| 摘要: | 研究目的：
由於目前篩檢性的乳房攝影在全球性的大量運用，使乳房原位癌( Ductal carcinoma in situ )的發現率逐年上升，而目前全球對於零期乳癌病人的治療方式並未獲得一致性的共識，其中包括了乳房保留手術或乳房全切除手術之選擇和後續的輔助性療法之應用。理論上而言，原位性乳癌屬未侵犯性癌，為一發展初期的狀況，其癌細胞尚未突破基底膜 (basement membrane)，但臨床上發現病人經完整治療後，其復發率仍舊維持在7%至20%之間。此研究之目的主要是針對零期乳癌的病人，其中是否有存在特殊之因子能夠預期復發之可能性進而給予此類病人輔助性治療而達到預防其復發之目的。
研究方法：
此研究是回朔性收集中國醫學大學附設醫院從1998年至2005年此7年期間共70例零期乳癌的病人，全數接受乳房全切除術或是乳房保留手術，部份病人並於術後接受輔助性放射線治療或荷爾蒙治療。此研究中根據病人停經與否(premenopausal or postmenopausal period)、腫瘤大小(tumor size)、腫瘤數目(tumor number)、腫瘤組織分級(histologic grade)、腫瘤組織形態(type)、顯微鈣化的呈現(microcalcification)、有無組織壞死(necrosis)、有無神經浸潤(perineyral invasion)、有無淋巴血管侵犯(lymphovascular invasion)及有無腺體異化增生(apocrine metaplasia)等10項病理組織因子及荷爾蒙接受體之狀態(ER和PR)和Her-2/new的表現等3項生化因子進行分析統計研究。
研究結果：
在收集的70例零期乳癌的病人當中有4位復發，復發率為5.7%而平均復發時間為38.25個月（範圍10-23個月），而70位病人的平均年紀為51.8歲（範圍31-89歲），平均追蹤的時間為35.6個月（範圍9-92個月）。在此篇研究當中，停經前原位癌患者似乎增加乳癌復發之機會，但根據統計的結果並沒有特別相關的因子能用於預測原位癌之復發。
研究結論：
根據近期相關的文獻報告Van Nuys 分級系統在臨床上而言是一個有用的預測復發的因子，但是此研究當中所分析的十項組織病理因子及三項生化方面的因子對復發而言都沒有特別的關聯性，不過隨著分子生物學的進步，許多的因子都正在進行相關的研究，這也是未來的一個重要方向。
Aims: Because of widespread use of screening mammography, the incidence of DCIS has risen, and recurrence rate from 7 to 20% are reported after mastectomy or breast conserving surgery with adjuvant radiotherapy in DCIS patients. The prognostic factors should be identified and these patients of DCIS with risk factors should receive appropriate treatment to prevent clinical recurrence.
Patients and Methods: The 70 patients of pure DCIS receiving total mastectomy or breast conserving surgery with or without adjuvant radiotherapy after pathology confirmed were enrolled between June 1998 and May 2005 in China Medical University Hospital (CMUH). The status of menses, tumor size, tumor number, histologic grade, type, presence or absence of microcalcification, necrosis, perineural invasion, lymphovascular invasion, apocrine metaplasia, estrogen receptor (ER), progesterone receptor (PR), and HER-2/neu are chosen to analyzed with immunohistochemistry method. Fisher’s exact test and the logistic regression were used for statistical analysis.
Results: There was a total of 70 patients with DCIS enrolled in this study. The four of the patients (5.7%, 4/70) had a recurrence with median interval to recurrence of 38.25 months (range 10-83 months). The median age in the 70 patients was 51.8 years (range 31-89 years) and the age at diagnosis of DCIS was 48.35 years ( range 27-86 years). The median length of follow-up was 35.6 months ( range 9-92 months). In this study, the DCIS patients within premenopausal period seem to be associated with increased risk of recurrence. However there were no histopathological or biological factors showing significant relation with recurrence.
Conclusion: Based on the current review, the Van Nuys classification system was a useful predictor for recurrence although there was no significant biological and histopathological difference in our study. In this study, the DCIS patients within premenopausal period seem to be associated with increased risk of recurrence. There is a need of further evaluation of the genetic expression to find the useful predictors for elimination of recurrence in DCIS patients. |
