Feasibility and Prognostic Analysis of Neoadjuvant Therapy Followed by Breast-Conserving Surgery for Invasive Ductal Carcinoma Combined with Ductal Carcinoma in Situ

This study aim to investigate the oncological safety of neoadjuvant therapy (NAT) followed by breast-conserving surgery (BCS) for invasive ductal carcinoma (IDC) patients with the presence of ductal carcinoma in situ (DCIS) on pre-NAT biopsy. The data of women with IDC who underwent radical surgery between January 2013 and December 2021 were retrospectively reviewed from two institutions. The study endpoints were 5-year disease-free survival (DFS) and local recurrence-fee survival (LRFS). Overall, 994 eligible patients were enrolled. Patients with IDC with DCIS (n = 277) and patients undergoing BCS (n = 285) were selected separately for prognostic analysis. For patients with IDC with DCIS, the 5-year DFS (p = 0.517) and 5-year LRFS (p = 0.397) rates of the patients undergoing BCS were similar to those of patients undergoing mastectomy after propensity score matching. In addition, the 285 patients who underwent BCS were divided into the IDC + DCIS and IDC groups. The 5-year DFS (p = 0.394) and 5-year LRFS (p = 0.341) rates were similar between the IDC and IDC + DCIS groups. NAT followed by BCS combined with adjuvant radiotherapy is a safe and feasible treatment option in patients with IDC with DCIS under the premise of strict adherence to the surgical indications and adequate incision margins.

本研究旨在探讨新辅助治疗（neoadjuvant therapy, NAT）序贯保乳手术（breast-conserving surgery, BCS）用于术前活检提示伴导管原位癌（ductal carcinoma in situ, DCIS）的浸润性导管癌（invasive ductal carcinoma, IDC）患者的肿瘤学安全性。本研究回顾性分析了2013年1月至2021年12月期间两家医疗机构收治的接受根治性手术的IDC女性患者数据。研究终点为5年无病生存期（disease-free survival, DFS）与5年局部无复发生存期（local recurrence-free survival, LRFS）。最终共纳入994例符合入组标准的患者。针对伴DCIS的IDC患者（n=277）以及接受BCS的患者（n=285）分别开展预后分析。经倾向性评分匹配（propensity score matching）后，伴DCIS的IDC患者中，接受BCS者与接受乳房切除术者的5年DFS（p=0.517）与5年LRFS（p=0.397）无显著差异。此外，将285例接受BCS的患者分为IDC伴DCIS亚组与单纯IDC亚组，两组的5年DFS（p=0.394）与5年LRFS（p=0.341）亦无显著差异。在严格遵循手术适应证并确保充足切缘的前提下，新辅助治疗序贯保乳手术联合辅助放疗用于伴DCIS的IDC患者是安全且可行的治疗方案。