乳腺導(dǎo)管浸潤(rùn)癌通常單獨(dú)發(fā)生，或者與乳腺導(dǎo)管原位癌共存（導(dǎo)管浸潤(rùn)癌＋導(dǎo)管原位癌）。若干研究已經(jīng)表明單純導(dǎo)管浸潤(rùn)癌可能表現(xiàn)出與導(dǎo)管浸潤(rùn)癌＋導(dǎo)管原位癌不同的生物學(xué)行為，但是尚不明確這能否轉(zhuǎn)化為不同結(jié)局。
2019年7月9日，英國(guó)《自然》旗下《科學(xué)報(bào)告》在線發(fā)表美國(guó)耶魯大學(xué)醫(yī)學(xué)院的研究報(bào)告，比較了單純導(dǎo)管浸潤(rùn)癌與導(dǎo)管浸潤(rùn)癌＋導(dǎo)管原位癌的總生存。
該研究通過(guò)國(guó)家癌癥研究所全國(guó)癌癥數(shù)據(jù)庫(kù)，確定被診斷為單純導(dǎo)管浸潤(rùn)癌或?qū)Ч芙?rùn)癌＋導(dǎo)管原位癌的I～I(xiàn)II期乳腺癌患者共計(jì)49萬(wàn)4801例。
結(jié)果發(fā)現(xiàn)，導(dǎo)管浸潤(rùn)癌＋導(dǎo)管原位癌與單純導(dǎo)管浸潤(rùn)癌相比，總生存顯著較好（5年總生存：89.3%比85.5%，P<0.001），并且通過(guò)多因素比例風(fēng)險(xiǎn)回歸模型分析，無(wú)論人口統(tǒng)計(jì)學(xué)、臨床和治療相關(guān)因素如何，總生存仍然顯著較好。
對(duì)于導(dǎo)管浸潤(rùn)癌＋導(dǎo)管原位癌，總生存顯著優(yōu)勢(shì)僅見(jiàn)于浸潤(rùn)癌小于4厘米或淋巴結(jié)陰性患者。對(duì)于導(dǎo)管原位癌比例≥25%的患者，總生存改善更大。
此外，導(dǎo)管浸潤(rùn)癌＋導(dǎo)管原位癌與TN分期較低、分級(jí)低或中、雌孕激素受體陽(yáng)性、接受乳房切除術(shù)相關(guān)。
因此，導(dǎo)管浸潤(rùn)癌患者存在導(dǎo)管原位癌成分與有利的臨床特征相關(guān)，并且可以獨(dú)立預(yù)測(cè)總生存改善。導(dǎo)管浸潤(rùn)癌＋導(dǎo)管原位癌可能為乳腺癌患者的有用預(yù)后因素，尤其如果考慮對(duì)腫瘤較小或淋巴結(jié)陰性乳腺癌進(jìn)行治療降級(jí)。
Sci Rep. 2019 Jul 9. [Epub ahead of print]
Overall survival is improved when DCIS accompanies invasive breast cancer.
Adam J. Kole, Henry S. Park, Skyler B. Johnson, Jacqueline R. Kelly, Meena S. Moran, Abhijit A. Patel.
Yale University School of Medicine, New Haven, CT, USA.
Invasive ductal carcinoma (IDC) often presents alone or with a co-existing ductal carcinoma in situ component (IDC + DCIS). Studies have suggested that pure IDC may exhibit different biological behavior than IDC + DCIS, but whether this translates to a difference in outcomes is unclear. Here, utilizing the National Cancer Database we identified 494,801 stage I-III breast cancer patients diagnosed with either IDC alone or IDC + DCIS. We found that IDC + DCIS was associated with significantly better overall survival (OS) compared to IDC alone (5-year OS, 89.3% vs. 85.5%, p < 0.001), and this finding persisted on multivariable Cox modeling adjusting for demographic, clinical, and treatment-related variables. The significantly superior OS observed for IDC + DCIS was limited to patients with invasive tumor size < 4 cm or with node negative disease. A greater improvement in OS was observed for tumors containing ≥25% DCIS component. We also found IDC + DCIS to be associated with lower T/N stage, low/intermediate grade, ER/PR positivity, and receipt of mastectomy. Thus, the presence of a DCIS component in patients with IDC is associated with favorable clinical characteristics and independently predicts improved OS. IDC + DCIS could be a useful prognostic factor for patients with breast cancer, particularly if treatment de-escalation is being considered for small or node negative tumors.
DOI: 10.1038/s41598-019-46309-2
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