Predictors of local recurrence after treatment of ductal carcinoma in situ - A meta-analysis

摘要: lBACKGROUND. Management of patients with ductal carcinoma in situ (DCIS) is a dilemma, as mastectomy provides nearly 100% cure rate but at the expense physical and psychologic morbidity. It would be helpful if we could predict which DCIS are sufficiently high risk local recurrence after conservative surgery (CS) alone to warrant postoperative radiotherapy (RT) sufficient CS + RT mastectomy. The authors reviewed published studies identified factors that may predictive management by mastectomy, alone, or RT. METHODS. examined patient, tumor, treatment potential predictors for estimated risks based on review studies. They effects patient (age diagnosis family history), tumor (sub-type DCIS, grade, size, necrosis, margins), (mastectomy, RT). 95% confidence intervals (CI) rates each were calculated subtype, using exact binomial; summary CI category quantitative meta-analysis fixed random models applied proportions. RESULTS, Meta-analysis yielded 22.5% (95% = 16.9-28.2) employing 8.9% 6.8-11.0) RT, 1.4% 0.7-2.1) involving alone. These figures indicate clear statistically significant separation, therefore outcome, between category, despite likelihood who underwent likely have had smaller, possibly low grade lesions margins. presence cytologic features, comedo subtype found derive greatest improvement control addition CS. Local among treated approximately 20%, one-half recurrences invasive cancers. For most patients, reduces least 50%. differences apparent those tumors close positive surgical CONCLUSIONS, recommend radiation added also choose breast conservation over suitable outside clinical trial little no Use statistics when discussing outcomes help make decisions. Cancer 1999;85:616-28. (C) 1999 American Society.