Kanbayashi Chizuko, Iwata Hiroji
Department of Breast Oncology, Niigata Cancer Center Hospital, Niigata, Japan.
Department of Medical Research and Developmental Strategy, Core Laboratory, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan.
Jpn J Clin Oncol. 2025 Jan 8;55(1):4-11. doi: 10.1093/jjco/hyae122.
The standard treatment for ductal carcinoma in situ became well established through the results of several valuable clinical trials, and its therapeutic benefits have now come to be taken for granted. Ductal carcinoma in situ has an extremely good prognosis with the current treatment approach, with a 10-year breast cancer-specific survival rate of 97-98%. According to one retrospective cohort study, the breast cancer-specific survival rate of patients with low-grade ductal carcinoma in situ does not differ significantly between patients undergoing and not undergoing surgery. Some patients with ductal carcinoma in situ are not at a risk of progression to invasive cancer, but the predictors of such progression have not yet been clearly identified. Therefore, the same therapeutic strategies have been used to treat ductal carcinoma in situ and under the assumption that they have risks of invasive breast cancer, and a well-balanced risk/benefit ratio in respect of treatment has not yet been achieved. Based on the results of several recent clinical trials aimed at ensuring provision of a well-balanced treatment for patients with ductal carcinoma in situ which carries a good prognosis, de-escalation of postoperative adjuvant therapy has now begun. Currently, not only is the optimization of postoperative adjuvant therapy accelerating, but also clinical trials to de-escalate basic surgical treatments are under way. There is a possibility of achieving individualized treatment for patients with ductal carcinoma in situ of the breast with reduced treatment intervention. In this review, we present an overview of the current treatment approaches and potential future management strategies for ductal carcinoma in situ of the breast.
通过多项重要临床试验的结果，导管原位癌的标准治疗方法已得到广泛确立，其治疗益处如今已被视为理所当然。采用当前的治疗方法，导管原位癌的预后非常好，10年乳腺癌特异性生存率为97% - 98%。根据一项回顾性队列研究，低级别导管原位癌患者接受手术和未接受手术的乳腺癌特异性生存率并无显著差异。一些导管原位癌患者没有进展为浸润性癌的风险，但此类进展的预测因素尚未明确确定。因此，对于导管原位癌的治疗采用了相同的治疗策略，且假定患者有浸润性乳腺癌的风险，然而尚未实现治疗方面良好的风险/获益平衡。基于近期旨在确保为预后良好的导管原位癌患者提供平衡治疗的多项临床试验结果，术后辅助治疗的降阶梯现已开始。目前，不仅术后辅助治疗的优化在加速，而且降低基本手术治疗强度的临床试验也在进行中。有可能以减少治疗干预的方式为乳腺导管原位癌患者实现个体化治疗。在本综述中，我们概述了乳腺导管原位癌当前的治疗方法以及未来潜在的管理策略。
