背景:2016年关于乳腺导管原位癌(DCIS)保乳手术(BCS)全乳照射(WBI)边缘的共识指南建议2mm边缘以降低局部复发率。我们检查了再切除率,成本,指南实施前后患者满意度。
方法:来自机构审查委员会批准的数据库,我们对在一家学术机构和一家社区癌症中心接受BCS随访超过1年的DCIS患者进行了评估.比较两组患者接受治疗的时间,即在2016年11月之前(共识前[PRE])和之后(共识后[POST]),关于结果和成本参数。
结果:实施共识指南后,再切除率(32.1%vs.20.0%)和乳房切除术转化率(8.3%vs.2.3%)显著增加,虽然总切除量,每位患者的手术费用,对乳房评分的满意度没有差异。并非所有边缘<2mm的患者都被重新切除,尽管该子集的再切除率显着增加(62.4%vs.31.3%)。关于控制年龄的多变量分析,雌激素受体状态,WBI使用,和保证金状态,一致指南发表后的手术与较高的再次切除率(比值比[OR]1.97,95%置信区间[CI]1.08~3.59,p=0.03)和较高的乳房切除术转阴率(OR6.84,95%CI1.67~28.00,p=0.007)独立相关.
结论:2016年DCIS边际共识指南的实施导致两个机构的再次切除和乳房切除术转换增加。需要研究降低DCIS再切除率的手术工具和策略。
BACKGROUND: The 2016
consensus guideline on margins for breast-conserving surgery (BCS) with whole-breast irradiation (WBI) for ductal carcinoma in situ (DCIS) recommended 2 mm margins to decrease local recurrence rates. We examined re-excision rates, cost, and patient satisfaction before and after
guideline implementation.
METHODS: From an Institutional Review Board-approved database, patients with DCIS who underwent BCS with over 1 year of follow-up at one academic institution and one community cancer center were evaluated. Two groups were compared based on when they received treatment, i.e. before (pre-consensus [PRE]) and after November 2016 (post consensus [POST]), with respect to outcome and cost parameters.
RESULTS: After
consensus guideline implementation, re-excision rate (32.1% vs. 20.0%) and mastectomy conversion (8.3% vs. 2.3%) significantly increased, although total resection volume, operative cost per patient, and satisfaction with breast scores did not differ. Not all patients with <2 mm margins were re-excised, although the re-excision rate among this subset significantly increased (62.4% vs. 31.3%). On multivariable analysis controlling for age, estrogen receptor status, WBI use, and margin status, surgery after consensus
guideline publication was independently associated with a higher re-excision rate (odds ratio [OR] 1.97, 95% confidence interval [CI] 1.08-3.59, p = 0.03) and a higher rate of conversion to mastectomy (OR 6.84, 95% CI 1.67-28.00, p = 0.007).
CONCLUSIONS: Implementation of the 2016 margin
consensus guideline for DCIS resulted in an increase in re-excisions and mastectomy conversions at two institutions. Research is needed for operative tools and strategies to decrease DCIS re-excision rates.