Habel L A, Daling J R, Newcomb P A, Self S G, Porter P L, Stanford J L, Seidel K, Weiss N S
Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington 98109, USA.
Cancer Epidemiol Biomarkers Prev. 1998 Aug;7(8):689-96.
A cohort study was conducted to estimate the risk of breast cancer recurrence among women diagnosed with ductal carcinoma in situ (DCIS) and to identify tumor or patient characteristics that influence that risk. A population-based cancer registry was used to identify a cohort of 709 female residents of western Washington who were diagnosed with DCIS between January 1980 and June 1992 and were treated with breast-conserving surgery. Information about breast cancer recurrences, treatment, and several patient characteristics and exposures was obtained from postal questionnaires. Recurrences were confirmed using information from the cancer registry or hospital pathology reports. Approximately 15% of women experienced a recurrence within the first 5 years after diagnosis [95% confidence interval (CI), 12-18%]; 31% had a recurrence within 10 years (95% CI, 24-38%). There was a suggestion that risk was slightly elevated for women with larger tumors (> or =1.5 cm) and tumors of comedo subtype. Relative risks (RRs) were elevated for women who were premenopausal at diagnosis of DCIS (RR = 2.3; 95% CI, 1.1-5.0). Women in the upper decile of body mass index were at twice the risk of a recurrence as those women in the lower four deciles (RR = 2.3; 95% CI, 1.1-4.8). There was also a suggestion that women who used menopausal hormones for at least 2 years after their diagnosis of DCIS were at increased risk of recurrence compared to nonusers of menopausal hormones (RR = 1.8; 95% CI, 0.7-5.0). Our results suggest that the risk of recurrence may be related to some tumor characteristics as well as the hormonal milieu of the patient at or after her diagnosis of DCIS. However, larger studies are needed to more clearly document predictors of disease recurrence after DCIS.
开展了一项队列研究，以评估原位导管癌（DCIS）女性患者乳腺癌复发的风险，并确定影响该风险的肿瘤或患者特征。利用基于人群的癌症登记系统，确定了华盛顿州西部709名女性居民组成的队列，她们于1980年1月至1992年6月期间被诊断为DCIS，并接受了保乳手术。通过邮政问卷获得了有关乳腺癌复发、治疗以及一些患者特征和暴露情况的信息。利用癌症登记系统或医院病理报告中的信息确认复发情况。约15%的女性在诊断后的前5年内出现复发[95%置信区间（CI），12 - 18%]；31%的女性在10年内出现复发（95% CI，24 - 38%）。有迹象表明，肿瘤较大（≥1.5 cm）和粉刺型肿瘤的女性风险略有升高。DCIS诊断时处于绝经前的女性相对风险（RRs）升高（RR = 2.3；95% CI，1.1 - 5.0）。体重指数处于上十分位数的女性复发风险是下四分位数女性的两倍（RR = 2.3；95% CI，1.1 - 4.8）。也有迹象表明，DCIS诊断后使用绝经激素至少2年的女性与未使用绝经激素的女性相比，复发风险增加（RR = 1.8；95% CI，0.7 - 5.0）。我们的结果表明，复发风险可能与一些肿瘤特征以及患者在诊断DCIS时或之后的激素环境有关。然而，需要更大规模的研究来更明确地记录DCIS后疾病复发的预测因素。
