Outcomes from low-risk ductal carcinoma in situ: a systematic review and meta-analysis.

IF 3 3区 医学 Q2 ONCOLOGY
Breast Cancer Research and Treatment Pub Date : 2024-11-01 Epub Date: 2024-08-24 DOI:10.1007/s10549-024-07473-w
Qian Chen, Ian Campbell, Mark Elwood, Alana Cavadino, Phyu Sin Aye, Sandar Tin Tin
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引用次数: 0

Abstract

Purpose: 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.

Conclusion: 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.

Abstract Image

低风险导管原位癌的治疗结果:系统回顾和荟萃分析。
目的:目前治疗导管原位癌(DCIS)的标准是手术加或不加辅助放疗。随着对低风险 DCIS 过度诊断和过度治疗的争论越来越多,目前正在进行的几项试验正在探索主动监测。我们进行了一项系统性回顾和荟萃分析,以评估各种治疗方法下低危DCIS的复发情况:方法:我们在 PubMed、Embase、Web of Science 和 Cochrane 上检索了报告低风险 DCIS 5 年和 10 年同侧乳腺肿瘤事件 (IBTE)、对侧乳腺癌 (CBC) 和乳腺癌特异性生存率 (BCSS) 的研究。主要结果是浸润性 IBTE(iIBTE),定义为同侧乳房的浸润性进展:结果:共确定了 33 项符合条件的研究,涉及 47,696 名患有低风险 DCIS 的女性。汇总的5年和10年iIBTE率分别为3.3%(95%置信区间[CI]:1.3, 8.1)和5.9%(95%置信区间:3.8, 9.0)。与未接受手术的患者相比,接受手术的患者在5年(3.5% vs. 9.0%,P = 0.003)和10年(6.4% vs. 22.7%,P = 0.008)时的iIBTE率明显较低。同样,手术组的 10 年 BCSS 率更高(96.0% 对 99.6%,P = 0.010)。在接受保乳手术治疗的患者中,额外的放疗能显著降低IBTE风险,但不能降低总CBC风险:本综述显示,接受手术和附加 RT 治疗低风险 DCIS 的女性患者病情恶化的风险更低,生存率更高。然而,我们的研究结果主要是基于观察性研究,应与正在进行的试验结果相印证。
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来源期刊
CiteScore
6.80
自引率
2.60%
发文量
342
审稿时长
1 months
期刊介绍: Breast Cancer Research and Treatment provides the surgeon, radiotherapist, medical oncologist, endocrinologist, epidemiologist, immunologist or cell biologist investigating problems in breast cancer a single forum for communication. The journal creates a "market place" for breast cancer topics which cuts across all the usual lines of disciplines, providing a site for presenting pertinent investigations, and for discussing critical questions relevant to the entire field. It seeks to develop a new focus and new perspectives for all those concerned with breast cancer.
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