對于年輕女性而言，乳腺導(dǎo)管原位癌保乳手術(shù)后的局部區(qū)域復(fù)發(fā)比例較高。不過，年齡對乳腺導(dǎo)管原位癌±微浸潤乳房切除手術(shù)后局部區(qū)域復(fù)發(fā)和遠(yuǎn)處復(fù)發(fā)的影響尚不明確。
2019年8月22日，美國乳腺外科醫(yī)師學(xué)會和美國腫瘤外科學(xué)會《腫瘤外科學(xué)報》在線發(fā)表紐約紀(jì)念醫(yī)院斯隆凱特林癌癥中心、哈佛大學(xué)布萊根和波士頓婦女醫(yī)院的研究報告，探討了年齡對乳腺導(dǎo)管原位癌±微浸潤乳房切除手術(shù)后局部區(qū)域復(fù)發(fā)和遠(yuǎn)處復(fù)發(fā)的影響。
該研究對1995～2017年紐約紀(jì)念醫(yī)院斯隆凱特林癌癥中心、2000～2015年布萊根和波士頓婦女醫(yī)院達(dá)納法伯癌癥研究所連續(xù)3121例乳腺導(dǎo)管原位癌±微浸潤乳房切除手術(shù)治療患者進(jìn)行回顧分析。將局部區(qū)域復(fù)發(fā)定義為乳腺癌同側(cè)胸壁或引流區(qū)域淋巴結(jié)的復(fù)發(fā)。
結(jié)果，其中乳腺導(dǎo)管原位癌＋微浸潤患者421例（13.5%）。中位年齡49歲，中位隨訪6.4年，范圍0～23年，其中821例隨訪≥10年。
局部區(qū)域復(fù)發(fā)34例，其中浸潤癌33例（97%）、僅胸壁復(fù)發(fā)23例（68%）。10年累計局部區(qū)域復(fù)發(fā)率為1.4%，10年累計遠(yuǎn)處復(fù)發(fā)率為0.8%。
根據(jù)單因素分析，局部區(qū)域復(fù)發(fā)相關(guān)因素：
年齡<50歲（風(fēng)險比：15.0，95%置信區(qū)間：3.58～62.4，P<0.001）
核分級高（風(fēng)險比：3.56，95%置信區(qū)間：1.60～7.88，P=0.001）
伴微浸潤（風(fēng)險比：3.35，95%置信區(qū)間：1.66～6.77，P<0.001）
切緣陽性（風(fēng)險比：2.83，95%置信區(qū)間：0.67～12.0，P=0.14）
根據(jù)多因素分析，局部區(qū)域復(fù)發(fā)相關(guān)因素：
年齡<50歲（風(fēng)險比：14.7，95%置信區(qū)間：3.5～61.5，P<0.001）
核分級高（風(fēng)險比：3.09，95%置信區(qū)間：1.38–6.94，P=0.006）
伴微浸潤（風(fēng)險比：2.88，95%置信區(qū)間：1.40–5.92，P=0.004）
與年齡50～85歲相比：
年齡20～40歲（風(fēng)險比：27.0，95%置信區(qū)間：6.0～121，P<0.001）
年齡40～49歲（風(fēng)險比：11.8，95%置信區(qū)間：2.8～50.5，P<0.001）
10年累計局部區(qū)域復(fù)發(fā)率：
年齡20～40歲：4.2%
年齡40～49歲：2.0%
年齡50～85歲：0.2%
10年累計遠(yuǎn)處復(fù)發(fā)率：
年齡20～40歲：1.6%（對數(shù)秩，P=0.051）
年齡40～49歲：0.7%
年齡50～85歲：0.7%
遠(yuǎn)處復(fù)發(fā)與核分級、乳腺導(dǎo)管原位癌＋微浸潤、切緣陽性的相關(guān)性不顯著。
因此，該研究結(jié)果表明，雖然乳腺導(dǎo)管原位癌±微浸潤乳房切除手術(shù)后局部區(qū)域復(fù)發(fā)少見，但是多見于年齡<50歲尤其<40歲的女性，年齡<40歲女性的10年累計局部區(qū)域復(fù)發(fā)率達(dá)4.2%，年輕可以作為保乳手術(shù)或乳房切除手術(shù)后局部區(qū)域復(fù)發(fā)的獨立風(fēng)險因素。
Ann Surg Oncol. 2019 Aug 22. [Epub ahead of print]
Impact of Age on Locoregional and Distant Recurrence After Mastectomy for Ductal Carcinoma In Situ With or Without Microinvasion.
Anita Mamtani, Faina Nakhlis, Stephanie Downs-Canner, Emily C. Zabor, Monica Morrow, Tari A. King, Kimberly J. Van Zee.
Memorial Sloan Kettering Cancer Center, New York, USA; Brigham and Women's Hospital, Boston, USA.
BACKGROUND: Locoregional recurrence (LRR) after breast-conserving surgery (BCS) for ductal carcinoma in situ (DCIS) is increased in young women. We examined the impact of age on LRR and distant disease after mastectomy for DCIS±m(xù)icroinvasion.
METHODS: We identified consecutive patients with DCIS±m(xù)icroinvasion treated with mastectomy from 1995 to 2017. LRR was defined as recurrence at the ipsilateral chest wall or regional nodes.
RESULTS: Overall, 3121 cases were identified, of which 421 (13.5%) had DCIS+microinvasion. Median age was 49 years and median follow-up was 6.4 years; 821 were followed for 10 or more years. Thirty-four LRRs were observed: 33 (97%) were invasive, and 23 (68%) were in the chest wall alone. Cumulative 10-year LRR incidence was 1.4%. Age<50 years, high grade, and DCIS+microinvasion were associated with LRR (p≤0.001); however, margin status was not (p=0.14). Adjusting for grade and DCIS+microinvasion, age<50 years (hazard ratio [HR] 14.7, 95% confidence interval [CI] 3.5-61.5; p<0.001) was associated with LRR. Compared with women ≥50 years of age, women age <40 years had the highest risk (HR 27.0, 95% CI 6.0-121), and women age 40-49 years had intermediate risk (HR 11.8, 95% CI 2.8-50.5). The cumulative 10-year LRR incidence was 4.2% for women <40 years of age, 2.0% for women 40-49 years of age, and 0.2% for women ≥50 years of age. Women age <40 years had a 10-year distant disease rate of 1.6% versus women age 40-49 years (0.7%) and women age ≥50 years (0.7%) (log-rank p=0.051). Grade, DCIS+microinvasion, and margins were unassociated with distant disease.
CONCLUSIONS: LRR after mastectomy for DCIS±m(xù)icroinvasion is uncommon, but is more frequent among women <50 years of age, particularly in those <40 years of age. The 10-year LRR rate in this youngest group remains low at 4.2%. Young age is an independent risk factor for LRR after BCS or mastectomy.
DOI: 10.1245/s10434-019-07693-1
