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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导管原位癌局部区域治疗后患者的疾病特异性生存结果：观察性队列研究。


背景 单独的保乳手术、保乳手术联合辅助放射治疗和乳房切除术是导管原位癌的指南一致治疗方法。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 2008 年至 2014 年诊断为纯导管原位癌的患者的分层随机样本中选出美国 1330 个地点。有关诊断、治疗和随访的数据由当地癌症登记员提取。通过结合采样和重叠权重获得单独保乳手术、保乳手术联合放射治疗和乳房切除术的疾病特异性生存率和总生存期的人群平均边际估计值。结果 共纳入 18 442 例女性，中位随访时间为 67.8 （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）。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，组间无显著差异（单独保乳手术与保乳手术联合放射治疗，HR 1.19（95% CI 0.29 至 4.85）;乳房切除术与保乳手术联合放射治疗，HR 1.74（95% CI 0.53 至 5.72）。接受乳房切除术的患者和接受保乳手术联合放射治疗的患者的总生存期没有差异 （HR 1.09 （95% ci. 0.83 至 1.43））。与接受保乳手术联合放射治疗的患者相比，仅接受保乳手术的患者总生存期较低 （HR 1.29 （95% CI： 1.00， 1.67））。 除了一个亚组外，所有亚组的生存差异都消失了，即 65 岁以下的患者 （HR 1.86 （95% ci. 1.15 至 3.00））。结论 单独保乳手术、保乳手术联合放疗或乳腺切除术治疗导管原位癌的妇女疾病特异性生存率差异无统计学意义。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区域治疗提供了信心，而不必担心牺牲生存率。