Fish E B, Chapman J A, Miller N A, Link M A, Fishell E, Wright B, McCready D R, Hiraki G Y, Ross T M, Hanna W M, Lickley H L
Henrietta Banting Breast Centre, Women's College Hospital, University of Toronto, Ontario, Canada.
Ann Surg Oncol. 1998 Dec;5(8):724-32. doi: 10.1007/BF02303484.
Current mammographic technology has resulted in increased detection of ductal carcinoma in situ (DCIS). It is necessary to assess which patients presenting with DCIS are good candidates for breast conservation and which of these patients should receive adjuvant radiation.
We accrued clinical data for 124 patients with a primary diagnosis of DCIS from 1979 through 1994. Primary therapy was a mastectomy for 18 patients, and a lumpectomy for 106 patients. Only 18 of the latter group of patients received adjuvant radiotherapy. For the 88 lumpectomy-alone patients (median follow-up, 5.2 years), we evaluated the effects of clinical (age and initial presentation) and pathologic (nuclear grade, architecture, parenchymal involvement, calcifications, and measured margins) factors on recurrence of DCIS or the development of invasive breast cancer.
Patients who underwent lumpectomy with or without adjuvant radiotherapy (median follow-up, 5.0 years) were significantly more likely to have recurrence of DCIS (P=.05) than those who underwent mastectomy (median follow-up, 6.7 years): 18% (19/106) versus 0% (0/18), respectively; lumpectomy-alone patients experienced a 19% (17/88) rate of DCIS recurrence. All recurrent DCIS was ipsilateral. For lumpectomy-alone patients, the factors associated with ipsilateral recurrence of DCIS were extent of involvement of the parenchyma (P=.01, for univariate; P=.07, for multivariate) and initial presentation (P=.05, for univariate; P=.07, for multivariate). Eleven lumpectomy-alone patients developed invasive breast cancer (6 ipsilateral, 5 contralateral); none of the 18 lumpectomy patients who received adjuvant radiation developed invasive disease. None of the factors investigated, including primary surgery and adjuvant radiotherapy, were associated with a significant effect on the development of invasive disease.
Longer follow-up is required to determine if the benefits of either mastectomy or radiotherapy following lumpectomy persist. There is a suggestion that patients under 40 years of age or women who present with nipple discharge might be considered for either adjuvant radiotherapy following lumpectomy or a simple mastectomy.
当前的乳腺钼靶技术已使导管原位癌（DCIS）的检出率增加。有必要评估哪些患有DCIS的患者适合保乳治疗，以及这些患者中哪些应接受辅助放疗。
我们收集了1979年至1994年期间124例初诊为DCIS患者的临床资料。18例患者接受了乳房切除术作为初始治疗，106例患者接受了肿块切除术。后一组患者中只有18例接受了辅助放疗。对于88例仅接受肿块切除术的患者（中位随访时间为5.2年），我们评估了临床因素（年龄和初始表现）和病理因素（核分级、结构、实质受累情况、钙化及切缘测量）对DCIS复发或浸润性乳腺癌发生的影响。
接受肿块切除术（无论是否进行辅助放疗）的患者（中位随访时间为5.0年）与接受乳房切除术的患者（中位随访时间为6.7年）相比，DCIS复发的可能性显著更高（P = 0.05）：分别为18%（19/106）和0%（0/18）；仅接受肿块切除术的患者DCIS复发率为19%（17/88）。所有复发性DCIS均位于同侧。对于仅接受肿块切除术的患者，与同侧DCIS复发相关的因素是实质受累范围（单因素分析P = 0.01；多因素分析P = 0.07）和初始表现（单因素分析P = 0.05；多因素分析P = 0.07）。11例仅接受肿块切除术的患者发生了浸润性乳腺癌（6例同侧，5例对侧）；接受辅助放疗的18例肿块切除术患者均未发生浸润性疾病。所研究的任何因素，包括初始手术和辅助放疗，对浸润性疾病的发生均无显著影响。
需要更长时间的随访来确定乳房切除术或肿块切除术后放疗的益处是否持续存在。有迹象表明，40岁以下的患者或出现乳头溢液的女性可考虑在肿块切除术后接受辅助放疗或单纯乳房切除术。
