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Objective To analyze the differences in the treatment patterns,clinical characteristics,treatment outcomes and prognostic factors between breast cancer patients with ductal carcinoma in situ (DCIS) and ductal carcinoma in situ with microinvasion (DCIS-MI).Methods Clinical data of 866 female patients including 631 DCIS cases and 235 DCIS-MI cases treated in our institution between 1999 and 2013 were retrospectively analyzed.The local control (LC),disease-free survival (DFS) and overall survival (OS) rates were calculated by Kaplan-Meier survival analysis.The prognostic factors were identified by Log-rank test.Results Similar LC,DFS and OS rates were obtained between two groups (all P＞ O.05).The univariate analysis demonstrated that Her-2-positive patients had worse OS and DFS than Her-2-negative counterparts.Patients undergoing breast-conserving surgery without radiotherapy had lower LC and DFS rates compared with those receiving radical mastectomy.Conclusions DCIS and DCIS-MI patients have similar clinical prognosis in terms of OS,LC and DFS.Her-2 positive is an unfavorable prognostic factor for DFS and OS.The LC and DFS rates in the breast-conserving surgery alone group are worse than those in the mastectomy group.
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Objective To analyze the changes in treatment patterns,clinical characteristics,treatment outcomes and prognostic factors of ductal carcinoma in situ (DCIS).Methods Clinical data of 617 female patients admitted to our institution between 2000 and 2013 were retrospectively analyzed.KaplanMeier survival analysis was adopted to calculate the local control (LC),disease-free survival (DFS) and overall survival (OS) rates.Log-rank test was utilized to identify the prognostic factors.Results Along the number of DCIS patients was gradually increased year by year,the proportion of breast conservative surgery was also elevated.However,mastectomy remained the primary surgical method.A total of 374 patients underwent mastectomy,160 cases received breast conservative surgery plus radiotherapy and 83 underwent breast conservative surgery alone.Postoperatively,366 patients (83.6％) with positive hormone receptor received hormone therapy and 45 patients (7.3％) underwent chemotherapy.The median follow-up time was 47 months.The 5-year LC,DFS and OS rates were 98.4％,97.5％ and 98.9％,respectively.Univariate analysis demonstrated that Her-2-positive patients obtained worse OS (P=0.019).Although mastectomy group had more adverse factors compared with breast conservative surgery with or without radiotherapy groups,similar survival results were obtained among three groups.Mastectomy yielded better LC and DFS compared with breast conservative surgery alone.Conclusions DCIS patients obtain favorable clinical prognosis between the breast conservative surgery and mastectomy groups.The LC rate in the mastectomy group is better than that in the breast conservative surgery group.
ABSTRACT
Breast ductal carcinoma in situ (DCIS) comprises a heterogeneous group of lesions with different forms of clinical and pathological presentation. Postoperative radiotherapy is usually performed in DCIS patients who underwent conservative breast surgery. The objective of the present study was to describe indications and clinical evidences of radiotherapy for breast DCIS patients
O carcinoma ductal in situ (CDIS) de mama compreende um grupo heterogêneo de lesões com diferentes formas de apresentação clínica e patológica. A radioterapia pós-operatória é normalmente realizada nas pacientes com CDIS submetidas à cirurgia conservadora de mama. O presente estudo teve o objetivo de apresentar as indicações e as evidências para a utilização da radioterapia na abordagem do CDIS de mama.
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Objective: To conduct a Meta-analysis to analyze the short-term and long-term preventive effects of whole breast irradiation combined with tumor bed boost on short- and long-term local recurrence rates and local recurrence rate of ipsilateral invasive breast cancer in patients with breast ductal carcinoma in situ (DCIS) after breast conserving-surgery (BCS). Methods: A computer-based online search of PubMed, China Journal Full-text Database (CJFD), China Biology Medicine disc (CBMdisc), Embase and Cochrane Library was performed to include eligible studies in accordance with the inclusion and exclusion criteria. Newcastle Ottawa Quality Assessment Scale was used for quality assessment of included articles. RevMan 5.3 software was used for Meta-analysis. Results: A total of 14 non-randomized controlled trials (13 were cohort study, and 1 was nonsimultaneous controlled trial) involving 8679 patients with breast DCIS were included. The results of this Meta-analysis showed that no statistically significant differences between whole breast irradiation and whole breast irradiation combined with tumor bed boost in terms of 5-year local recurrence rate [odds ratio (OR) = 0.92, 95% confidence interval (CI): 0.46-1.82; P = 0.81], 7-year local recurrence rate (OR = 0.70, 95% CI: 0.45-1.09; P = 0.11), ≥ 10-year local recurrence rate (OR = 0.95, 95% CI: 0.79-1.15; P= 0.62) and the local recurrence rate of ipsilateral invasive breast cancer (OR = 0.89, 95% CI: 0.62-1.29; P = 0.55). Conclusion: As compared with whole breast irradiation, the whole breast irradiation combined with tumor bed boost in patients with DCIS after BCS can not obviously decrease the 5-year, 7-year and ≥ 10-year local recurrence rates, as well as the local recurrence rate of ipsilateral invasive breast cancer.