Impact of young age on outcome in patients with ductal carcinoma-in-situ treated with breast-conserving therapy
Impact of young age on outcome in patients with ductal carcinoma-in-situ treated with breast-conserving therapy
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DOI：
10.1200/jco.2000.18.2.296
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发表时间：
2000-01-01
影响因子：
45.3
通讯作者：
Martinez, AA
中科院分区：
文献类型：
--
作者：
Vicini, FA;Kestin, LL;Martinez, AA
目的：我们回顾了我院用保乳疗法治疗导管原位癌（DCIS）的经验，以确定患者年龄对结果的影响。患者与方法：1980 ~ 1993年，146例DCIS患者行BCT治疗，所有患者均行切除活检，64%再次行切除，所有患者均接受中位剂量为45 Gy的全乳照射，94%的患者接受肿瘤床放射治疗，中位总剂量为60.4 Gy，每位患者的所有载片均由一名病理学家复查，中位随访期为7.2年。结果：17例患者发生同侧局部复发，5年和10年精算率分别为10.2%和12.4%，45岁以下患者10年同侧手术失败率为26.1%，而45岁以下患者10年同侧手术失败率为8.6% （P = 0.03）。在多变量分析中，无论如何分析（例如，< 45岁或作为连续变量），年轻年龄与指数病变的复发（真实复发/边缘遗漏[TR/MM]失败）独立相关。此外，年轻患者的10年侵袭性TR/MM失败率显著高于年轻患者（19.9% vs 3.2%）。在一项单独的多因素分析中，侵袭性TR/MM失败的发生，只有患者的年龄和主要的核分级与复发独立相关，在95例再次切除的患者中分析了切除体积和结果之间的关系，只有再切除体积较小（< 40 mt）的年轻患者的5年精算率TR/MM失败明显更糟（33.3% vs 9.1%; P = 0.02）。在一项单独的多变量分析中，仅有95例患者（其中25例年龄< 45岁），再次切除的体积与结果的相关性最强（P = 0.05）。患者年龄不再与局部复发相关。结论：这些研究结果表明，年轻DCIS患者在BCT后局部复发的风险显著增加，这与其他先前定义的风险因素无关。我们的数据还表明，切除的程度可能部分与这些患者观察到的不太理想的结果有关，(C) 2000年美国临床肿瘤学会。
Purpose: We reviewed our institution's experience treating patients with ductal carcinoma-in-situ (DCIS) with breast-conserving therapy (BCT) to determine the impact of patient age on outcome.Patients and Methods: From 1980 to 1993, 146 patients were treated with BCT for DCIS, All patients underwent excisional biopsy, and 64% underwent reexcision, All patients received whole-breast irradiation to a median dose of 45 Gy, Ninety-four percent of patients received a boast to the tumor bed, for a median total dose of 60.4 Gy, All slides an every patient were reviewed by one pathologist, The median follow-up period was 7.2 years.Results: Seventeen patients developed an ipsilateral local recurrence, far 5- and 10-year actuarial rates of 10.2% and 12.4%, respectively, The 10-year rate of ipsilateral failure was 26.1% in patients younger than 45 years of age versus 8.6% in older patients (P = .03). On multivariate analysis, young age was independently associated with recurrence of the index lesion (true recurrence/marginal miss [TR/MM] failures), regardless of how it was analysed (eg, < 45 years of age or as a continuous variable). In addition, young patients had a dramatically higher 10-year rate of invasive TR/MM failures (19.9% v 3.2%). In a separate multivariate analysis for the development of invasive TR/MM failures, only patient age cmd predominant nuclear grade were independently associated with recurrence, The relationship between excision volume and outcome was analysed in the 95 patients who underwent re-excision, The 5-year actuarial rate of TR/MM failure was significantly worse only in young patients with smaller (< 40 mt) re-excision volumes (33.3% v 9.1%; P = .02). In a separate multivariate analysis of only these 95 patients (25 of whom were < 45 years of age), the volume of re-excision had the strongest association with outcome (P = .05). Patient age was no longer associated with local recurrence.Conclusion: These findings suggest that young patients with DCIS have a significantly gt eater risk of local recurrence after BCT that is independent of other previously defined risk factors, Our data also suggest that the extent of resection may in part be related to the less optimal results that are observed in these patients, (C) 2000 by American Society of Clinical Oncology.