• 重慶醫(yī)科大學(xué)附屬第一醫(yī)院普通外科(重慶 400016);

目的 　總結(jié)乳腺導(dǎo)管原位癌的治療現(xiàn)狀與進(jìn)展。
方法 　查閱近年來關(guān)于乳腺導(dǎo)管原位癌治療現(xiàn)狀與進(jìn)展的文獻(xiàn)資料，并作綜述。
結(jié)果 　隨著乳腺導(dǎo)管原位癌發(fā)病率的增加，其治療方法也在不斷演變。外科治療包括全乳切除術(shù)和保乳術(shù)（BCS）。保乳術(shù)聯(lián)合放療被認(rèn)為是標(biāo)準(zhǔn)的減少局部腫瘤復(fù)發(fā)的方法。內(nèi)分泌治療也在臨床上得到了重視及應(yīng)用。
結(jié)論 　保乳術(shù)與綜合治療已成為乳腺導(dǎo)管原位癌治療的主要方法，需要通過進(jìn)一步的研究來確定何種乳腺導(dǎo)管原位癌亞組只需行BCS術(shù)而不需要其他的輔助治療。微創(chuàng)治療將是乳腺導(dǎo)管原位癌治療的一個(gè)發(fā)展方向。

引用本文： 成宏,楊光倫. 乳腺導(dǎo)管原位癌的治療現(xiàn)狀與進(jìn)展. 中國普外基礎(chǔ)與臨床雜志, 2013, 20(6): 704-708. doi: 復(fù)制

1. Ernster VL， Ballard-Barbash R， Barlow WE， et al. Detection of ductal carcinoma in situ in women undergoing screening mammography[J]. J Natl Cancer Inst， 2002， 94(20)：1546-1554.
2. Cutuli B， Lemanski C， Fourquet A， et al. Breast-conserving surgery with or without radiotherapy vs. mastectomy for ductal carcinoma in situ：French survey experience[J]. Br J Cancer， 2009， 100(7)：1048-1054.
3. Lambert K， Patani N， Mokbel K. Ductal carcinoma in situ：recentadvances and future prospects[J]. Int J Surg Oncol， 2012. [Epub ahead of print].
4. Liberman L， Morris EA， Dershaw DD， et al. Mr imaging of the ipsilateral breast in women with percutaneously proven breast cancer[J]. AJR Am J Roentgenol， 2003， 180(4)：901-910.
5. Boyages J， Delaney G， Taylor R. Predictors of local recurrence after treatment of ductal carcinoma in situ：a meta-analysis[J]. Cancer， 1999， 85(3)：616-628.
6. Carlson GW， Styblo TM， Lyles RH， et al. Local recurrence after skin-sparing mastectomy：tumor biology or surgical conservatism?[J]. Ann Surg Oncol， 2003， 10(2)：108-112.
7. Spiegel AJ， Butler CE. Recurrence following treatment of ductal carcinoma in situ with skin-sparing mastectomy and immediate breast reconstruction[J]. Plast Reconstr Surg， 2003， 111(2)：706-711.
8. Brachtel EF， Rusby JE， Michaelson JS， et al. Occult nipple involvement in breast cancer：clinicopathologic findings in 316 consecutive mastectomy specimens[J]. J Clin Oncol， 2009， 27(30)：4948-4954.
9. Dillon MF， Hill AD， Quinn CM， et al. A pathologic assessment of adequate margin status in breast-conserving therapy[J]. Ann Surg Oncol， 2006， 13(3)：333-339.
10. Dunne C， Burke JP， Morrow M， et al. Effect of margin status on local recurrence after breast conservation and radiation therapy for ductal carcinoma in situ[J]. J Clin Oncol， 2009， 27(10)：1615-1620.
11. Ruggiero R， Procaccini E， Sanguinetti A， et al. Ductal carcinoma in situ of the breast：our experience[J]. G Chir， 2009， 30(3)：121-124.
12. Revesz E， Khan SA. What are safe margins of resection forinvasive and in situ breast cancer?[J]. Oncology， 2011， 25(10)：890-895.
13. Holmberg L， Garmo H， Granstrand B， et al. Absolute riskreductions for local recurrence after postoperative radiotherapyafter sector resection for ductal carcinoma in situ of the breast[J]. J Clin Oncol， 2008， 26(8)：1247-1252.
14. 張慶德， 王立澤， 歐陽濤， 等. 乳腺導(dǎo)管原位癌保乳治療的安全性研究[J]. 中華普通外科雜志， 2011， 26(9)：747-750.
15. Wapnir IL， Dignam JJ， Fisher B， et al. Long-term outcomes of invasive ipsilateral breast tumor recurrences after lumpectomy in NSABP B-17 and B-24 randomized clinical trials for DCIS[J]. J Natl Cancer Inst， 2011， 103(6)：478-488.
16. Hughes LL， Wang M， Page DL， et al. Local excision alone withoutirradiation for ductal carcinoma in situ of the breast：a trial of the Eastern Cooperative Oncology Group[J]. J Clin Oncol， 2009， 27(32)：5319-5324.
17. Viani G， Stefano EJ， Afonso SL， et al. 2029 oral breast-conserving surgery with or without radiotherapy in women with ductal carcinoma in situ：a meta-analysis of randomized trials[J]. Radiat Oncol， 2007， 5(4)：192-193.
18. Bijker N， Peterse JL， Duchateau L， et al. Risk factors for recurrence and metastasis after breast-conserving therapy for ductalcarcinoma-in-situ：analysis of European Organization for Researchand Treatment of Cancer Trial 10853[J]. J Clin Oncol， 2001， 19(8)：2263-2271.
19. Silverstein MJ， Buchanan C. Ductal carcinoma in situ：USC/van nuys prognostic index and the impact of margin status[J]. Breast， 2003， 12(6)：457-471.
20. Motwani SB， Goyal S， Moran MS， et al. Ductal carcinoma in situ treated with breast-conserving surgery and radiotherapy：a comparison with ECOG study 5194[J]. Cancer， 2011， 117(6)：1156-1162.
21. Cuzick J， Sestak I， Pinder SE， et al. Effect of tamoxifen and radiotherapy in women with locally excised ductal carcinoma in situ：long-term results from the UK/ANZ DCIS trial[J]. Lancet Oncol， 2011， 12(1)：21-29.
22. 劉志艷， 劉維帥， 王平. 乳腺導(dǎo)管原位癌術(shù)后輔助放療[J]. 國際腫瘤學(xué)雜志， 2012， 39(12)：928-931.
23. Silverstein MJ. An argument against routine use of radiotherapy for ductal carcinoma in situ[J]. Oncology， 2003， 17(11)：1511-1533.
24. Wapnir I. Long-term outcomes after invasive breast tumor recurrence (IBTR) in women with DCIS in NSABP B-17 and B-24[J]. J Clin Oncol， 2007， 25(520)：95-102.
25. Fisher B， Land S， Mamounas E， et al. Prevention of invasive breast cancer in women with ductal carcinoma in situ：an update of the National Surgical Adjuvant Breast and Bowel Project experience[J]. Semin Oncol， 2001， 28(4)：400-418.
26. Morrow M， Strom EA， Bassett LW， et al. Standard for the management of ductal carcinoma in-situ of the breast (DCIS)[J]. CA Cancer J Clin， 2002， 52(5)：256-276.
27. Yen TW， Hunt KK， Ross MI， et al. Predictors of invasive breast cancer in patients with an initial diagnosis of ductal carcinoma in situ：a guide to selective use of sentinel lymph node biopsy in management of ductal carcinoma in situ[J]. J Am Coll Surg， 2005， 200(4)：516-526.
28. Dillon MF， Mcdermott EW， Quinn CM， et al. Predictors of invasive disease in breast cancer when core biopsy demonstrates DCIS only[J]. J Surg Oncol， 2006， 93(7)：559-563.
29. Intra M， Rotmensz N， Veronesi P， et al. Sentinel node biopsy is not a standard procedure in ductal carcinoma in situ of the breast：the experience of the European institute of oncology on 854 patientsin 10 years[J]. Ann Surg， 2008， 247(2)：315-319.
30. Tada K， Ogiya A， Kimura K， et al. Ductal carcinoma in situ and sentinel lymph node metastasis in breast cancer[J]. World J Surg Oncol， 2010， 8：6.
31. Shapiro-Wright HM， Julian TB. Sentinel lymph node biopsy and management of the axilla in ductal carcinoma in situ[J]. J Natl Cancer Inst Monogr， 2010， 2010(41)：145-149.
32. Veronesi P， Intra M， Vento AR， et al. Sentinel lymph node biopsyfor localised ductal carcinoma in situ?[J]. Breast， 2005， 14(6)：520-522.
33. Julian TB， Land SR， Fourchotte V， et al. Is sentinel node biopsy necessary in conservatively treated DCIS?[J]. Ann Surg Oncol， 2007， 14(8)：2202-2208.
34. Sakr R， Antoine M， Barranger E， et al. Value of sentinel lymph node biopsy in breast ductal carcinoma in situ upstaged to invasive carcinoma[J]. Breast J， 2008， 14(1)：55-60.
35. Morrow M， Lantz P， Janz N， et al. Patterns and correlates of breast reconstruction：results of a population based study[J]. J Clin Oncol， 2004， 22(14 Suppl)：557.
36. Solin LJ， Fourquet A， Vicini FA， et al. Long-term outcome after breast-conservation treatment with radiation for mammographicallydetected ductal carcinoma in situ of the breast[J]. Cancer， 2005，.
37. Lawrence JS， Fourquet A， Vicini FA， et al. Salvage treatment for local or local-regional recurrence after initial breast conservationtreatment with radiation for ductal carcinoma in situ[J]. Eur J Cancer， 2005， 41(12)：1715-1723.
38. Fisher ER， Dignam J， Tan-Chiu E， et al. Pathologic findings from the National Surgical Adjuvant Breast Project (NSABP) eight-year update of protocol B-17：intraductal carcinoma[J]. Cancer， 1999， 86(3)：429-438.
39. 廖寧， 錢學(xué)珂. 導(dǎo)管原位癌行區(qū)段切除術(shù)后同側(cè)浸潤(rùn)性癌復(fù)發(fā)的長(zhǎng)期隨訪結(jié)果：NSABP B-17和B-24兩項(xiàng)研究的聯(lián)合分析[J]. 循證醫(yī)學(xué)， 2011， 11(3)：145-147.
40. Head JF， Elliott RL. Stereotactic radiofrequency ablation：a minimally invasive technique for nonpalpable breast cancer in postmenopausal patients[J]. Cancer Epidemiol， 2009， 33(3-4)：300-305.
41. Wen HC， Avivar-Valderas A， Sosa MS， et al. p38α signaling induces anoikis and lumen formation during mammary morphogenesis[J]. Sci Signal， 2011， 4(174)：ra34.
42. Chen L， Mayer JA， Krisko TI， et al. Inhibition of the p38 kinase suppresses the proliferation of human ER-negative breast cancer cells[J]. Cancer Res， 2009， 69(23)：8853-8861.
43. (6)：1137-1146.
  1. 1. Ernster VL， Ballard-Barbash R， Barlow WE， et al. Detection of ductal carcinoma in situ in women undergoing screening mammography[J]. J Natl Cancer Inst， 2002， 94(20)：1546-1554.
  2. 2. Cutuli B， Lemanski C， Fourquet A， et al. Breast-conserving surgery with or without radiotherapy vs. mastectomy for ductal carcinoma in situ：French survey experience[J]. Br J Cancer， 2009， 100(7)：1048-1054.
  3. 3. Lambert K， Patani N， Mokbel K. Ductal carcinoma in situ：recentadvances and future prospects[J]. Int J Surg Oncol， 2012. [Epub ahead of print].
  4. 4. Liberman L， Morris EA， Dershaw DD， et al. Mr imaging of the ipsilateral breast in women with percutaneously proven breast cancer[J]. AJR Am J Roentgenol， 2003， 180(4)：901-910.
  5. 5. Boyages J， Delaney G， Taylor R. Predictors of local recurrence after treatment of ductal carcinoma in situ：a meta-analysis[J]. Cancer， 1999， 85(3)：616-628.
  6. 6. Carlson GW， Styblo TM， Lyles RH， et al. Local recurrence after skin-sparing mastectomy：tumor biology or surgical conservatism?[J]. Ann Surg Oncol， 2003， 10(2)：108-112.
  7. 7. Spiegel AJ， Butler CE. Recurrence following treatment of ductal carcinoma in situ with skin-sparing mastectomy and immediate breast reconstruction[J]. Plast Reconstr Surg， 2003， 111(2)：706-711.
  8. 8. Brachtel EF， Rusby JE， Michaelson JS， et al. Occult nipple involvement in breast cancer：clinicopathologic findings in 316 consecutive mastectomy specimens[J]. J Clin Oncol， 2009， 27(30)：4948-4954.
  9. 9. Dillon MF， Hill AD， Quinn CM， et al. A pathologic assessment of adequate margin status in breast-conserving therapy[J]. Ann Surg Oncol， 2006， 13(3)：333-339.
  10. 10. Dunne C， Burke JP， Morrow M， et al. Effect of margin status on local recurrence after breast conservation and radiation therapy for ductal carcinoma in situ[J]. J Clin Oncol， 2009， 27(10)：1615-1620.
  11. 11. Ruggiero R， Procaccini E， Sanguinetti A， et al. Ductal carcinoma in situ of the breast：our experience[J]. G Chir， 2009， 30(3)：121-124.
  12. 12. Revesz E， Khan SA. What are safe margins of resection forinvasive and in situ breast cancer?[J]. Oncology， 2011， 25(10)：890-895.
  13. 13. Holmberg L， Garmo H， Granstrand B， et al. Absolute riskreductions for local recurrence after postoperative radiotherapyafter sector resection for ductal carcinoma in situ of the breast[J]. J Clin Oncol， 2008， 26(8)：1247-1252.
  14. 14. 張慶德， 王立澤， 歐陽濤， 等. 乳腺導(dǎo)管原位癌保乳治療的安全性研究[J]. 中華普通外科雜志， 2011， 26(9)：747-750.
  15. 15. Wapnir IL， Dignam JJ， Fisher B， et al. Long-term outcomes of invasive ipsilateral breast tumor recurrences after lumpectomy in NSABP B-17 and B-24 randomized clinical trials for DCIS[J]. J Natl Cancer Inst， 2011， 103(6)：478-488.
  16. 16. Hughes LL， Wang M， Page DL， et al. Local excision alone withoutirradiation for ductal carcinoma in situ of the breast：a trial of the Eastern Cooperative Oncology Group[J]. J Clin Oncol， 2009， 27(32)：5319-5324.
  17. 17. Viani G， Stefano EJ， Afonso SL， et al. 2029 oral breast-conserving surgery with or without radiotherapy in women with ductal carcinoma in situ：a meta-analysis of randomized trials[J]. Radiat Oncol， 2007， 5(4)：192-193.
  18. 18. Bijker N， Peterse JL， Duchateau L， et al. Risk factors for recurrence and metastasis after breast-conserving therapy for ductalcarcinoma-in-situ：analysis of European Organization for Researchand Treatment of Cancer Trial 10853[J]. J Clin Oncol， 2001， 19(8)：2263-2271.
  19. 19. Silverstein MJ， Buchanan C. Ductal carcinoma in situ：USC/van nuys prognostic index and the impact of margin status[J]. Breast， 2003， 12(6)：457-471.
  20. 20. Motwani SB， Goyal S， Moran MS， et al. Ductal carcinoma in situ treated with breast-conserving surgery and radiotherapy：a comparison with ECOG study 5194[J]. Cancer， 2011， 117(6)：1156-1162.
  21. 21. Cuzick J， Sestak I， Pinder SE， et al. Effect of tamoxifen and radiotherapy in women with locally excised ductal carcinoma in situ：long-term results from the UK/ANZ DCIS trial[J]. Lancet Oncol， 2011， 12(1)：21-29.
  22. 22. 劉志艷， 劉維帥， 王平. 乳腺導(dǎo)管原位癌術(shù)后輔助放療[J]. 國際腫瘤學(xué)雜志， 2012， 39(12)：928-931.
  23. 23. Silverstein MJ. An argument against routine use of radiotherapy for ductal carcinoma in situ[J]. Oncology， 2003， 17(11)：1511-1533.
  24. 24. Wapnir I. Long-term outcomes after invasive breast tumor recurrence (IBTR) in women with DCIS in NSABP B-17 and B-24[J]. J Clin Oncol， 2007， 25(520)：95-102.
  25. 25. Fisher B， Land S， Mamounas E， et al. Prevention of invasive breast cancer in women with ductal carcinoma in situ：an update of the National Surgical Adjuvant Breast and Bowel Project experience[J]. Semin Oncol， 2001， 28(4)：400-418.
  26. 26. Morrow M， Strom EA， Bassett LW， et al. Standard for the management of ductal carcinoma in-situ of the breast (DCIS)[J]. CA Cancer J Clin， 2002， 52(5)：256-276.
  27. 27. Yen TW， Hunt KK， Ross MI， et al. Predictors of invasive breast cancer in patients with an initial diagnosis of ductal carcinoma in situ：a guide to selective use of sentinel lymph node biopsy in management of ductal carcinoma in situ[J]. J Am Coll Surg， 2005， 200(4)：516-526.
  28. 28. Dillon MF， Mcdermott EW， Quinn CM， et al. Predictors of invasive disease in breast cancer when core biopsy demonstrates DCIS only[J]. J Surg Oncol， 2006， 93(7)：559-563.
  29. 29. Intra M， Rotmensz N， Veronesi P， et al. Sentinel node biopsy is not a standard procedure in ductal carcinoma in situ of the breast：the experience of the European institute of oncology on 854 patientsin 10 years[J]. Ann Surg， 2008， 247(2)：315-319.
  30. 30. Tada K， Ogiya A， Kimura K， et al. Ductal carcinoma in situ and sentinel lymph node metastasis in breast cancer[J]. World J Surg Oncol， 2010， 8：6.
  31. 31. Shapiro-Wright HM， Julian TB. Sentinel lymph node biopsy and management of the axilla in ductal carcinoma in situ[J]. J Natl Cancer Inst Monogr， 2010， 2010(41)：145-149.
  32. 32. Veronesi P， Intra M， Vento AR， et al. Sentinel lymph node biopsyfor localised ductal carcinoma in situ?[J]. Breast， 2005， 14(6)：520-522.
  33. 33. Julian TB， Land SR， Fourchotte V， et al. Is sentinel node biopsy necessary in conservatively treated DCIS?[J]. Ann Surg Oncol， 2007， 14(8)：2202-2208.
  34. 34. Sakr R， Antoine M， Barranger E， et al. Value of sentinel lymph node biopsy in breast ductal carcinoma in situ upstaged to invasive carcinoma[J]. Breast J， 2008， 14(1)：55-60.
  35. 35. Morrow M， Lantz P， Janz N， et al. Patterns and correlates of breast reconstruction：results of a population based study[J]. J Clin Oncol， 2004， 22(14 Suppl)：557.
  36. 36. Solin LJ， Fourquet A， Vicini FA， et al. Long-term outcome after breast-conservation treatment with radiation for mammographicallydetected ductal carcinoma in situ of the breast[J]. Cancer， 2005，.
  37. 37. Lawrence JS， Fourquet A， Vicini FA， et al. Salvage treatment for local or local-regional recurrence after initial breast conservationtreatment with radiation for ductal carcinoma in situ[J]. Eur J Cancer， 2005， 41(12)：1715-1723.
  38. 38. Fisher ER， Dignam J， Tan-Chiu E， et al. Pathologic findings from the National Surgical Adjuvant Breast Project (NSABP) eight-year update of protocol B-17：intraductal carcinoma[J]. Cancer， 1999， 86(3)：429-438.
  39. 39. 廖寧， 錢學(xué)珂. 導(dǎo)管原位癌行區(qū)段切除術(shù)后同側(cè)浸潤(rùn)性癌復(fù)發(fā)的長(zhǎng)期隨訪結(jié)果：NSABP B-17和B-24兩項(xiàng)研究的聯(lián)合分析[J]. 循證醫(yī)學(xué)， 2011， 11(3)：145-147.
  40. 40. Head JF， Elliott RL. Stereotactic radiofrequency ablation：a minimally invasive technique for nonpalpable breast cancer in postmenopausal patients[J]. Cancer Epidemiol， 2009， 33(3-4)：300-305.
  41. 41. Wen HC， Avivar-Valderas A， Sosa MS， et al. p38α signaling induces anoikis and lumen formation during mammary morphogenesis[J]. Sci Signal， 2011， 4(174)：ra34.
  42. 42. Chen L， Mayer JA， Krisko TI， et al. Inhibition of the p38 kinase suppresses the proliferation of human ER-negative breast cancer cells[J]. Cancer Res， 2009， 69(23)：8853-8861.
  43. 43. (6)：1137-1146.

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