Risk Prediction for Local Breast Cancer Recurrence Among Women with DCIS Treated in a Community Practice: A Nested, Case-Control Study
Risk Prediction for Local Breast Cancer Recurrence Among Women with DCIS Treated in a Community Practice: A Nested, Case-Control Study
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DOI：
10.1245/s10434-015-4641-x
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发表时间：
2015-12-01
影响因子：
3.7
通讯作者：
Fletcher, Suzanne W.
中科院分区：
文献类型：
--
作者：
Collins, Laura C.;Achacoso, Ninah;Fletcher, Suzanne W.
背景各种患者、治疗和病理因素与乳腺导管原位癌（DCIS）保乳治疗（BCT）后局部复发（LR）风险增加相关。然而，单个因素的强度和重要性各不相同;结合因素是否可以提高预测，特别是在社区实践中，是不确定的。在一个大型的，基于人群的队列中，在三个以社区为基础的做法与BCT治疗的DCIS妇女，我们评估了纪念斯隆-凯特琳癌症中心（MSKCC）DCIS诺模图的有效性，它结合了临床，病理和治疗特征来预测LR。我们回顾了BCT治疗单侧DCIS患者的切片。回归方法被用来估计LR的风险。将MSKCC DCIS列线图应用于研究人群，比较5年和10年时列线图预测和观察到的LR。我们研究中的495例患者被分为四分位数和八分位数，以比较观察到的LR和诺模图预测的LR。最低和最高四分位数的5年绝对复发风险分别为4.8和33.1%（95%CI分别为3.1-6.4和24.2-40.9; p < 0.0001）。10年列线图预测的复发率与观察到的复发率之间的总体相关性为0.95。与观察到的10年LR率相比，诺模图提供的风险估计值显示出良好的相关性，并具有合理的区分度，c统计量为0.68。MSKCC DCIS列线图在社区实践中应用于接受BCT治疗的DCIS患者人群时，可良好预测5年和10年LR。因此，该列线图是DCIS患者治疗决策的有用辅助工具。
Background. Various patient, treatment, and pathologic factors have been associated with an increased risk of local recurrence (LR) following breast-conserving therapy (BCT) for ductal carcinoma in situ (DCIS). However, the strength and importance of individual factors has varied; whether combining factors improves prediction, particularly in community practice, is uncertain. In a large, population-based cohort of women with DCIS treated with BCT in three community-based practices, we assessed the validity of the Memorial Sloan-Kettering Cancer Center (MSKCC) DCIS nomogram, which combines clinical, pathologic, and treatment features to predict LR.Methods. We reviewed slides of patients with unilateral DCIS treated with BCT. Regression methods were used to estimate risks of LR. The MSKCC DCIS nomogram was applied to the study population to compare the nomogram-predicted and observed LR at 5 and 10 years.Results. The 495 patients in our study were grouped into quartiles and octiles to compare observed and nomogram-predicted LR. The 5-year absolute risk of recurrence for lowest and highest quartiles was 4.8 and 33.1 % (95 % CI 3.1-6.4 and 24.2-40.9, respectively; p < 0.0001). The overall correlation between 10-year nomogram-predicted recurrences and observed recurrences was 0.95. Compared with observed 10-year LR rates, the risk estimates provided by the nomogram showed good correlation, and reasonable discrimination with a c-statistic of 0.68.Conclusions. The MSKCC DCIS nomogram provided good prediction of the 5-and 10-year LR when applied to a population of patients with DCIS treated with BCT in a community-based practice. This nomogram, therefore, is a useful treatment decision aid for patients with DCIS.