乳腺导管原位癌保乳治疗的安全性研究

The oncologic safety of breast-conserving surgery for breast ductal carcinoma in situ

目的探讨乳腺导管原位癌（ductal carc in omainsitu，DCIS）施行保乳手术的安全性。方法回顾性分析经病理证实的119例DCIS患者资料，对手术方式、年龄、肿瘤直径、ER／PR状态、HER-2状态与局部复发、远处转移的关系进行单因素及多因素分析。结果119例DCIS患者中48例接受保乳手术治疗，71例接受乳房全切治疗。随访7～132个月（中位随访时间35个月），乳房全切组胸壁复发1例，保乳组无同侧乳房内肿瘤复发病例，差异无统计学意义（P=0．384）。全切组远处转移2例，保乳组远处转移1例，差异亦无统计学意义（P=0．383）。保乳组和全切组3年无病生存率（DFS）分别为100％、94。4％，差异无统计学意义（P=0．225）。单因素分析显示年龄≤40岁是出现远处转移的高危因素（P=0．035），但多因素分析未显示其为独立影响因素（P=0．086）。结论乳腺DCIS患者实施保乳或乳房全切，其术后局部复发和远处转移的风险无明显差异。

Objective To evaluate the safety of breast-conserving surgery for ductal carcinoma in situ （DCIS）. Methods One hundred and nineteen patients with pathologically confirmed DCIS were analyzed retrospectively. The relationship among local recurrence and distant metastasis with relevant factors including surgical procedure, age, tumor size, estrogen/progesterone status and human epithelial receptor 2 （HER-2） status were analyzed by univariate and multivariate methods. Results In this study 48 patients received breast conserving surgery,71 patients received mastectomy. All patients were followed up for 7 - 132 months （median 35 months）. Chest wall recurrence was found in mastectomy group in one case and none in ipsilateraJ breast tumor recurrence （IBTR） in breast conservation group （P = 0. 384）. Two patients had distant metastasis in mastectomy group, and one patient in breast conserving group （ P = 0. 383 ）. The three year disease-free survival （DFS）were 100% and 94.4% in breast conserving and mastectomy groups respectively（ P = 0. 225 ）. Univariate analysis showed that age （ 〈 40 years ） was the risk factor for distant metastasis （ P = 0. 035 ） , a factor not confirmed by multivariate analysis （ P = 0. 086）. Conclusions There is no significant difference on local recurrence and distant metastasis between breast conserving surgery and mastectomy for DCIS of the breast.