荷兰癌症研究所Renée S J M Schmitz团队研究了DCIS大小和边缘状态与治疗后患乳腺癌风险的相关性。相关论文于2023年10月30日发表在《英国医学杂志》上。

为了研究导管原位癌（DCIS）的大小和边缘状态与治疗后发展为同侧浸润性乳腺癌和同侧DCIS的风险以及同侧浸润性癌症的分期和亚型之间的关系，四个大型国际团队进行了一项多国联合队列研究。使用1999年至2017年间，荷兰、英国和美国47695名诊断为单纯原发性DCIS的女性患者水平数据，她们接受了保乳或乳房切除术，通常后续进行放射治疗或内分泌治疗，或两者兼而有之。主要结局是同侧浸润性乳腺癌的10年累积发病率，以及与DCIS大小和边缘状态相关的同侧DCIS，以及校正后的风险比和95%置信区间，使用多变量Cox比例风险分析和多个估算数据进行估计。

同侧浸润性癌症10年累计发病率为3.2%。在接受保乳手术或不接受放疗的女性中，与DCIS<20 mm相比，较大DCIS（20-49 mm）的同侧DCIS校正后风险显著增加（风险比1.38）。同侧浸润性乳腺癌和同侧DCIS的风险均显著高于有明显边缘的乳腺癌（侵袭性癌症1.40；DCIS 1.39）。与仅保乳手术治疗相比，辅助内分泌治疗与同侧浸润性乳腺癌癌症的风险较低无关（0.86）。

在接受保乳治疗或不接受放疗的女性中，较高的DCIS等级与同侧浸润性乳腺癌症无显著相关性，仅与同侧DCIS的风险较高（等级1：1.42；等级3：2.17）。确诊时年龄越高，同侧DCIS的风险（每年）越低（0.98），但与同侧浸润性癌症的风险（1.00）无关。与DCIS＜20 mm的女性相比，DCIS较大（≥50 mm）的女性更常发展为同侧浸润性乳腺癌III期和IV期癌症。未发现受累边缘与同侧浸润性乳腺癌癌症高分期之间的这种关联。研究发现较大DCIS与激素受体阴性和人表皮生长因子受体2阳性的同侧浸润性乳腺癌、受累边缘和激素受体阴性的同侧浸润性癌症之间存在相关性。

研究结果表明，DCIS大小和边缘状态与同侧侵袭性癌症和同侧DCIS的相关性很小。当将这两个因素添加到多变量模型中的其他已知风险因素中时，发现仅临床病理风险因素在区分低风险和高风险DCIS方面是有限的。

附：英文原文

Title: Association of DCIS size and margin status with risk of developing breast cancer post-treatment: multinational, pooled cohort study

Author: Renée S J M Schmitz, Alexandra W van den Belt-Dusebout, Karen Clements, Yi Ren, Chiara Cresta, Jasmine Timbres, Yat-Hee Liu, Danalyn Byng, Thomas Lynch, Brian A Menegaz, Deborah Collyar, Terry Hyslop, Samantha Thomas, Jason K Love, Michael Schaapveld, Proteeti Bhattacharjee, Marc D Ryser, Elinor Sawyer, E Shelley Hwang, Alastair Thompson, Jelle Wesseling, Esther H Lips, Marjanka K Schmidt

Issue&Volume: 2023/10/30

Abstract:

Objective To examine the association between size and margin status of ductal carcinoma in situ (DCIS) and risk of developing ipsilateral invasive breast cancer and ipsilateral DCIS after treatment, and stage and subtype of ipsilateral invasive breast cancer.

Design Multinational, pooled cohort study.

Setting Four large international cohorts.

Participants Patient level data on 47695 women with a diagnosis of pure, primary DCIS between 1999 and 2017 in the Netherlands, UK, and US who underwent surgery, either breast conserving or mastectomy, often followed by radiotherapy or endocrine treatment, or both.

Main outcome measures The main outcomes were 10 year cumulative incidence of ipsilateral invasive breast cancer and ipsilateral DCIS estimated in relation to DCIS size and margin status, and adjusted hazard ratios and 95% confidence intervals, estimated using multivariable Cox proportional hazards analyses with multiple imputed data

Results The 10 year cumulative incidence of ipsilateral invasive breast cancer was 3.2%. In women who underwent breast conserving surgery with or without radiotherapy, only adjusted risks for ipsilateral DCIS were significantly increased for larger DCIS (20-49 mm) compared with DCIS <20 mm (hazard ratio 1.38, 95% confidence interval 1.11 to 1.72). Risks for both ipsilateral invasive breast cancer and ipsilateral DCIS were significantly higher with involved compared with clear margins (invasive breast cancer 1.40, 1.07 to 1.83; DCIS 1.39, 1.04 to 1.87). Use of adjuvant endocrine treatment was not significantly associated with a lower risk of ipsilateral invasive breast cancer compared to treatment with breast conserving surgery only (0.86, 0.62 to 1.21). In women who received breast conserving treatment with or without radiotherapy, higher DCIS grade was not significantly associated with ipsilateral invasive breast cancer, only with a higher risk of ipsilateral DCIS (grade 1: 1.42, 1.08 to 1.87; grade 3: 2.17, 1.66 to 2.83). Higher age at diagnosis was associated with lower risk (per year) of ipsilateral DCIS (0.98, 0.97 to 0.99) but not ipsilateral invasive breast cancer (1.00, 0.99 to 1.00). Women with large DCIS (≥50 mm) more often developed stage III and IV ipsilateral invasive breast cancer compared to women with DCIS <20 mm. No such association was found between involved margins and higher stage of ipsilateral invasive breast cancer. Associations between larger DCIS and hormone receptor negative and human epidermal growth factor receptor 2 positive ipsilateral invasive breast cancer and involved margins and hormone receptor negative ipsilateral invasive breast cancer were found.

Conclusions The association of DCIS size and margin status with ipsilateral invasive breast cancer and ipsilateral DCIS was small. When these two factors were added to other known risk factors in multivariable models, clinicopathological risk factors alone were found to be limited in discriminating between low and high risk DCIS.

DOI: 10.1136/bmj-2023-076022

Source: https://www.bmj.com/content/383/bmj-2023-076022