Risk Factors for Ipisilateral Breast Tumor Recurrence in Patients with Ductal Carcinoma in Situ Undergoing Wide Excision Alone

乳管原位癌接受乳房保留手術後之局部復發相關危險因子

10.6316/TRO/200714(3)141

黃奎綱(Kuei-Kang Huang)；呂美君(Mei-Chun Lu)；曹美華(Mei-Hua Tsou)；林寬仁(Christopher K.J. Lin)；鄭鴻鈞(Skye Hung-Chun Cheng)；簡哲民(Jer-Min Jian)

同側乳房腫瘤復發 ； 乳管原位癌 ； 乳房保留手術 ； Ipsilateral breast tumor recurrence ； Ductal carcinoma in situ ； Wide excision

放射治療與腫瘤學

14卷3期（2007 / 09 / 01）

141 - 147

英文

目的：我們回顧本院乳管原位癌以乳房保留手術治療的病人，並分析其同側乳房腫瘤復發相關的危險因子。 材料與方法：自1990年1月至2002年12月間，於和信治癌中心醫院治療的257位乳管原位癌病人中，有47位只接受乳房保留手術且無術後放射線治療的病人列入分析。我們探討下列危險因子，包括腫瘤大小、細胞核分化、病灶切除周邊安全距離、病灶組織壞死、細胞核的有絲分裂、多發性腫瘤、賀爾蒙受體、年齡、鈣化點、再次切除、對側侵犯性癌症、奈氏指數等等，與同側乳房腫瘤復發的關係。 結果：於中位數5.94年的追蹤時間，同側乳房腫瘤復發發生於6位病人，其中有3位是侵犯性癌症，3位仍是乳管原位癌單。單變項分析中，病灶組織壞死是唯一統計學上有意義的危險因子，而細胞核分化、細胞核的有絲分裂、奈氏指數≥6，則是接近有統計學上的意義。至於多單變項分析則未得到有意義的危險因子。 結論：病灶組織壞死是和同側乳房腫瘤復發相關的危險因子。

Purpose: We review our experience of treating ductal carcinoma in situ (DCIS) patients with wide excision alone and examine risk factors that are associated with ipsilateral breast tumor recurrence (IBTR). Materials and Methods: Between January 1990 and December 2002, 47 out of 257 DCIS patients who were treated with wide excision alone were included in this study. The primary end point of this study was IBTR. Local control rate was calculated by Kaplan-Meier method. Variables including tumor size, nuclear grade, margin status, necrosis, mitosis, multifocal disease, ER/PR status, patient's age, microcalcification, re-excision, contralateral invasive carcinoma, and Van Nuys prognostic index (VNPI) were enrolled for analysis Result: With a median follow-up interval of 5.94 years, IBTR developed in 6 patients (12.5%), with 3 invasive carcinomas, and 3 DCIS. Necrosis was the only significant prognostic factor for IBTR (p= 0.0249) by Fisher's exact test. Nuclear grade, VNPI ≥ 6, and mitosis were marginal significant (p= 0.0586, p= 0.0718, and p= 0.0684, respectively). Multivariate analysis failed to identify any significant risk factors. Conclusion: Necrosis is a significant risk factor for IBRT in patients with DCIS undergoing wide excision alone.