Burmeister Sandy, Jóźwiak Katarzyna, Richter-Ehrenstein Christiane, Buchali André, Holmberg Christine, von Rüsten Anne, Schneider Constanze, Hauptmann Michael
Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany.
Department of Gynecology and Obstetrics, Interdisciplinary Breast Center, Klinikum Frankfurt (Oder), Frankfurt (Oder), Germany.
Geburtshilfe Frauenheilkd. 2025 Jan 30;85(6):620-630. doi: 10.1055/a-2505-1682. eCollection 2025 Jun.
Ductal carcinoma in situ (DCIS) of the female breast is treated with surgery possibly followed by radiotherapy (RT) and/or adjuvant hormonal therapy despite their known long-term side effects. Since not every DCIS will progress into an invasive breast cancer (IBC), disease progression and de-escalation of treatment is an important topic of current research.
During 2007-2020, 3905 individuals with a DCIS diagnosis were reported to the cancer registry of Brandenburg and Berlin. We selected 3424 women who were cancer-free prior to DCIS diagnosis and without synchronous diagnoses of DCIS or ipsilateral IBC (iIBC). The objective was to describe changes over time in DCIS treatment and risk of developing iIBC by treatment.
We observed decreasing proportions of mastectomy, breast-conserving surgery (BCS) with RT, and standard versus hypofractionated RT over time. During a median follow-up of 3.8 years, 105 women developed iIBC. Compared with BCS + RT with standard fractionation (54.9%, 1878/3424, 53 iIBC events), hazard ratios (HR) for ilBC were 0.72 (95% confidence interval [CI] 0.26, 1.99; 4 events) for BCS + hypofractionated RT, 0.70 (95% CI 0.33, 1.41; 11 events) for BCS alone, and 0.83 (95% CI 0.50, 1.37; 26 events) for mastectomy. Analyses were adjusted for DCIS size, grade, residual tumor status and ECOG score.
We observed a de-escalation of treatment over time, with fewer mastectomies, less RT, and more hypofractionation of RT. No substantial differences in risk of iIBC were observed between these treatments. There is a need to evaluate DCIS treatment de-escalation in larger cohorts with longer follow-up.
女性乳腺导管原位癌（DCIS）采用手术治疗，术后可能进行放疗（RT）和/或辅助激素治疗，尽管已知这些治疗存在长期副作用。由于并非所有DCIS都会进展为浸润性乳腺癌（IBC），疾病进展和治疗方案的降级是当前研究的一个重要课题。
2007年至2020年期间，3905例诊断为DCIS的患者被报告至勃兰登堡州和柏林的癌症登记处。我们选取了3424名在DCIS诊断前无癌症且无DCIS或同侧IBC（iIBC）同步诊断的女性。目的是描述DCIS治疗随时间的变化以及不同治疗方式下发生iIBC的风险。
我们观察到随着时间的推移，乳房切除术、保乳手术（BCS）联合放疗以及标准分割放疗与大分割放疗的比例均有所下降。在中位随访3.8年期间，105名女性发生了iIBC。与标准分割的BCS + RT（54.9%，1878/3424，53例iIBC事件）相比，大分割BCS + RT发生iIBC的风险比（HR）为0.72（95%置信区间[CI] 0.26，1.99；4例事件），单纯BCS为0.70（95% CI 0.33，1.41；11例事件），乳房切除术为0.83（95% CI 0.50，1.37；26例事件）。分析对DCIS大小、分级、残留肿瘤状态和ECOG评分进行了调整。
我们观察到随着时间的推移治疗方案出现降级，乳房切除术减少，放疗减少，大分割放疗增多。这些治疗方式在发生iIBC的风险上未观察到实质性差异。有必要在更大规模、更长随访时间的队列中评估DCIS治疗方案的降级情况。
