Characteristics of second breast events among women treated with breast-conserving surgery for DCIS in the community.
Characteristics of second breast events among women treated with breast-conserving surgery for DCIS in the community.
复制标题
社区 DCIS 保乳手术女性第二次乳房事件的特征。
DOI：
10.1007/s10549-016-3692-4
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发表时间：
2016
影响因子：
3.8
通讯作者：
Punglia,RinaaS
中科院分区：
文献类型：
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作者：
Hassett,MichaelJ;Jiang,Wei;Habel,LaurelA;Nekhlyudov,Larissa;Achacoso,Ninah;Acton,Luana;Schnitt,StuartJ;Schrag,Deb;Punglia,RinaaS
我们检查了社区治疗患者中因DCIS行保乳手术（BCS）后同侧第二乳腺癌（IP-SBC）的临床/病理特征，并确定了指数DCIS和IP-SBC事件特征之间的相关程度。从1990-2001年诊断为DCIS并接受BCS治疗的癌症研究网络队列中，我们确定了随后发生同侧DCIS或浸润性乳腺癌的女性。所有索引DCIS肿瘤均接受专家病理学审查。IP-SBC的病理特征从现有的病历中提取。Logistic回归分析用于检查病理特征之间的关联，并确定与侵袭性和非侵袭性IP-SBC相关的因素。在1969例DCIS患者中，182例在中位38个月（范围6-160）内发生了IP-SBC。IP-SBC的非侵入性（53%）略高于侵入性（47%）。在侵袭性IP-SBC中，31%为高级别，67%<20 mm，74%为雌激素受体阳性，7%为HER 2阳性，16%为淋巴结阳性。在非侵入性IP-SBC中，33%为高级别。比较指数DCIS和IP-SBC标本，HR状态和分级有中度-高度相关性。在IP-SBC患者中，年龄较轻且索引DCIS肿瘤为HR阴性的患者在索引和IP-SBC诊断之间的间隔较短（3年内）。无指标DCIS特征与侵袭性与非侵袭性IP-SBC在统计学上显著相关。了解SBC的特征并确定这些与指数DCIS事件之间的相关性可能会影响DCIS的治疗选择，并可能帮助患者和提供者制定SBC的治疗范式。
We examined the clinical/pathologic features of ipsilateral second breast cancers (IP-SBCs) following breast-conserving surgery (BCS) for DCIS among community-treated patients and ascertained the degree of correlation between the features of index DCIS and IP-SBC events. From a Cancer Research Network cohort of DCIS patients diagnosed 1990–2001 and treated with BCS, we identified women who subsequently developed an ipsilateral DCIS or invasive breast cancer. All index DCIS tumors underwent expert pathology review. Pathologic characteristics of IP-SBCs were abstracted from available medical records. Logistic regression was used to examine associations between pathologic characteristics and identify factors associated with invasive versus non-invasive IP-SBC. Of 1969 DCIS patients, 182 developed an IP-SBC within a median of 38 months (range 6–160). IP-SBCs were slightly more commonly non-invasive (53 %) versus invasive (47 %). Of invasive IP-SBCs, 31 % were high grade, 67 % were <20 mm, 74 % were estrogen receptor positive, 7 % were HER2 positive, and 16 % were node positive. Of non-invasive IP-SBCs, 33 % were high grade. Comparing index DCIS and IP-SBC specimens, there was moderate–high correlation for HR status and grade. Among patients with IP-SBCs, those who were younger and whose index DCIS tumors were HR negative had shorter intervals (within 3 years) between index and IP-SBC diagnoses. No index DCIS feature was statistically significantly associated with an IP-SBC that was invasive versus non-invasive. Understanding the characteristics of SBCs and identifying correlations between these and index DCIS events could influence treatment choices for DCIS, and may help patients and providers develop treatment paradigms for SBCs.