 2024 Feb 20.
Increasing rates of diagnosis of ductal carcinoma in situ (DCIS), given the widespread use of mammography, is a global trend. Various attempts have been made in the selection of surgical methods and application of radiation therapy (RT), and the prevalence of infectious diseases has also affected these attempts. This study aimed to investigate evolving treatment patterns and trends in the management of DCIS in South Korea.
We conducted a comprehensive search of the Korean Health Insurance Review and Assessment Service-National Patient Sample (HIRA-NPS) database and selected patients who underwent breast surgery following a DCIS diagnosis between 2009 and 2020. Based on this sample, the analyses were weighted according to the Korean population. We examined annual variations in mastectomy types, reconstructive procedures, and RT utilization from a multidisciplinary perspective.
In our weighted sample, 43,780 patients with DCIS underwent surgery, with a consistent annual increase of 10%. The proportion of lumpectomy procedures increased from 56.7% to 65.4%, showing a greater growth rate than that of total mastectomies (TMs). Following the availability of reconstruction data in 2015, shifts have emerged toward a preference for implant-based autologous tissue reconstruction. As we transitioned to the latter part of our study, the trend was marked by the increasing adoption of hypofractionated RT and omission of RT. Of the patients who underwent lumpectomy in 2020, 25.6% adopted hypofractionated RT and 53.8% omitted RT. This transformation was particularly evident among older patients, individuals treated in metropolitan areas, and those treated in small-sized healthcare facilities.
Our study sheds light on the changing landscape of DCIS treatment in South Korea incorporating perspectives from surgeons, plastic surgeons, and radiation oncologists. We observed an increase in the rates of lumpectomy and implant-based reconstruction. Adoption of hypofractionated RT and omission of RT showed increasing trends.
鉴于乳腺钼靶检查的广泛应用，导管原位癌（DCIS）的诊断率不断上升是一个全球趋势。在手术方法的选择和放射治疗（RT）的应用方面已经进行了各种尝试，传染病的流行也影响了这些尝试。本研究旨在调查韩国DCIS治疗模式的演变和趋势。
我们对韩国健康保险审查和评估服务 - 全国患者样本（HIRA - NPS）数据库进行了全面搜索，并选择了2009年至2020年间在DCIS诊断后接受乳房手术的患者。基于该样本，分析根据韩国人口进行了加权。我们从多学科角度研究了乳房切除术类型、重建手术和RT使用的年度变化。
在我们的加权样本中，43,780例DCIS患者接受了手术，年增长率持续为10%。保乳手术的比例从56.7%增加到65.4%，显示出比全乳房切除术（TMs）更高的增长率。2015年有重建数据后，出现了向基于植入物的自体组织重建的偏好转变。随着我们进入研究的后半部分，趋势表现为超分割RT的采用增加和RT的省略。在2020年接受保乳手术的患者中，25.6%采用了超分割RT，53.8%省略了RT。这种转变在老年患者、大城市地区接受治疗的个体以及小型医疗机构接受治疗的患者中尤为明显。
我们的研究从外科医生、整形外科医生和放射肿瘤学家的角度揭示了韩国DCIS治疗格局的变化。我们观察到保乳手术和基于植入物的重建率有所增加。超分割RT的采用和RT的省略呈上升趋势。
