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随着局部治疗方法的进步，乳腺导管原位癌女性发生对侧乳腺癌风险可能超过再次发生同侧乳腺癌的风险。 2018年6月26日，施普林格·自然旗下《乳腺癌研究与治疗》在线发表哈佛大学医学院、哈佛皮尔格林医保研究所、达纳法伯癌症研究所、达纳法伯哈佛癌症中心、犹他大学、威斯康星大学的研究报告，探讨了雌激素受体状态是否影响对侧乳腺癌风险。 该研究根据监测流行病学最终结果（SEER）数据库找出1990～2002年诊断为乳腺导管原位癌的40～79岁女性，通过多因素竞争风险回归模型，分析由首次乳腺导管原位癌至对侧乳腺癌（浸润或原位）的时间预测因素。 结果发现，雌激素受体状态为对侧乳腺癌10年累计发生率的高度显著预测因素：
因此，该研究结果表明，雌激素受体阳性乳腺导管原位癌可能代表一种组织效应，可以增加所有乳腺组织发生癌症的倾向，无论同侧还是对侧。相反，雌激素受体阴性乳腺导管原位癌可能代表孤立的局部事件。由于大多数乳腺导管原位癌为雌激素受体阳性，并且只有少数乳腺导管原位癌患者接受激素治疗，考虑雌激素受体状态可能影响治疗和监测手段。 Breast Cancer Res Treat. 2018 Jun 26. Estrogen-receptor status and risk of contralateral breast cancer following DCIS. Natasha K. Stout, Angel M. Cronin, Hajime Uno, Elissa M. Ozanne, Michael J. Hassett, Elizabeth S. Frank, Caprice C. Greenberg, Rinaa S. Punglia. Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, USA; Harvard Medical School, Dana-Farber Cancer Institute, Boston, USA; University of Utah, Salt Lake City, USA; Dana-Farber/Harvard Cancer Center Breast Cancer Advocacy Group, Dana-Farber Cancer Institute, Boston, USA; University of Wisconsin School of Medicine, Madison, USA. PURPOSE: As local therapies improve, contralateral breast cancer (CBC) risk for women with ductal carcinoma in situ (DCIS) may exceed the risk of a second ipsilateral breast cancer. We sought to determine whether estrogen-receptor (ER) status influenced CBC risk. METHODS: We identified women aged 40-79 with DCIS diagnosed between 1990 and 2002 using the Surveillance, Epidemiology, and End Results database. We used multivariable competing risk regression to examine predictors of time from index DCIS to CBC (invasive or in situ). RESULTS: Multivariable competing risk regression found ER status to be a highly significant predictor of CBC. The 10-year cumulative incidence was estimated to be 5.3% (95% CI 4.8-5.8%) among ER positive (ER+) cases and 3.3% (95% CI 2.6-4.0%) among ER negative (ER-). CONCLUSIONS: This finding suggests that ER+ DCIS may represent a field effect that confers increased propensity for developing cancer across breast tissue, regardless of laterality. In contrast, ER- DCIS may represent an isolated local event. Given that the majority of DCIS is ER+, and only a minority of DCIS patients receive hormonal therapy, consideration of ER status may influence treatment and surveillance approaches. KEYWORDS: Breast cancer; Estrogen receptor; Ductal carcinoma in situ; Recurrence DOI: 10.1007/s10549-018-4860-5 |
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