巴西一家医院中导管癌治疗的范奈斯预后指数与美国国立综合癌症网络（NCCN）指南的比较分析

Comparative Analyses of Van Nuys Prognostic Index and NCCN Guidelines in Ductal Carcinoma Treatment in a Brazilian Hospital.

作者信息

Antonini Marcelo, Barros Vasconcelos Raissa, Mattar André, Medeiros Mariana Pollone, Teixeira Marina Diógenes, Amorim Andressa Gonçalves, Ferraro Odair, de Oliveira Larissa Chrispim, Ramos Marcellus do Nascimento Moreira, Cavalcante Francisco Pimentel, Zerwes Felipe, Madeira Marcelo, Millen Eduardo de Camargo, Frasson Antonio Luiz, Brenelli Fabricio Palermo, Facina Gil, Couto Henrique Lima, Gebrim Luiz Henrique

机构信息

Department of Breast Surgery, Hospital do Servidor Público Estadual Francisco Morato de Oliveira, Sao Paulo 04039-000, SP, Brazil.

Centro de Desenvolvimento de Ensino e Pesquisa do Instituo de Assistência Médica ao Servidor Público Estadual (CEDEP-IAMSPE), Sao Paulo 04039-000, SP, Brazil.

出版信息

Life (Basel). 2025 Mar 9;15(3):432. doi: 10.3390/life15030432.

DOI:10.3390/life15030432

PMID:40141777

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11944086/

Abstract

BACKGROUND

Ductal carcinoma (DCIS) is a precursor of invasive breast cancer and its early diagnosis and treatment are essential to prevent progression and recurrences. Risk stratification guidelines, such as the Van Nuys Prognostic Index (VNPI) and those by the National Comprehensive Cancer Network (NCCN), help guide appropriate treatment. This study compares VNPI recommendations for DCIS patients treated at Hospital do Servidor Público Estadual de São Paulo (HSPE) with NCCN guidelines, focusing on treatment conducted and recurrence rates.

METHODS

This retrospective, cross-sectional study reviewed medical records of 145 patients treated for DCIS at HSPE between January 1996 and June 2022, with a mean follow-up of 60.3 months.

RESULTS

Based on VNPI, 38.8% were low risk, 53.2% intermediate risk, and 7.8% high risk. NCCN guidelines classified only 12.9% as low risk and 87.1% as high risk. Treatment included breast-conserving surgery (BCS) with radiotherapy (43.1%), BCS alone (38.8%), and mastectomy (18.1%). There were 18 recurrences (15.5%): 5.2% as DCIS and 10.3% as invasive cancer. Of these recurrences, 5.6% occurred in patients who, according to NCCN, would have received BCS with radiotherapy or mastectomy.

CONCLUSION

By integrating the VNPI with NCCN treatment guidelines, the NCCN's recommendations could potentially reduce local recurrence rates by 5.6%. However, further studies are necessary to evaluate the long-term impact of these guidelines on overall survival outcomes.

摘要

背景

导管原位癌（DCIS）是浸润性乳腺癌的前驱病变，其早期诊断和治疗对于预防病情进展和复发至关重要。风险分层指南，如范努伊斯预后指数（VNPI）和美国国立综合癌症网络（NCCN）的指南，有助于指导恰当的治疗。本研究比较了圣保罗州立公立医院（HSPE）按照VNPI对DCIS患者的治疗建议与NCCN指南，重点关注所实施的治疗和复发率。

方法

这项回顾性横断面研究回顾了1996年1月至2022年6月期间在HSPE接受DCIS治疗的145例患者的病历，平均随访时间为60.3个月。

结果

根据VNPI，低风险患者占38.8%，中风险患者占53.2%，高风险患者占7.8%。NCCN指南仅将12.9%的患者分类为低风险，87.1%为高风险。治疗方法包括保乳手术（BCS）加放疗（43.1%）、单纯保乳手术（3 .8%）和乳房切除术（18.1%）。有18例复发（15.5%）：导管原位癌复发率为5.2%，浸润性癌复发率为10.3%。在这些复发患者中，5.6%发生在根据NCCN本应接受保乳手术加放疗或乳房切除术的患者中。