O'Keefe Thomas J, Yau Christina, Iaconetti Emma, Jeong Eliza, Brabham Case, Kim Paul, McGuire Joseph, Griffin Ann, Wallace Anne M, Esserman Laura J, Harismendy Olivier, Hirst Gillian L
Department of Surgery, University of California, San Diego, CA, USA.
Department of Surgery, University of California, San Francisco, CA, USA.
NPJ Breast Cancer. 2025 Jul 1;11(1):63. doi: 10.1038/s41523-025-00774-3.
Ductal carcinoma in situ (DCIS) incidence has risen rapidly with the introduction of screening mammography, yet it is unclear who benefits from both the amount and type of adjuvant treatment (radiation therapy, endocrine therapy) versus what constitutes over-treatment. Our goal was to identify the effects of adjuvant radiation therapy, or endocrine ± radiation therapy versus breast conservation surgery alone in a large multi-center registry of retrospective DCIS cases (N = 1916) with median follow up of 7.0 (IQR: 8.43) years. We show that patients with DCIS who took less than 2 years of adjuvant endocrine therapy alone have a similar second event rate as breast conservation surgery. However, patients who took more than 2 years of endocrine therapy show a significantly reduced second event rate, similar to those who received either radiation or combined endocrine + radiation therapy, which was independent of age, tumor size, grade, or period of diagnosis. This highlights the importance of endocrine therapy duration for risk reduction.
随着乳腺钼靶筛查的引入，导管原位癌（DCIS）的发病率迅速上升，但目前尚不清楚谁能从辅助治疗（放射治疗、内分泌治疗）的剂量和类型中获益，以及什么构成了过度治疗。我们的目标是在一个大型多中心回顾性DCIS病例登记处（N = 1916）中，确定辅助放射治疗、内分泌±放射治疗与单纯保乳手术相比的效果，中位随访时间为7.0（IQR：8.43）年。我们发现，仅接受不到2年辅助内分泌治疗的DCIS患者的二次事件发生率与保乳手术相似。然而，接受超过2年内分泌治疗的患者二次事件发生率显著降低，类似于接受放射治疗或内分泌+放射联合治疗的患者，这与年龄、肿瘤大小、分级或诊断时期无关。这突出了内分泌治疗持续时间对降低风险的重要性。
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