Treatment trends and prognosis of breast ductal carcinoma in situ:a single center analysis
Liu Weixin, Wang Shulian, Song Yongwen, Tang Yu, Jing Hao, Wang Jianyang, Zhang Jianghu, Jin Jing, Wang Weihu, Liu Yueping, Fang Hui, Ren Hua, Qi Shunan, Lu Ningning, Tang Yuan, Li Ning, Li Yexiong
Department of Radiation Oncology,National Cancer Center/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China
Abstract：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. Kaplan-Meier 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.
Liu Weixin,Wang Shulian,Song Yongwen et al. Treatment trends and prognosis of breast ductal carcinoma in situ:a single center analysis[J]. Chinese Journal of Radiation Oncology, 2019, 28(2): 96-101.
[1] Olivotto I,Levine M,Care SCoCPGft,et al. Clinical practice guidelines for the care and treatment of breast cancer:the management of ductal carcinoma in situ (summary of the 2001 update)[J].Can Med Assoc J,2001,165(7):912-913. [2] Mokbel K.Towards optimal management of ductal carcinoma in situ of the breast[J].Eur J Surg Oncol,2003,29(2):191-197. [3] Kerlikowske K.Epidemiology of ductal carcinoma in situ[J].J Natl Cancer I Monographs,2010,2010(41):139-141. [4] Fisher B,Dignam J,Wolmark N,et al. Lumpectomy and radiation therapy for the treatment of intraductal breast cancer:findings from National Surgical Adjuvant Breast and Bowel Project B-17[J].J Clin Oncol,1998,16(2):441-452.DOI:10.1200/JCO.1998.16.2.441. [5] Julien JP,Bijker N,Fentiman IS,et al. Radiotherapy in breast-conserving treatment for ductal carcinoma in situ:first results of the EORTC randomised phase Ⅲ trial 10853[J].Lancet,2000,355(9203):528-533.DOI:10.1016/s0140-6736(99)06341-2. [6] Fisher B,Land S,Mamounas E,et al. Prevention of invasive breast cancer in women with ductal carcinoma in situ:an update of the National Surgical Adjuvant Breast and Bowel Project experience[J].Sem Oncol,2001,28(4):400-418. [7] Donker M,Litiere S,Werutsky G,et al. Breast-conserving treatment with or without radiotherapy in ductal carcinoma In Situ:15-year recurrence rates and outcome after a recurrence,from the EORTC 10853 randomized phase Ⅲ trial[J].J Clin Oncol.2013,31(32):4054-4059.DOI:10.1200/JCO.2013.49.5077. [8] Wärnberg F,Garmo H,Emdin S,et al. Effect of radiotherapy after breast-conserving surgery for ductal carcinoma in situ:20 years follow-up in the randomized SweDCIS trial[J].J Clin Oncol,2014,32(32):3613-3618.DOI:10.1200/JCO.2014.56.2595. [9] Omlin A,Amichetti M,Azria D,et al. Boost radiotherapy in young women with ductal carcinoma in situ:a multicentre,retrospective study of the Rare Cancer Network[J].Lancet Oncol,2006,7(8):652-656.DOI:10.1016/S1470-2045(06)70765-3. [10] Bartelink H,Horiot JC,Poortmans PM,et al. Impact of a higher radiation dose on local control and survival in breast-conserving therapy of early breast cancer:10-year results of the randomized boost versus no boost EORTC 22881-10882 trial[J].J Clin Oncol,2007,25(22):3259-3265.DOI:10.1200/JCO.2007.11.4991. [11] Wong P,Lambert C,Agnihotram RV,et al. Ductal carcinoma in situ—the influence of the radiotherapy boost on local control[J].Int J Radiat Oncol Biol Phys,2012,82(2):e153-e158.DOI:10.1016/j.ijrobp.2011.03.045. [12] Moran MS,Zhao Y,Ma S,et al. Association of radiotherapy boost for ductal carcinoma in situ with local control after whole-breast radiotherapy[J].JAMA Oncol,2017,3(8):1060-1068.DOI:10.1001/jamaoncol.2016.6948. [13] Cuzick J,Sestak I,Pinder SE,et al. Effect of tamoxifen and radiotherapy in women with locally excised ductal carcinoma in situ:long-term results from the UK/ANZ DCIS trial[J].Lancet Oncol,2011,12(1):21-29.DOI:10.1016/ s1470-2045(10)70266-7. [14] Allred DC,Anderson SJ,Paik S,et al. Adjuvant tamoxifen reduces subsequent breast cancer in women with estrogen receptor-positive ductal carcinoma in situ:a study based on NSABP protocol B-24[J].J Clin Oncol.2012,30(12):1268-1273.DOI:10.1200/JCO.2010.34.0141. [15] Siziopikou KP,Anderson SJ,Cobleigh MA,et al. Preliminary results of centralized Her-2 testing in ductal carcinoma in situ (DCIS):NSABP B-43[J].Breast Cancer Res Treat,2013,142(2):415-421.DOI:10.1007/s10549-013-2755-z. [16] Howlader N NA,Krapcho M,et al. SEER cancer statistics review,1975–2009(Vintage 2009 Populations).National Cancer Institute,Bethesda,MD.2012[DB/OL][2018-04-26].http://seer.cancer.gov/csr/1975_2009_. [17] Boyages M,Delaney M,Taylor M.Predictors of local recurrence after treatment of ductal carcinoma in situ:a meta-analysis[J].Cancer,1999,85(3):616-628. [18] Cutuli B,Fay R, Le Nir CS,et al. Ductal carcinoma in situ of the breast. Analysis of 882 cases[J].Presse Med,2004,33(2):83-89. [19] Kelley L,Silverstein M,Guerra L.Analyzing the risk of recurrence after mastectomy for DCIS:a new use for the USC/Van Nuys Prognostic Index[J].Ann Surg Oncol,2011,18(2):459-462.DOI:10.1245/s10434-010-1335-2. [20] De Lara CT,Giard S,Buttarelli M,et al. Sentinel node procedure is warranted in ductal carcinoma in situ with high risk of occult invasive carcinoma and microinvasive carcinoma treated by mastectomy[J].Breast,2008,14(2):135-140.DOI:10.1111/j.1524-4741.2007.00543.x. [21] Han JS,Molberg KH,Sarode V.Predictors of invasion and axillary lymph node metastasis in patients with a core biopsy diagnosis of ductal carcinoma in situ:an analysis of 255 cases[J].Breast,2011,23(1):223-229.DOI:10.1111/j.1524-4741.2011.01069.x. [22] Houssami N,Ambrogetti D,Marinovich ml,et al. Accuracy of a preoperative model for predicting invasive breast cancer in women with ductal carcinoma-in-situ on vacuum-assisted core needle biopsy[J].Ann Surg Oncol,2011,18(5):1364-1371.DOI:10.1245/s10434-010-1438-9. [23] Meretoja TJ,Heikkilä PS,Salmenkivi K,et al. Outcome of Patients with ductal carcinoma in situ and sentinel node biopsy[J].Ann Surg Oncol,2012,19(7):2345-2351.DOI:10.1245/s10434-012-2287-5. [24] Trentin C,Dominelli V,Maisonneuve P,et al. Predictors of invasive breast cancer and lymph node involvement in ductal carcinoma in situ initially diagnosed by vacuum-assisted breast biopsy:experience of 733 cases[J].Breast,2012,21(5):635-640.DOI:10.1016/j.breast.2012.06.009. [25] Tunondelara C,Chauvet MP,Baranzelli MC,et al. The role of sentinel lymph node biopsy and factors associated with invasion in extensive DCIS of the breast treated by mastectomy:the cinnamome prospective multicenter study[J].Ann Surg Oncol,2015,22(12):3853-5860.DOI:10.1245/s10434-015-4476-5. [26] Fisher B,Bauer M,Margolese R,et al. Five-year results of a randomized clinical trial comparing total mastectomy and segmental mastectomy with or without radiation in the treatment of breast cancer[J].N Eng J Med,1985,312(11):665-673. [27] Fisher B,Dignam J,Wolmark N,et al. Tamoxifen in treatment of intraductal breast cancer:national surgical adjuvant breast and bowel project B-24 randomised controlled trial[J].Lancet,1999,353(9169):1993-2000.DOI:10.1016/S0140-6736(99)05036-9. [28] Houghton J.Radiotherapy and tamoxifen in women with completely excised ductal carcinoma in situ of the breast in the UK,Australia,and New Zealand:randomized controlled trial[J].Lancet,2003,362(9378):95-102.DOI:10.1016/s0140-6736(03)13859-7. [29] Wapnir IL,Dignam JJ,Fisher B,et al. Long-term outcomes of invasive ipsilateral breast tumor recurrences after lumpectomy in NSABP B-17 and B-24 randomized clinical trials for DCIS[J].J Natl Cancer Inst,2011,103(6):478-88.DOI:10.1093/jnci/djR027. [30] McCormick B,Winter K,Hudis C,et al. RTOG 9804:a prospective randomized trial for good-risk ductal carcinoma in situ comparing radiotherapy with observation[J].J Clin Oncol,2015,33(7):709-15.DOI:10.1200/JCO.2014.57.9029. [31] Kanbayashi C,Iwata H.Current approach and future perspective for ductal carcinoma in situ of the breast[J].Japn J Clin Oncol,2017,47(8):671-7.DOI:10.1093/jjco/hyx059. [32] Silverstein MJ.The university of southern california/van nuys prognostic index for ductal carcinoma in situ of the breast[J].Am J Surg,2003,186(4):337-343.DOI:10.1016/s0002-9610(03)00265-4. [33] Wong JS,Chen YH,Gadd MA,et al. Eight-year update of a prospective study of wide excision alone for small low-or intermediate-grade ductal carcinoma in situ (DCIS)[J].Breast Cancer Res Treat,2014,143(2):343-350.DOI:10.1007/s10549-013-2813-6. [34] Solin LJ,Gray R,Hughes LL,et al. Surgical Excision Without Radiation for Ductal Carcinoma in Situ of the Breast:12-Yea. Results From the ECOG-ACRIN E5194 Study[J].J Clin Oncol,2015,33(33):3938-3944.DOI:10.1200/JCO.2015.60.8588.
2019, Vol. 28 
