Is conservative management of ductal carcinoma in situ risky?
Is conservative management of ductal carcinoma in situ risky?
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DOI：
10.1038/s41523-022-00420-2
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发表时间：
2022-04-28
影响因子：
5.9
通讯作者：
Badve, Sunil S.
中科院分区：
文献类型：
--
作者：
Zheng, Lan;Gokmen-Polar, Yesim;Badve, Sunil S.
导管原位癌的非手术治疗是有争议的，这种方法的长期后果知之甚少。在本研究中，我们的目的是确定（a）在切除时升级为浸润性癌的风险和（B）可能符合DCIS试验非手术治疗条件的患者的同侧乳腺癌事件。整理了2010年1月1日至2014年12月31日期间活检诊断为DCIS的20岁或以上女性的数据。这些妇女接受了活检和手术切除（乳房肿瘤切除术或乳房切除术），并根据治疗医生的选择接受了放射或内分泌治疗。在DCIS标准治疗后至少随访5年的患者中分析了同侧乳腺癌事件（IBE）的发展。进行亚组分析以确定符合非手术治疗试验条件的患者中IBE的发生率。研究人群包括378例匹配活检和手术切除病例的患者。COMET的总体IBC分期上调率为14.3%和12.9%，洛里斯为8.8%，LORD试验“合格”患者为10.7%。在5年随访时，约11.5%的总体和试验合格患者发生了IBE，其中约一半为侵袭性IBE。总之，符合非手术治疗试验条件的DCIS女性在诊断后5年内发生同侧乳腺事件的风险显著较高。需要更好的选择标准来识别DCIS患者，这些患者发生IBC的风险非常低。
Nonsurgical management of ductal carcinoma in situ is controversial and little is known about the long-term consequences of this approach. In this study, we aimed to determine the risk of (a) upstaging to invasive carcinoma at excision and (b) ipsilateral breast cancer events in patients who might have been eligible for nonsurgical management of DCIS trials. Data from women aged 20 years or older with a biopsy diagnosis of DCIS between January 1, 2010 to December 31, 2014 were collated. The women underwent biopsy and surgical resection (lumpectomy or mastectomy) and were treated with radiation or endocrine therapy as per treating physicians’ choice. The development of ipsilateral breast cancer events (IBEs) was analyzed in patients with at least 5 years of follow-up after standard of care therapy for DCIS. Subset-analysis was undertaken to identify the incidence of IBEs in patients eligible for nonsurgical management trials. The study population consisted of 378 patients with matched cases of biopsy and surgical excision. The overall upstaging rate to IBC was 14.3 and 12.9% for COMET, 8.8% for LORIS, and 10.7% for LORD trial “eligible” patients. At 5 years of follow-up, ~11.5% of overall and trial eligible patients developed IBEs of which approximately half were invasive IBEs. In conclusion, women with DCIS who would have been eligible for nonsurgical management trials have a significantly high risk of developing ipsilateral breast events within 5 years of diagnosis. Better selection criteria are needed to identify DCIS patients who are at very low risk for the development of IBC.
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影响因子：
2.1
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