|
2018年5月10日，施普林格·自然旗下《乳腺癌研究与治疗》在线发表西雅图华盛顿大学、纽约纪念医院斯隆凯特林癌症中心、杜克大学、佛罗里达大西洋大学、哈佛大学麻省总医院、布列根医院和波士顿女子医院、西雅图癌症治疗联盟的研究报告，根据临床病理特征，探讨了乳腺钼靶监测结局不良的预测因素。 该队列回顾研究符合《医疗保险隐私及责任法案》并且获得伦理审查委员会批准，对美国癌症联合委员会（AJCC）I～II期乳腺浸润癌接受保乳治疗后同侧乳腺癌复发或发生对侧乳腺癌的患者队列进行电子病历回顾。监测结局不良被定义乳腺钼靶监测未检出再发乳腺癌，包括间隔癌（乳腺钼靶监测结果阴性后365天内确诊）和临床检出癌（乳腺钼靶监测前365天内确诊）。通过单因素和多因素逻辑回归分析，确定乳腺钼靶监测结局不良的预测因素，包括患者和原发肿瘤特征、乳腺钼靶密度、原发肿瘤检出形式以及至再发癌确诊时间。 结果，共有164例女性符合入选标准，其中同侧乳腺癌复发65例、发生对侧乳腺癌99例；124例筛查检出再发癌。 单因素分析表明，监测结局不良（40例）相关因素：
多因素分析表明，原发乳腺癌确诊时年龄<50岁仍为监测结局不良的重要预测因素（P=0.001）。 因此，原发乳腺癌确诊时年龄小于50岁女性的乳腺钼靶监测结局不良风险较高，并且可能需要接受更为密切的临床和影像监测。 Breast Cancer Res Treat. 2018 May 10. [Epub ahead of print] Predictors of surveillance mammography outcomes in women with a personal history of breast cancer. Kathryn P. Lowry, Lior Z. Braunstein, Konstantinos P. Economopoulos, Laura Salama, Constance D. Lehman, G. Scott Gazelle, Elkan F. Halpern, Catherine S. Giess, Alphonse G. Taghian, Janie M. Lee. University of Washington, Seattle, USA; Memorial Sloan Kettering Cancer Center, New York, USA; Duke University, Durham, USA; Florida Atlantic University, Boca Raton, USA; Massachusetts General Hospital, Boston, USA; Brigham and Women's Hospital, Boston, USA; Seattle Cancer Care Alliance, Seattle, USA. PURPOSE: To identify predictors of poor mammography surveillance outcomes based on clinico-pathologic features. METHODS: This study was HIPAA compliant and IRB approved. We performed an electronic medical record review for a cohort of women with American Joint Committee on Cancer (AJCC) Stage I or II invasive breast cancer treated with breast conservation therapy who developed subsequent in-breast treatment recurrence (IBTR) or contralateral breast cancer (CBC). Poor surveillance outcome was defined as second breast cancer not detected by surveillance mammography, including interval cancers (diagnosed within 365 days of surveillance mammogram with negative results) and clinically detected cancers (diagnosed without a surveillance mammogram in the preceding 365 days). Univariate and multivariate logistic regression were performed to identify predictors of poor mammography surveillance outcome, including patient and primary tumor characteristics, breast density, mode of primary tumor detection, and time to second cancer diagnosis. RESULTS: 164 women met inclusion criteria (65 with IBTR, 99 with CBC); 124 had screen-detected second cancers. On univariate analysis, poor surveillance outcome (n = 40) was associated with age at primary cancer diagnosis < 50 years (p < 0.0001), AJCC stage II primary cancers (p = 0.007), and heterogeneously or extremely dense breasts (p = 0.04). On multivariate analysis, age < 50 years at primary breast cancer diagnosis remained a significant predictor of poor surveillance outcome (p = 0.001). CONCLUSION: Women younger than age 50 at primary breast cancer diagnosis are at risk of poor surveillance mammography outcomes, and may be appropriate candidates for more intensive clinical and imaging surveillance. KEYWORDS: History of breast cancer; Surveillance; Screening outcomes; Mammography DOI: 10.1007/s10549-018-4808-9 |
|
|
