Histoplathological risk factors for ipsilateral breast events after breast conserving treatment for ductal carcinoma in situ of the breast -: Results from the Swedish randomised trial
Histoplathological risk factors for ipsilateral breast events after breast conserving treatment for ductal carcinoma in situ of the breast -: Results from the Swedish randomised trial
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DOI：
10.1016/j.ejca.2006.09.018
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发表时间：
2007-01-01
影响因子：
8.4
通讯作者：
Holmberg, L.
中科院分区：
文献类型：
--
作者：
Ringberg, A.;Nordgren, H.;Holmberg, L.
目的：主要目的是在一项比较辅助放疗与无治疗的试验中，研究乳腺导管原位癌（DCIS）部分切除术后发生同侧乳房事件（IBE）的危险因素，并评估对放疗反应的预测因素。次要目的是分析组织病理学评估的可重复性，并评估试验中诊断的正确性。背景：瑞典的一项随机试验（SweDCIS试验），包括1046名妇女，随访时间中位数为5.2年，提供常规乳房x线摄影筛查。方法：采用病例队列设计，共161例IBE（其中42例为亚队列），284例为亚队列。95%的参与者的幻灯片可以被检索，并由三名经验丰富的病理学家重新评估。结果：低核分级（NG 1-2）和无坏死使放疗和未放疗患者发生IBE的风险减半。病变的大小、切除的边缘和诊断时的年龄并没有改变这些相关性。坏死的存在改变了放疗的效果：坏死存在的相对危险度为0.40，坏死不存在的相对危险度为0.07（相互作用的p值为0.068）。在预后因素的所有亚组中，放射治疗都带来了实质性的益处。原位IBE和侵袭性IBE的危险因素相似。病理学家之间的一致性为中等（kappa = 0.486）。SweDCIS亚队列的诊断正确率为84.8%。结论：虽然核分级和坏死具有预后信息，但我们不能确定单独切除部分后风险极低的组。放射治疗对所研究的所有危险因素都有保护作用。坏死与放疗之间的相互作用是一个临床和生物学相关的研究领域。(c) 2006 Elsevier Ltd.版权所有。
Aim: The primary aims were to study risk factors for an ipsilateral breast event (IBE) after sector resection for ductal carcinoma in situ of the breast (DCIS) in a trial comparing adjuvant radiotherapy to no therapy and to assess predictive factors for response to radiotherapy Secondary aims were to analyse reproducibility of the histopathological evaluation and to estimate correctness of diagnosis in the trial.Setting: A randomised trial in Sweden (the SweDCIS trial), including 1046 women with a median of 5.2 years of follow-up in a population, offered routine mammographic screening.Methods: A case-cohort design with a total of 161 cases of IBE (42 of those being members of the subcohort) and 284 sampled for the sub-cohort. Ninety five percent of the participants' slides could be retrieved and were re-evaluated by three experienced pathologists.Results: Low nuclear grade (NG 1-2) and absence of necrosis halves the risk of IBE in both irradiated and non-irradiated patients. Lesion size, margins of excision and age at diagnosis did not modify these associations. The presence of necrosis modified the effect of radiotherapy: relative risk was 0.40 with necrosis present and 0.07 with necrosis absent (p-value for interaction 0.068). In all subsets of prognostic factors, radiotherapy conferred a substantial benefit. The risk factors for in situ and invasive IBE were similar. The agreement between pathologists was moderate (kappa = 0.486). Correctness of diagnosis in the subcohort of SweDCIS was 84.8%.Conclusion: Although nuclear grade and necrosis carry prognostic information, we could not define a group with very low risk after sector resection alone. Radiotherapy has a protective effect in all substrata of risk factors studied. The interaction between the presence of necrosis and radiotherapy is a clinically and biologically relevant research area. (c) 2006 Elsevier Ltd. All rights reserved.