美国杜克大学医学中心E Shelley Hwang团队近日研究了未进行导管原位癌前期手术的女性癌症结局。相关论文发表在2025年7月8日出版的《英国医学杂志》上。

为了确定未接受导管原位癌（DCIS）前期手术的女性发生同侧浸润性乳腺癌的风险，研究组进行了一项观察性队列研究，使用直接从患者医疗记录和国家癌症登记处提取的数据，研究2008年至2015年间诊断为原发性DCIS的患者，均来自美国癌症委员会认可的机构（n=1330）。参与者为1780名经针活检诊断为原发性DCIS的女性，在诊断后6个月存活且无浸润性乳腺癌。

干预措施为诊断后6个月内未手术。主要结局为同侧浸润性乳腺癌；次要结局为因乳腺癌死亡。根据正在进行的主动监测试验的资格标准，按风险状况进行亚组分析：诊断时年龄≥40岁、核分级I/II和激素受体阳性DCIS的风险较低；否则风险很高。

患者诊断时的中位年龄为63岁，中位随访时间为53.3个月。在所有1780名妇女中，患同侧浸润性乳腺癌的人数为115人（6.5%），乳腺癌死亡人数为29人（1.6%）。同侧浸润性乳腺癌的8年累积发病率为10.7%（95%可信区间（CI） 8.4%至12.8%）。浸润性乳腺癌的发病率因疾病和患者相关因素而异，8年同侧浸润性乳腺癌的累积发病率在低危女性（n=650）中为8.5% (95% CI 4.7% - 12.1%)，在高危女性（n=833）中为13.9%（10.5% - 17.2%）。总体的8年疾病特异性生存率为96.4% (95% CI 95.0% ~ 97.9%)，低风险妇女的8年特异性生存率为98.1%（96.7% ~ 99.6%）。

研究结果表明，在一组未接受DCIS初始手术的患者中，同一乳腺浸润性癌的8年累积发病率在8%至14%之间变化。有效的风险分层工具和共同决策对这一患者群体至关重要。

附：英文原文

Title: Cancer outcomes in women without upfront surgery for ductal carcinoma in situ: observational cohort study

Author: Marc D Ryser, Samantha M Thomas, Yan Li, Thomas Lynch, Anne Barber, Amanda B Francescatti, Deborah Collyar, Danalyn Byng, Lars J Grimm, Ann H Partridge, Alastair M Thompson, Terry Hyslop, E Shelley Hwang

Issue&Volume: 2025/07/08

Abstract:

Objective To determine the risk of subsequent ipsilateral invasive breast cancer in women who do not receive upfront surgery on diagnosis of ductal carcinoma in situ (DCIS).

Design Observational cohort study using data abstracted directly from patients’ medical records and from a national cancer registry in patients with primary DCIS diagnosed between 2008 and 2015.

Setting Commission on Cancer accredited facilities (n=1330) in the US.

Participants 1780 women with diagnosis of primary DCIS on needle biopsy who were alive and free of invasive breast cancer at 6 months after diagnosis.

Interventions No surgery within 6 months of diagnosis.

Main outcome measures Primary outcome: ipsilateral invasive breast cancer; secondary outcome: death due to breast cancer. Subgroup analysis by risk status, based on eligibility criteria of ongoing active monitoring trials: low risk if aged ≥40 years at diagnosis of an imaging detected, nuclear grade I/II, and hormone receptor positive DCIS; high risk otherwise.

Results Median age at diagnosis was 63 years, and median follow-up was 53.3 months. Among all 1780 women, the number of ipsilateral invasive breast cancer events was 115 (6.5%) and the number of deaths from breast cancer was 29 (1.6%). The 8 year cumulative incidence of ipsilateral invasive breast cancer was 10.7% (95% confidence interval (CI) 8.4% to 12.8%). Incidence of invasive cancer differed by both disease and patient related factors, with 8 year cumulative incidences of ipsilateral invasive breast cancer ranging from 8.5% (95% CI 4.7% to 12.1%) among women at low risk (n=650) to 13.9% (10.5% to 17.2%) among those at high risk (n=833). The 8 year disease specific survival probability was 96.4% (95% CI 95.0% to 97.9%) overall and 98.1% (96.7% to 99.6%) among women at low risk.

Conclusions In a cohort of patients who did not receive initial surgery for DCIS, the 8 year cumulative incidence of invasive cancer in the same breast varied between 8% and 14%. Effective risk stratification tools and shared decision making are essential for this patient population.

DOI: 10.1136/bmj-2024-083542

Source: https://www.bmj.com/content/390/bmj-2024-083542