乳腺导管原位癌的单中心预后分析

doi:10.19401/j.cnki.1007-3639.2022.03.005

摘要/Abstract

摘要：

背景与目的：目前中国乳腺导管原位癌（ductal carcinoma in situ,DCIS）的发病率逐年升高,而现有治疗策略主要基于欧美大型随机对照研究。探索中国人群中DCIS患者的临床特征、复发模式和预后影响因素,以便优化临床决策。方法：回顾性分析2008年1月—2017年1月复旦大学附属肿瘤医院收治的1 185例DCIS患者的病历资料,采用Kaplan-Meier法计算无局部复发生存（local recurrence-free survival,LRFS）率、无病生存（disease-free survival,DFS）率和总生存（overall survival,OS）率,采用COX风险比例回归模型进行单因素和多因素分析。结果：中位随访时间为61个月,5年OS率、LRFS率和DFS率分别为99.9%、98.7%和96.6%。随访期间共观察到50例治疗失败事件,包括局部区域复发16例、对侧乳腺事件30例和远处转移4例。多因素分析中,人表皮生长因子受体2（human epidermal growth factor receptor 2,HER2）阳性的患者更容易发生局部区域复发,LRFS率较差（P=0.029）。结论：DCIS患者预后极好,HER2阳性是LRFS的不良预后因素。

关键词: 乳腺导管原位癌, 乳腺肿瘤, 预后

Abstract:

Background and purpose: The incidence of ductal carcinoma in situ (DCIS) has increased annually with the popularity of mammography screening. However, current treatment strategies are mostly based on the results of prospective randomized clinical trials in western countries. This study aimed to explore the clinical characteristics, recurrence patterns and prognostic factors of Chinese DCIS patients, hoping to optimize clinical decision-making. Methods: Medical records of 1 185 DCIS patients treated in Fudan University Shanghai Cancer Center from January 2008 to January 2017 were retrospectively analyzed. The local recurrence-free survival (LRFS) rate, disease-free survival (DFS) rate and overall survival (OS) rate were calculated using the Kaplan-Meier method. Univariate and multivariate analyses were performed using the COX proportional hazards regression model. Results: With a median follow-up of 61 months, 50 treatment failure events were observed, including 16 locoregional recurrences, 30 contralateral breast cancer events and 4 distant metastases. The 5-year OS rate, LRFS rate and DFS rate were 99.9%, 98.7% and 96.6%, respectively. In the multivariate analysis, the positive status of human epidermal growth factor receptor 2 (HER2) was related to higher risk of local recurrence and the LRFS rate was poor (P=0.029). Conclusion: The patient with DCIS was associated with favorable prognosis. HER2 positivity was the risk factor for poor LRFS.

Key words: Ductal carcinoma in situ, Breast cancer, Prognosis

中图分类号:

R737.9

杨贻兰, 赵旭, 陈星星, 汪宣伊, 金恺睿, 章真, 邵志敏, 郭小毛, 俞晓立. 乳腺导管原位癌的单中心预后分析[J]. 中国癌症杂志, 2022, 32(3): 228-233.

YANG Yilan, ZHAO Xu, CHEN Xingxing, WANG Xuanyi, JIN Kairui, ZHANG Zhen, SHAO Zhimin, GUO Xiaomao, YU Xiaoli. A single-center prognotic analysis of breast ductal carcinoma in situ[J]. China Oncology, 2022, 32(3): 228-233.

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参考文献 16

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Characteristic	Case (N=1 185)	Characteristic	Case (N=1 185)
Age/year		Negative	225 (19.0)
≤40	201 (17.0)	Positive	960 (81.0)
41-60	750 (63.3)	HER2 status
>60	234 (19.7)	Negative	585 (49.4)
Menopausal status		Positive	274 (23.1)
Premenopausal	658 (55.5)	Unknown	326 (27.5)
Postmenopausal	514 (43.4)	Breast and axillary surgery
Unknown	13 (1.1)	Lumpectomy	133 (11.2)
Family history of malignant tumors		BCS+SLNB	146 (12.3)
No	821 (69.3)	BCS+ALND	10 (0.8)
Yes	364 (30.7)	Mastectomy	81 (6.8)
Tumor size D/cm		Mastectomy+SLNB	610 (51.5)
≤2.5	919 (77.6)	Mastectomy+ALND	205 (17.3)
>2.5	165 (13.9)	Reconstructive surgery
Unknown	101 (8.5)	No	1 086 (91.6)
Nuclear grade		Yes	99 (8.4)
Low	300 (25.3)	Radiotherapy
Intermediate	548 (46.2)	No	957 (80.8)
High	286 (24.1)	Yes	218 (18.4)
Unknown	51 (4.3)	Unknown	10 (0.8)
Margins		Hormone therapy
Negative (≥2 mm)	1 174 (99.1)	No	510 (43.0)
Positive (<2 mm)	11 (0.9)	Yes	659 (55.6)
HR status		Unknown	16 (1.4)

Patterns of treatment failure	Case n
Locoregional recurrence
Local recurrence
Breast	11
Chest wall	2
Regional recurrence
Lymph nodes in the axillary area	1
Lymph nodes in the collarbone area	2
Contralateral breast cancer
Carcinoma in situ	18
Invasive carcinoma	12
Distant metastasis	4

Variable	LRFS			DFS
Variable	HR	95% CI	P value	HR	95% CI	P value
Age/year
41-60 vs ≤40	0.4	0.1-1.0	0.054	0.7	0.3-1.3	0.221
>60 vs ≤40	0.3	0.1-1.4	0.131	0.6	0.2-1.4	0.235
Menopausal status (postmenopausal vs premenopausal)	0.3	0.1-1.0	0.058	0.7	0.4-1.3	0.282
Family history of malignant tumors (yes vs no)	1.3	0.5-3.5	0.632	1.5	0.9-2.7	0.129
Tumor size D/cm（>2.5 vs ≤2.5）	1.4	0.4-4.7	0.639	0.8	0.3-2.0	0.578
Nuclear grade
Low	No event	No event	No event	1.0	Reference	Reference
Intermediate	1.3	0.4-4.1	0.656	1.2	0.6-2.5	0.604
High	1.0	Reference	Reference	1.2	0.5-2.8	0.616
Margins (positive vs negative)	No event	No event	No event	2.3	0.3-16.7	0.409
HR status (positive vs negative)	0.4	0.2-1.3	0.124	0.9	0.4-1.8	0.737
HER2 status (positive vs negative)	2.7	0.8-8.9	0.098	1.3	0.7-2.6	0.399
Local treatment (mastectomy vs BCS + radiotherapy)	0.4	0.1-1.1	0.086	1.0	0.5-1.9	0.883
Reconstructive surgery (yes vs no)	0.8	0.1-6.1	0.835	1.6	0.7-3.8	0.265
Hormone therapy (yes vs no)	0.7	0.3-2.0	0.566	0.7	0.4-1.2	0.205
Chemotherapy (yes vs no)	2.4	0.6-10.7	0.242	1.3	0.5-3.6	0.624

Variable	LRFS
Variable	HR	95% CI	P value
Age/year
41-60 vs ≤40	0.5	0.1-2.2	0.349
>60 vs ≤40	1.5	0.1-15.5	0.754
Menopausal status (postmenopausal vs premenopausal)	0.4	0.1-2.3	0.295
HER2 status (positive vs negative)	4.2	1.2-15.5	0.029^*
Local treatment (mastectomy vs BCS + radiotherapy)	0.4	0.1-1.4	0.146