BACKGROUND Breast-conserving surgery alone, breast-conserving surgery with adjuvant radiation treatment, and mastectomy are guideline-concordant treatments for ductal carcinoma in situ. The aim of this study was to compare survival outcomes between these treatment options. METHODS A stratified random sample of patients diagnosed with pure ductal carcinoma in situ between 2008 and 2014 was selected from 1330 sites in the USA. Data on diagnosis, treatment, and follow-up were abstracted by local cancer registrars. Population-averaged marginal estimates of disease-specific survival and overall survival for breast-conserving surgery alone, breast-conserving surgery with radiation treatment, and mastectomy were obtained by combining sampling and overlap weights. RESULTS A total of 18 442 women were included, with a median follow-up of 67.8 (interquartile range 46.1-93.5) months. A total of 35 women died from breast cancer, at a median age of 62 (interquartile range 50-74) years. Population-averaged 8-year rates of disease-specific survival were 99.6% or higher for all treatment groups, with no significant differences between groups (breast-conserving surgery alone versus breast-conserving surgery with radiation treatment, HR 1.19 (95% c.i. 0.29 to 4.85); and mastectomy versus breast-conserving surgery with radiation treatment, HR 1.74 (95% c.i. 0.53 to 5.72). There was no difference in overall survival between the patients who underwent a mastectomy and the patients who underwent breast-conserving surgery with radiation treatment (HR 1.09 (95% c.i. 0.83 to 1.43)). Patients who underwent breast-conserving surgery alone had lower overall survival compared with the patients who underwent breast-conserving surgery with radiation treatment (HR 1.29 (95% c.i. 1.00 to 1.67)). This survival difference vanished for all but one subgroup, namely patients less than 65 years (HR 1.86 (95% c.i. 1.15 to 3.00)). CONCLUSION There was no statistically significant difference in disease-specific survival between women operated with breast-conserving surgery alone, breast-conserving surgery with radiation treatment, or mastectomy for ductal carcinoma in situ. Given the low absolute risk of disease-specific mortality, these results provide confidence in offering individualized locoregional treatment without fear of compromising survival.

中文翻译：

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导管原位癌局部治疗后患者的疾病特异性生存结果：观察性队列研究。


背景单纯保乳手术、保乳手术联合辅助放射治疗以及乳房切除术是导管原位癌的符合指南的治疗方法。本研究的目的是比较这些治疗方案之间的生存结果。方法 从美国 1330 个地点中选取 2008 年至 2014 年间诊断为单纯导管原位癌的患者进行分层随机样本。有关诊断、治疗和随访的数据由当地癌症登记员提取。通过结合抽样和重叠权重，获得了单独保乳手术、保乳手术加放射治疗和乳房切除术的疾病特异性生存率和总体生存率的群体平均边际估计。结果 总共纳入了 18 442 名女性，中位随访时间为 67.8 个月（四分位距 46.1-93.5）个月。共有 35 名女性死于乳腺癌，中位年龄为 62 岁（四分位距 50-74 岁）。所有治疗组的人群平均 8 年疾病特异性生存率为 99.6% 或更高，组间无显着差异（单独保乳手术与放疗联合保乳手术，HR 1.19（95% CI 0.29）至 4.85）；乳房切除术与保乳手术加放射治疗相比，HR 1.74（95% CI 0.53 至 5.72）。与接受放射治疗的保乳手术患者相比（HR 1.09（95% CI 0.83 至 1.43）），仅接受保乳手术的患者总体生存率较低（HR 1.29（95% ci 1.00 至 1.67））。 ））。 除一个亚组（即小于 65 岁的患者）外，所有亚组的生存率差异都消失了（HR 1.86（95% CI 1.15 至 3.00））。结论：单纯保乳手术、保乳手术加放射治疗或导管原位癌乳房切除术的女性之间，疾病特异性生存率没有统计学上的显着差异。鉴于疾病特异性死亡率的绝对风险较低，这些结果为提供个体化局部治疗提供了信心，而不必担心影响生存。