Characteristics associated with recurrence among women with ductal carcinoma in situ treated by lumpectomy
Characteristics associated with recurrence among women with ductal carcinoma in situ treated by lumpectomy
复制标题
DOI：
10.1093/jnci/djg097
复制
发表时间：
2003-11-19
影响因子：
10.3
通讯作者：
Waldman, F
中科院分区：
文献类型：
--
作者：
Kerlikowske, K;Molinaro, A;Waldman, F
背景乳腺导管原位癌（DCIS）的临床和组织病理学特征可能预测复发的风险尚未得到一致的确定。我们确定了与DCIS和浸润性乳腺癌复发相关的因素，并确定了作为这些因素函数的5年绝对复发风险。研究方法：我们对1983年1月至1994年12月在旧金山弗朗西斯科湾区诊断为DCIS并仅接受乳房肿瘤切除术治疗的1036名年龄在40岁或以上的妇女进行了一项基于人群的队列研究。进行标准化病理学审查，以确定疾病复发，定义为DCIS或浸润性乳腺癌在包含初始DCIS病变的同侧乳房中或在DCIS初始诊断和治疗后6个月以上的远处部位诊断。使用条件Logistic回归模型确定与复发相关的因素。所有统计学显著性检验均为双侧检验。结果：在中位随访77.9个月期间，209名女性（20.2%）复发。总体而言，浸润性癌和DCIS的5年复发风险分别为8.2%（95%置信区间[CI] = 6.6%至9.8%）和11.7%（95% CI = 9.9%至13.3%）。浸润性癌和DCIS的5年复发风险为4.8%（95% CI = 3.7%至6.8%）和4.8%（95% CI = 3.8%-5.8%）;百分之十一点八（95% CI = 9.9%至14.1%）和17.1%（95% CI = 15.5%-18.7%）;百分之十一点六（95% CI = 11.3%至12.0%）和8.6%（95% CI = 7.1%至10.2%），分别用于通过触诊检测到初始DCIS病变的女性;乳腺X线摄影单独检出DCIS的女性分别为6.6%（95%CI = 6.2%-7.1%）和14.1%（95%CI = 11.4%-17.8%）。高（与低）核分级DCIS病变和触诊（与乳腺X线摄影）检测到初始DCIS病变与浸润性癌症复发相关。与DCIS复发相关的因素有：高级别（与低级别）病变;切除边缘阳性、不确定或小于10 mm无病（与10 mm无病）;诊断时年龄40-49岁（与大于或等于50岁）。结论：核分级与复发密切相关，但与复发类型无关。与低核分级或乳房X线检查检测到的DCIS的女性相比，仅接受肿块切除术治疗的高核分级DCIS或触诊检测到的DCIS的女性具有相对较高的浸润性乳腺癌复发风险，并且可能是额外治疗的合适候选人。
Background. Clinical and histopathologic characteristics that may predict risks of recurrence in women with ductal carcinoma in situ (DCIS) have not been consistently identified. We identified factors associated with recurrence as DCIS versus invasive breast cancer and determined the 5-year absolute risks of recurrence as a function of these factors. Methods: We conducted a population-based cohort study among 1036 women in the San Francisco Bay Area who were aged 40 years or older when diagnosed with DCIS and treated by lumpectomy alone from January 1983 through December 1994. Standardized pathology reviews were conducted to determine disease recurrence, defined as DCIS or invasive breast cancer diagnosed in the ipsilateral breast containing the initial DCIS lesion or at a distant site more than 6 months after the initial diagnosis and treatment of DCIS. Conditional logistic regression models were used to determine factors associated with recurrence. All statistical significance tests were two-sided. Results: During a median follow-up of 77.9 months, 209 women (20.2%) experienced a recurrence. Overall, the 5-year risks of recurrence as invasive cancer and as DCIS were 8.2% (95% confidence interval [CI] = 6.6 % to 9.8 %) and 11.7 % (95 % CI = 9.9 % to 13.3 %), respectively. The 5-year risks of recurrence as invasive cancer and as DCIS were 4.8 % (95 % CI = 3.7 % to 6.8 %) and 4.8% (95% CI = 3.8% to 5.8%), respectively, for women with low-nuclear-grade DCIS; 11.8% (95% CI = 9.9% to 14.1%) and 17.1% (95% CI = 15.5% to 18.7%), respectively, for women with high-nuclear-grade DCIS; 11.6% (95% CI = 11.3% to 12.0%) and 8.6% (95% CI = 7.1% to 10.2%), respectively, for women whose initial DCIS lesion was detected by palpation; and 6.6 % (95 % CI = 6.2 % to 7.1 %) and 14.1 % (95% CI = 11.4% to 17.8%), respectively, for women with DCIS detected by mammography alone. High- (versus low-) nuclear-grade DCIS lesions and detection of the initial DCIS lesion by palpation (versus mammography) were associated with recurrence as invasive cancer. High- (versus low-) nuclear-grade lesions; resection margins that were positive, uncertain, or less than 10 mm disease-free (versus :10 mm disease-free); and age 40-49 years at diagnosis (versus greater than or equal to50 years) were associated with recurrence as DCIS. Conclusions: Nuclear grade is strongly associated with recurrence but not with the type of recurrence. Women with high-nuclear-grade DCIS or DCIS detected by palpation who are treated by lumpectomy alone are at relatively high risk of having an invasive breast cancer recurrence, compared with women with low-nuclear-grade or mammographically detected DCIS, and may be appropriate candidates for additional treatment.