Residual ductal carcinoma in situ in patients with complete eradication of invasive breast cancer after neoadjuvant chemotherapy does not adversely affect patient outcome
Residual ductal carcinoma in situ in patients with complete eradication of invasive breast cancer after neoadjuvant chemotherapy does not adversely affect patient outcome
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DOI：
10.1200/jco.2006.08.2271
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发表时间：
2007-07-01
影响因子：
45.3
通讯作者：
Pusztai, Lajos
中科院分区：
文献类型：
--
作者：
Mazouni, Chafika;Peintinger, Florentia;Pusztai, Lajos
目的探讨术前化疗完成后残余导管原位癌（DCIS）是否影响组织学定义的浸润性肿瘤完全根除患者的预后。患者和方法回顾性分析了1980年至2004年间在德克萨斯大学安德森癌症中心接受新辅助化疗的2302例乳腺癌患者的数据库。比较无残留浸润性癌或原位癌患者（病理完全缓解[pCR]）和无残留浸润性癌但持续原位癌患者（pCR + DCIS）的总生存期（OS）、无病生存期（DFS）和局部无复发生存期。结果平均随访250个月。在2302例接受治疗的患者中，78例（3.4%）有pCR， 199例（8.6%）有pCR + DCIS， 2025例（88%）有残余浸润性癌症。对于pCR和pCR + DCIS患者，5年DFS率（两组分别为87.1%）和10年DFS率（分别为81.3%和81.7%）相似；5年OS率（91.9% v 92.5%）和10年OS率（91.8% v 92.5%）相似且显著优于浸润性癌残留患者（74.4%,P < 0.001）。pCR组患者的5年局部无复发生存率（92.8%,95% CI, 86.1% ~ 96.4%）与pCR + DCIS组患者（90.9%,95% CI, 77.3% ~ 96.5%, P = 0.63）也无差异。结论乳腺及淋巴结浸润性肿瘤完全根治后残留DCIS对患者生存及局部复发率无不良影响。将残留DCIS患者纳入pCR的定义是合理的，因为该结果可作为长期生存的早期替代指标。
PurposeTo determine whether residual ductal carcinoma in situ ( DCIS) after completion of preoperative chemotherapy affects the outcome of patients with histologically defined complete eradication of invasive cancer.Patients and MethodsRetrospective analysis of a database including 2,302 breast cancer patients treated with neoadjuvant chemotherapy at The University of Texas M. D. Anderson Cancer Center between 1980 and 2004 was performed. The overall survival (OS), disease-free survival (DFS), and local recurrence-free survival were compared for patients with no residual invasive or in situ cancer (pathologic complete response [pCR]) and patients with no residual invasive cancer but persistent in situ disease (pCR + DCIS).ResultsThe mean follow-up time was 250 months. Of the 2,302 treated patients, 78 (3.4%) had pCR, 199 (8.6%) had pCR + DCIS, and 2,025 (88%) had residual invasive cancer. For patients with pCR and pCR + DCIS, the 5-year DFS rates (87.1% in both groups) and 10-year DFS rates (81.3% v 81.7%, respectively) were similar; the 5-year OS rates (91.9% v 92.5%, respectively) and 10-year OS rates (91.8% v 92.5%, respectively) were also similar and significantly better than the rate of patients with residual invasive cancer (74.4%; P < .001). The 5-year locoregional recurrence-free survival rates were also not different between patients with pCR (92.8%; 95% CI, 86.1% to 96.4%) and patients with pCR + DCIS (90.9%; 95% CI, 77.3% to 96.5%; P = .63).ConclusionResidual DCIS in patients who experience complete eradication of the invasive cancer in the breast and lymph nodes does not adversely affect survival or local recurrence rate. Inclusion of patients with residual DCIS in the definition of pCR is justified when this outcome is used as an early surrogate for long-term survival.