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Long-term risk of subsequent ipsilateral lesions after surgery with or without radiotherapy for ductal carcinoma in situ of the breast
British Journal of Cancer ( IF 6.4 ) Pub Date : 2021-08-18 , DOI: 10.1038/s41416-021-01496-6
Maartje van Seijen 1 , Esther H Lips 1 , Liping Fu 1 , Daniele Giardiello 1 , Frederieke van Duijnhoven 2 , Linda de Munck 3 , Lotte E Elshof 4 , Alastair Thompson 5 , Elinor Sawyer 6 , Marc D Ryser 7, 8 , E Shelley Hwang 9 , Marjanka K Schmidt 1, 10 , Paula H M Elkhuizen 11 , , Jelle Wesseling 12, 13 , Michael Schaapveld 14
Affiliation  

Background

Radiotherapy (RT) following breast-conserving surgery (BCS) for ductal carcinoma in situ (DCIS) reduces ipsilateral breast event rates in clinical trials. This study assessed the impact of DCIS treatment on a 20-year risk of ipsilateral DCIS (iDCIS) and ipsilateral invasive breast cancer (iIBC) in a population-based cohort.

Methods

The cohort comprised all women diagnosed with DCIS in the Netherlands during 1989–2004 with follow-up until 2017. Cumulative incidence of iDCIS and iIBC following BCS and BCS + RT were assessed. Associations of DCIS treatment with iDCIS and iIBC risk were estimated in multivariable Cox models.

Results

The 20-year cumulative incidence of any ipsilateral breast event was 30.6% (95% confidence interval (CI): 28.9–32.6) after BCS compared to 18.2% (95% CI 16.3–20.3) following BCS + RT. Women treated with BCS compared to BCS + RT had higher risk of developing iDCIS and iIBC within 5 years after DCIS diagnosis (for iDCIS: hazard ratio (HR)age < 50 3.2 (95% CI 1.6–6.6); HRage ≥ 50 3.6 (95% CI 2.6–4.8) and for iIBC: HRage<50 2.1 (95% CI 1.4–3.2); HRage ≥ 50 4.3 (95% CI 3.0–6.0)). After 10 years, the risk of iDCIS and iIBC no longer differed for BCS versus BCS + RT (for iDCIS: HRage < 50 0.7 (95% CI 0.3–1.5); HRage ≥ 50 0.7 (95% CI 0.4–1.3) and for iIBC: HRage < 50 0.6 (95% CI 0.4–0.9); HRage ≥ 50 1.2 (95% CI 0.9–1.6)).

Conclusion

RT is associated with lower iDCIS and iIBC risk up to 10 years after BCS, but this effect wanes thereafter.



中文翻译:

乳腺导管原位癌手术加或不加放疗后后续同侧病变的长期风险

背景

在临床试验中,导管原位癌 (DCIS) 保乳手术 (BCS) 后的放疗 (RT) 可降低同侧乳房事件发生率。本研究评估了基于人群的队列中 DCIS 治疗对同侧 DCIS (iDCIS) 和同侧浸润性乳腺癌 (iIBC) 20 年风险的影响。

方法

该队列包括 1989-2004 年在荷兰被诊断患有 DCIS 并随访至 2017 年的所有女性。评估了 BCS 和 BCS + RT 后 iDCIS 和 iIBC 的累积发生率。在多变量 Cox 模型中估计了 DCIS 治疗与 iDCIS 和 iIBC 风险的关联。

结果

BCS 后任何同侧乳房事件的 20 年累积发生率为 30.6%(95% 置信区间 (CI):28.9-32.6),而 BCS + RT 后为 18.2%(95% CI 16.3-20.3)。与 BCS + RT 相比,接受 BCS 治疗的女性在 DCIS 诊断后 5 年内发生 iDCIS 和 iIBC 的风险更高(对于 iDCIS:风险比 (HR)年龄 < 50 3.2(95% CI 1.6–6.6);HR年龄 ≥ 50 3.6 (95% CI 2.6–4.8) 和 iIBC:HR年龄<50 2.1 (95% CI 1.4–3.2);HR年龄≥ 50 4.3 (95% CI 3.0–6.0))。10 年后,BCS 与 BCS + RT 的 iDCIS 和 iIBC 风险不再存在差异(对于 iDCIS:HR年龄 < 50 ± 0.7 (95% CI 0.3–1.5);HR年龄 ≥ 50 ±0.7 (95% CI 0.4–1.3)对于 iIBC:HR年龄 < 500.6(95% CI 0.4–0.9);HR年龄 ≥ 50 1.2 (95% CI 0.9–1.6))。

结论

RT 与 BCS 后长达 10 年的较低 iDCIS 和 iIBC 风险相关,但此后这种影响减弱。

更新日期:2021-08-19
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