Chen Qian, Campbell Ian, Elwood Mark, Cavadino Alana, Aye Phyu Sin, Tin Tin Sandar
Department of Epidemiology and Biostatistics, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
Breast. 2025 Jun 18;82:104521. doi: 10.1016/j.breast.2025.104521.
Although adjuvant endocrine therapy (ET) is a standard treatment for hormone receptor positive ductal carcinoma in situ (DCIS), its use is variably recommended by clinicians. This paper reviewed the effects of ET in relation to recurrence and survival across diverse populations.
PubMed, Embase, Web of Science, and Cochrane were searched for studies that reported outcomes of DCIS treated with ET versus no ET.
Three randomised trials and 42 cohort studies were included. In the trials, tamoxifen significantly reduced the risk of in-breast recurrence with a pooled hazard ratio (HR) of 0.69 (95 % CI: 0.60, 0.80). In the cohort studies, ET was associated with lower risks of any recurrence (HR 0.67; 95 % CI: 0.55, 0.83), ipsilateral breast tumour recurrence (HR 0.59; 0.51, 0.69), loco-regional recurrence (HR 0.74; 0.53, 1.02) and contralateral breast cancer (HR 0.70; 0.49, 1.00), and improved overall survival (HR 0.85; 0.79, 0.90). No significant association between ET and breast cancer specific survival was observed in either trials or cohort studies. Subgroup analyses within the cohort studies showed no significant differences in the pooled HRs for recurrence and survival by follow-up length, confounding adjustment or treatment type.
The use of adjuvant ET reduces the risk of recurrence in patients with DCIS in clinical trials, as well as in the real-world setting. Survival benefits, however, warrant further study.
尽管辅助内分泌治疗（ET）是激素受体阳性导管原位癌（DCIS）的标准治疗方法，但临床医生对其使用的推荐存在差异。本文回顾了ET在不同人群中对复发和生存的影响。
检索了PubMed、Embase、Web of Science和Cochrane数据库，以查找报告ET治疗与未接受ET治疗的DCIS结局的研究。
纳入了三项随机试验和42项队列研究。在试验中，他莫昔芬显著降低了乳腺内复发风险，合并风险比（HR）为0.69（95%CI：0.60，0.80）。在队列研究中，ET与任何复发风险较低（HR 0.67；95%CI：0.55，0.83）、同侧乳腺肿瘤复发风险较低（HR 0.59；0.51，0.69）、局部区域复发风险较低（HR 0.74；0.53，1.02）和对侧乳腺癌风险较低（HR 0.70；0.49，1.00）相关，并改善了总生存期（HR 0.85；0.79，0.90）。在试验或队列研究中均未观察到ET与乳腺癌特异性生存期之间存在显著关联。队列研究中的亚组分析显示，按随访时间、混杂因素调整或治疗类型划分，复发和生存的合并HRs无显著差异。
在临床试验以及实际临床环境中，辅助ET的使用降低了DCIS患者的复发风险。然而，生存获益仍需进一步研究。
