Department of Epidemiology, Maastricht University, Maastricht, Netherlands.
Department of Radiology, Canisius Wilhelmina Hospital, Nijmegen, Netherlands.
Br J Cancer. 2024 Sep;131(5):852-859. doi: 10.1038/s41416-024-02785-6. Epub 2024 Jul 9.
The first aim of this study was to examine trends in the risk of ipsilateral invasive breast cancer (iIBC) after breast-conserving surgery (BCS) of ductal carcinoma in situ (DCIS). A second aim was to analyse the association between DCIS grade and the risk of iIBC following BCS.
In this population-based, retrospective cohort study, the Netherlands Cancer Registry collected information on 25,719 women with DCIS diagnosed in the period 1989-2021 who underwent BCS. Of these 19,034 received adjuvant radiotherapy (RT). Kaplan-Meier analyses and Cox regression models were used.
A total of 1135 patients experienced iIBC. Ten-year cumulative incidence rates of iIBC for patients diagnosed in the periods 1989-1998, 1999-2008 and 2009-2021 undergoing BCS without RT, were 12.6%, 9.0% and 5.0% (P < 0.001), respectively. For those undergoing BCS with RT these figures were 5.7%, 3.7% and 2.2%, respectively (P < 0.001). In the multivariable analyses, DCIS grade was not associated with the risk of iIBC.
Since 1989 the risk of iIBC has decreased substantially and has become even lower than the risk of invasive contralateral breast cancer. No significant association of DCIS grade with iIBC was found, stressing the need for more powerful prognostic factors to guide the treatment of DCIS.
本研究的首要目的是探讨保乳手术后（BCS）导管原位癌（DCIS）同侧浸润性乳腺癌（iIBC）的风险趋势。第二个目的是分析 DCIS 分级与 BCS 后 iIBC 风险之间的关联。
在这项基于人群的回顾性队列研究中，荷兰癌症登记处收集了 1989 年至 2021 年期间接受 BCS 治疗的 25719 名 DCIS 女性患者的信息。其中 19034 名患者接受了辅助放疗（RT）。使用 Kaplan-Meier 分析和 Cox 回归模型。
共有 1135 例患者发生 iIBC。未接受 RT 的 BCS 患者在 1989-1998 年、1999-2008 年和 2009-2021 年诊断的患者 10 年 iIBC 累积发生率分别为 12.6%、9.0%和 5.0%（P<0.001）。接受 RT 的 BCS 患者的这些数据分别为 5.7%、3.7%和 2.2%（P<0.001）。在多变量分析中，DCIS 分级与 iIBC 风险无关。
自 1989 年以来，iIBC 的风险已大幅降低，甚至低于浸润性对侧乳腺癌的风险。未发现 DCIS 分级与 iIBC 之间存在显著关联，这强调需要更强大的预后因素来指导 DCIS 的治疗。
