目的:目前导管原位癌(DCIS)的治疗标准是手术加或不加辅助放疗。随着关于低风险DCIS的过度诊断和过度治疗的争论越来越多,一些正在进行的试验正在探索主动监测.我们进行了系统评价和荟萃分析,以评估各种治疗方法下低危DCIS的复发情况。
方法:PubMed,Embase,WebofScience,和Cochrane搜索报告同侧乳腺肿瘤事件(IBTE)的研究,对侧乳腺癌(CBC),低风险DCIS患者的5年和10年乳腺癌特异性生存率(BCSS)。主要结果是侵入性IBTE(iIBTE),定义为同侧乳腺的侵入性进展。
结果:确定了33项符合条件的研究,涉及47,696名低风险DCIS女性。合并的5年和10年iIBTE率为3.3%(95%置信区间[CI]:1.3,8.1)和5.9%(95%CI:3.8,9.0),分别。与未接受手术的患者相比,接受手术的患者的iIBTE发生率显着降低,在5年(3.5%与9.0%,P=0.003)和10年(6.4%与22.7%,P=0.008)。同样,手术组的10年BCSS率较高(96.0%vs.99.6%,P=0.010)。在接受保乳手术治疗的患者中,额外放疗显著降低IBTE风险,但不是总的CBC风险。
结论:本综述显示,接受手术和额外RT治疗低危DCIS的女性患者的进展风险较低,生存率较高。然而,我们的发现主要基于观察性研究,并应与正在进行的试验的结果确认。
OBJECTIVE: The current standard of treatment for ductal carcinoma in situ (DCIS) is surgery with or without adjuvant radiotherapy. With a growing debate about overdiagnosis and overtreatment of low-risk DCIS, active surveillance is being explored in several ongoing trials. We conducted a systematic review and meta-analysis to evaluate the recurrence of low-risk DCIS under various treatment approaches.
METHODS: PubMed, Embase, Web of Science, and Cochrane were searched for studies reporting ipsilateral breast tumour event (IBTE), contralateral breast cancer (CBC), and breast cancer-specific survival (BCSS) rates at 5 and 10 years in low-risk DCIS. The primary outcome was invasive IBTE (iIBTE) defined as invasive progression in the ipsilateral breast.
RESULTS: Thirty three eligible studies were identified, involving 47,696 women with low-risk DCIS. The pooled 5-year and 10-year iIBTE rates were 3.3% (95% confidence interval [CI]: 1.3, 8.1) and 5.9% (95% CI: 3.8, 9.0), respectively. The iIBTE rates were significantly lower in patients who underwent surgery compared to those who did not, at 5 years (3.5% vs. 9.0%, P = 0.003) and 10 years (6.4% vs. 22.7%, P = 0.008). Similarly, the 10-year BCSS rate was higher in the surgery group (96.0% vs. 99.6%, P = 0.010). In patients treated with breast-conserving surgery, additional radiotherapy significantly reduced IBTE risk, but not total-CBC risk.
CONCLUSIONS: This review showed a lower risk of progression and better survival in women who received surgery and additional RT for low-risk DCIS. However, our findings were primarily based on observational studies, and should be confirmed with the results from the ongoing trials.