Re: Cancer Outcomes in DCIS Patients Without Locoregional Treatment.
Re: Cancer Outcomes in DCIS Patients Without Locoregional Treatment.
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回复：未经局部治疗的 DCIS 患者的癌症结果。
DOI：
10.1093/jnci/djz118
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发表时间：
2020
期刊：
影响因子：
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通讯作者：
Buist,DianaSM
中科院分区：
文献类型：
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作者：
Habel,LaurelA;Buist,DianaSM
我们饶有兴趣地阅读了 Ryser 等人最近发表的文章(1)，该文章涉及 1992 年至 2014 年诊断为导管原位癌 (DCIS) 的女性的癌症结果，这些女性在监测、流行病学和最终结果 (SEER) 登记处被归类为未接受明确手术或放疗。他们对 1286 名女性进行了平均 5.5 年的随访，报告称 10 年累积同侧浸润性乳腺癌 (iIBC) 风险低得惊人，为 10.5%（95% 置信区间 [CI]= 8.5% 至 12.4%）。相比之下，国家外科辅助乳腺和肠道项目 B-17 临床试验比较了 817 名接受肿瘤切除术的 DCIS 女性的 iIBC 发生率（实现明确的手术效果）单纯肿瘤切除术与放疗相比，10 年累积发病率分别为 16.4%（95% CI= 13.7% 至 19.1%）和 5.5%（95% CI= 3.4% 至 7.6%）（2）。最近的另一项 DCIS 研究对 89 名经穿刺活检确诊且至少 1 年未进行手术切除的女性进行了随访，结果发现 33% 的女性在中位间隔 45 个月后发展为 iIBC (3)。因此，SEER 中未经治疗的 DCIS 的 iIBC 率 (1) 比 B-17 试验中肿瘤已完全切除的女性报告的比率低三分之一以上 (2)，比最近一项针对未切除的 DCIS 的研究低三分之二以上 (3)。
We read with interest the recent article by Ryser et al.(1) on cancer outcomes among women diagnosed with ductal carcinoma in situ (DCIS) from 1992 to 2014 and classified as not receiving definitive surgery or radiotherapy in the Surveillance, Epidemiology and End Results (SEER) registry. They followed 1286 women for a median of 5.5 years and reported a surprisingly low 10-year cumulative ipsilateral invasive breast cancer (iIBC) risk of 10.5%(95% confidence interval [CI]= 8.5% to 12.4%).To contrast, the National Surgical Adjuvant Breast and Bowel Project B-17 clinical trial compared iIBC rates in 817 women with DCIS who received lumpectomy (achieving clear surgical margins) alone vs lumpectomy with radiotherapy and reported 10-year cumulative incidence rates of 16.4%(95% CI= 13.7% to 19.1%) and 5.5%(95% CI= 3.4% to 7.6%), respectively (2). Another recent study of DCIS followed up 89 women diagnosed on needle biopsy with no surgical resection for at least 1year and reported that 33% developed iIBC after a median interval of 45 months (3). Thus, the iIBC rate for untreated DCIS in SEER (1) is more than one-third lower than the rate reported for women in the B-17 trial whose tumors had been completely excised (2) and more than two-thirds lower than a recent study of unresected DCIS (3).