乳腺导管浸润癌±原位癌的总生存

　　乳腺导管浸润癌通常单独发生，或者与乳腺导管原位癌共存（导管浸润癌＋导管原位癌）。若干研究已经表明单纯导管浸润癌可能表现出与导管浸润癌＋导管原位癌不同的生物学行为，但是尚不明确这能否转化为不同结局。

　　2019年7月9日，英国《自然》旗下《科学报告》在线发表美国耶鲁大学医学院的研究报告，比较了单纯导管浸润癌与导管浸润癌＋导管原位癌的总生存。

　　该研究通过国家癌症研究所全国癌症数据库，确定被诊断为单纯导管浸润癌或导管浸润癌＋导管原位癌的I～III期乳腺癌患者共计49万4801例。

　　结果发现，导管浸润癌＋导管原位癌与单纯导管浸润癌相比，总生存显著较好（5年总生存：89.3%比85.5%，P<0.001），并且通过多因素比例风险回归模型分析，无论人口统计学、临床和治疗相关因素如何，总生存仍然显著较好。

　　对于导管浸润癌＋导管原位癌，总生存显著优势仅见于浸润癌小于4厘米或淋巴结阴性患者。对于导管原位癌比例≥25%的患者，总生存改善更大。

　　此外，导管浸润癌＋导管原位癌与TN分期较低、分级低或中、雌孕激素受体阳性、接受乳房切除术相关。

　　因此，导管浸润癌患者存在导管原位癌成分与有利的临床特征相关，并且可以独立预测总生存改善。导管浸润癌＋导管原位癌可能为乳腺癌患者的有用预后因素，尤其如果考虑对肿瘤较小或淋巴结阴性乳腺癌进行治疗降级。

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