【原】年龄对乳腺癌切除术后复发的影响

　　对于年轻女性而言，乳腺导管原位癌保乳手术后的局部区域复发比例较高。不过，年龄对乳腺导管原位癌±微浸润乳房切除手术后局部区域复发和远处复发的影响尚不明确。

　　2019年8月22日，美国乳腺外科医师学会和美国肿瘤外科学会《肿瘤外科学报》在线发表纽约纪念医院斯隆凯特林癌症中心、哈佛大学布莱根和波士顿妇女医院的研究报告，探讨了年龄对乳腺导管原位癌±微浸润乳房切除手术后局部区域复发和远处复发的影响。

　　该研究对1995～2017年纽约纪念医院斯隆凯特林癌症中心、2000～2015年布莱根和波士顿妇女医院达纳法伯癌症研究所连续3121例乳腺导管原位癌±微浸润乳房切除手术治疗患者进行回顾分析。将局部区域复发定义为乳腺癌同侧胸壁或引流区域淋巴结的复发。

　　结果，其中乳腺导管原位癌＋微浸润患者421例（13.5%）。中位年龄49岁，中位随访6.4年，范围0～23年，其中821例随访≥10年。

　　局部区域复发34例，其中浸润癌33例（97%）、仅胸壁复发23例（68%）。10年累计局部区域复发率为1.4%，10年累计远处复发率为0.8%。

　　根据单因素分析，局部区域复发相关因素：

• 年龄<50岁（风险比：15.0，95%置信区间：3.58～62.4，P<0.001）

• 核分级高（风险比：3.56，95%置信区间：1.60～7.88，P=0.001）

• 伴微浸润（风险比：3.35，95%置信区间：1.66～6.77，P<0.001）

• 切缘阳性（风险比：2.83，95%置信区间：0.67～12.0，P=0.14）

　　根据多因素分析，局部区域复发相关因素：

• 年龄<50岁（风险比：14.7，95%置信区间：3.5～61.5，P<0.001）

• 核分级高（风险比：3.09，95%置信区间：1.38–6.94，P=0.006）

• 伴微浸润（风险比：2.88，95%置信区间：1.40–5.92，P=0.004）

　　与年龄50～85岁相比：

• 年龄20～40岁（风险比：27.0，95%置信区间：6.0～121，P<0.001）

• 年龄40～49岁（风险比：11.8，95%置信区间：2.8～50.5，P<0.001）

　　10年累计局部区域复发率：

• 年龄20～40岁：4.2%

• 年龄40～49岁：2.0%

• 年龄50～85岁：0.2%

　　10年累计远处复发率：

• 年龄20～40岁：1.6%（对数秩，P=0.051）

• 年龄40～49岁：0.7%

• 年龄50～85岁：0.7%

　　远处复发与核分级、乳腺导管原位癌＋微浸润、切缘阳性的相关性不显著。

　　因此，该研究结果表明，虽然乳腺导管原位癌±微浸润乳房切除手术后局部区域复发少见，但是多见于年龄<50岁尤其<40岁的女性，年龄<40岁女性的10年累计局部区域复发率达4.2%，年轻可以作为保乳手术或乳房切除手术后局部区域复发的独立风险因素。

Ann Surg Oncol. 2019 Aug 22. [Epub ahead of print]

Impact of Age on Locoregional and Distant Recurrence After Mastectomy for Ductal Carcinoma In Situ With or Without Microinvasion.

Anita Mamtani, Faina Nakhlis, Stephanie Downs-Canner, Emily C. Zabor, Monica Morrow, Tari A. King, Kimberly J. Van Zee.

Memorial Sloan Kettering Cancer Center, New York, USA; Brigham and Women's Hospital, Boston, USA.

BACKGROUND: Locoregional recurrence (LRR) after breast-conserving surgery (BCS) for ductal carcinoma in situ (DCIS) is increased in young women. We examined the impact of age on LRR and distant disease after mastectomy for DCIS±microinvasion.

METHODS: We identified consecutive patients with DCIS±microinvasion treated with mastectomy from 1995 to 2017. LRR was defined as recurrence at the ipsilateral chest wall or regional nodes.

RESULTS: Overall, 3121 cases were identified, of which 421 (13.5%) had DCIS+microinvasion. Median age was 49 years and median follow-up was 6.4 years; 821 were followed for 10 or more years. Thirty-four LRRs were observed: 33 (97%) were invasive, and 23 (68%) were in the chest wall alone. Cumulative 10-year LRR incidence was 1.4%. Age<50 years, high grade, and DCIS+microinvasion were associated with LRR (p≤0.001); however, margin status was not (p=0.14). Adjusting for grade and DCIS+microinvasion, age<50 years (hazard ratio [HR] 14.7, 95% confidence interval [CI] 3.5-61.5; p<0.001) was associated with LRR. Compared with women ≥50 years of age, women age <40 years had the highest risk (HR 27.0, 95% CI 6.0-121), and women age 40-49 years had intermediate risk (HR 11.8, 95% CI 2.8-50.5). The cumulative 10-year LRR incidence was 4.2% for women <40 years of age, 2.0% for women 40-49 years of age, and 0.2% for women ≥50 years of age. Women age <40 years had a 10-year distant disease rate of 1.6% versus women age 40-49 years (0.7%) and women age ≥50 years (0.7%) (log-rank p=0.051). Grade, DCIS+microinvasion, and margins were unassociated with distant disease.

CONCLUSIONS: LRR after mastectomy for DCIS±microinvasion is uncommon, but is more frequent among women <50 years of age, particularly in those <40 years of age. The 10-year LRR rate in this youngest group remains low at 4.2%. Young age is an independent risk factor for LRR after BCS or mastectomy.

DOI: 10.1245/s10434-019-07693-1