Jiang Guobin, Ren Xia, Shang Xi
Thyroid and Breast Surgery Department, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China.
Thyroid and Breast Surgery Department, Enze Hospital, Taizhou Enze Medical Center (Group), Taizhou, China.
Gland Surg. 2024 Jun 30;13(6):910-926. doi: 10.21037/gs-23-468. Epub 2024 Jun 27.
Breast cancer, as one of the most common malignancies among women globally, presents a concerning incidence rate, underscoring the importance of addressing the treatment of its precursor lesion, ductal carcinoma in situ (DCIS). Treatment decisions for DCIS, involving the balance between breast-conserving surgery (BCS) and mastectomy, remain an area requiring further investigation. This study aimed to compare influence of different surgical types on overall survival (OS) of patients with DCIS and identify specific subgroups with improved OS to develop an effective survival nomogram for patients.
Patient data from the Surveillance, Epidemiology, and End Results (SEER) database for DCIS cohort from 2010 to 2020 were retrieved. Kaplan-Meier (K-M) survival curves were utilized to compare prognostic OS of patients with different surgical methods. Cox regression analysis was employed to determine prognostic factors and establish a nomogram to predict 3-, 5-, and 10-year survival rates. The model was confirmed by Concordance Index (C-index), calibration curves, and receiver operating characteristic (ROC) curves.
A total of 71,675 patients with DCIS were included. Patients who underwent subcutaneous mastectomy (SM) demonstrated the best OS compared to other surgical types. Additionally, adjuvant radiotherapy or chemotherapy in combination with surgery significantly improved OS compared to surgery alone. Among DCIS patients aged ≤74 years, those who underwent SM benefited the most in terms of OS, while in the age group of 63-74 years, patients who underwent BCS had significantly higher OS than those who underwent total (simple) mastectomy (TM)/modified radical mastectomy (MRM). Multiple factors were associated with improved OS in DCIS patients, and these factors were integrated into the nomogram to establish OS predictions. The C-index, calibration curves, and ROC curves indicated that the nomogram was suitable for assessing patient prognosis.
This study demonstrated that SM treatment yielded the best survival rates for DCIS patients, providing important guidance for future surgical decision-making. Moreover, identifying multiple independent factors related to survival and establishing reliable survival nomograms can assist physicians in developing personalized treatment plans and prolonging patient survival.
乳腺癌是全球女性中最常见的恶性肿瘤之一，发病率令人担忧，这凸显了处理其前驱病变原位导管癌（DCIS）治疗的重要性。DCIS的治疗决策，涉及保乳手术（BCS）和乳房切除术之间的权衡，仍然是一个需要进一步研究的领域。本研究旨在比较不同手术类型对DCIS患者总生存期（OS）的影响，并确定OS得到改善的特定亚组，以便为患者制定有效的生存列线图。
检索了监测、流行病学和最终结果（SEER）数据库中2010年至2020年DCIS队列的患者数据。采用Kaplan-Meier（K-M）生存曲线比较不同手术方法患者的预后OS。采用Cox回归分析确定预后因素并建立列线图以预测3年、5年和10年生存率。该模型通过一致性指数（C指数）、校准曲线和受试者工作特征（ROC）曲线进行验证。
共纳入71675例DCIS患者。与其他手术类型相比，接受皮下乳房切除术（SM）的患者表现出最佳的OS。此外，辅助放疗或化疗联合手术与单纯手术相比，显著改善了OS。在年龄≤74岁的DCIS患者中，接受SM的患者在OS方面受益最大，而在63 - 74岁年龄组中，接受BCS的患者的OS显著高于接受全乳（单纯）切除术（TM）/改良根治性乳房切除术（MRM）的患者。多个因素与DCIS患者OS的改善相关，这些因素被纳入列线图以建立OS预测。C指数、校准曲线和ROC曲线表明该列线图适用于评估患者预后。
本研究表明，SM治疗为DCIS患者带来了最佳生存率，为未来的手术决策提供了重要指导。此外，识别多个与生存相关的独立因素并建立可靠的生存列线图可以帮助医生制定个性化治疗方案并延长患者生存期。
