Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA.
Duke Cancer Institute Biostatistics Shared Resource, Duke University Medical Center, Durham, North Carolina, USA.
Br J Surg. 2024 Aug 30;111(9). doi: 10.1093/bjs/znae198.
Breast-conserving surgery alone, breast-conserving surgery with adjuvant radiation treatment, and mastectomy are guideline-concordant treatments for ductal carcinoma in situ. The aim of this study was to compare survival outcomes between these treatment options.
A stratified random sample of patients diagnosed with pure ductal carcinoma in situ between 2008 and 2014 was selected from 1330 sites in the USA. Data on diagnosis, treatment, and follow-up were abstracted by local cancer registrars. Population-averaged marginal estimates of disease-specific survival and overall survival for breast-conserving surgery alone, breast-conserving surgery with radiation treatment, and mastectomy were obtained by combining sampling and overlap weights.
A total of 18 442 women were included, with a median follow-up of 67.8 (interquartile range 46.1-93.5) months. A total of 35 women died from breast cancer, at a median age of 62 (interquartile range 50-74) years. Population-averaged 8-year rates of disease-specific survival were 99.6% or higher for all treatment groups, with no significant differences between groups (breast-conserving surgery alone versus breast-conserving surgery with radiation treatment, HR 1.19 (95% c.i. 0.29 to 4.85); and mastectomy versus breast-conserving surgery with radiation treatment, HR 1.74 (95% c.i. 0.53 to 5.72). There was no difference in overall survival between the patients who underwent a mastectomy and the patients who underwent breast-conserving surgery with radiation treatment (HR 1.09 (95% c.i. 0.83 to 1.43)). Patients who underwent breast-conserving surgery alone had lower overall survival compared with the patients who underwent breast-conserving surgery with radiation treatment (HR 1.29 (95% c.i. 1.00 to 1.67)). This survival difference vanished for all but one subgroup, namely patients less than 65 years (HR 1.86 (95% c.i. 1.15 to 3.00)).
There was no statistically significant difference in disease-specific survival between women operated with breast-conserving surgery alone, breast-conserving surgery with radiation treatment, or mastectomy for ductal carcinoma in situ. Given the low absolute risk of disease-specific mortality, these results provide confidence in offering individualized locoregional treatment without fear of compromising survival.
保乳手术、保乳手术加辅助放疗和乳房切除术是导管原位癌的指南推荐治疗方法。本研究旨在比较这些治疗方法的生存结果。
从美国 1330 个地点中抽取了 2008 年至 2014 年期间诊断为单纯导管原位癌的患者进行分层随机抽样。当地癌症登记员提取了诊断、治疗和随访的数据。通过结合抽样和重叠权重，获得了单纯保乳手术、保乳手术加放疗和乳房切除术的疾病特异性生存和总生存的人群平均边缘估计值。
共纳入 18442 名女性，中位随访时间为 67.8（四分位距 46.1-93.5）个月。共有 35 名女性死于乳腺癌，中位年龄为 62（四分位距 50-74）岁。所有治疗组的 8 年疾病特异性生存率均在 99.6%或更高，组间无显著差异（单纯保乳手术与保乳手术加放疗，HR 1.19（95%CI 0.29 至 4.85）；乳房切除术与保乳手术加放疗，HR 1.74（95%CI 0.53 至 5.72）。乳房切除术与保乳手术加放疗的患者之间的总生存率没有差异（HR 1.09（95%CI 0.83 至 1.43））。单纯保乳手术患者的总生存率低于保乳手术加放疗患者（HR 1.29（95%CI 1.00 至 1.67））。除一个亚组（年龄小于 65 岁的患者，HR 1.86（95%CI 1.15 至 3.00））外，这种生存差异消失。
在导管原位癌的治疗中，单纯保乳手术、保乳手术加放疗和乳房切除术在疾病特异性生存方面无统计学差异。鉴于疾病特异性死亡率的绝对风险较低，这些结果为提供个体化局部区域治疗提供了信心，而不会担心影响生存。
