Trends in Treatment Patterns and Outcomes for Ductal Carcinoma in Situ
Identifieur interne : 001664 ( Main/Exploration ); précédent : 001663; suivant : 001665Trends in Treatment Patterns and Outcomes for Ductal Carcinoma in Situ
Auteurs : Mathias Worni ; Igor Akushevich ; Rachel Greenup ; Deba Sarma ; Marc D. Ryser ; Evan R. Myers ; E. Shelley HwangSource :
- JNCI Journal of the National Cancer Institute [ 0027-8874 ] ; 2015.
Abstract
Impact of contemporary treatment of pre-invasive breast cancer (ductal carcinoma in situ [DCIS]) on long-term outcomes remains poorly defined. We aimed to evaluate national treatment trends for DCIS and to determine their impact on disease-specific (DSS) and overall survival (OS).
The Surveillance, Epidemiology, and End Results (SEER) registry was queried for patients diagnosed with DCIS from 1991 to 2010. Treatment pattern trends were analyzed using Cochran-Armitage trend test. Survival analyses were performed using inverse probability weights (IPW)–adjusted competing risk analyses for DSS and Cox proportional hazard regression for OS. All tests performed were two-sided.
One hundred twenty-one thousand and eighty DCIS patients were identified. The greatest proportion of patients was treated with lumpectomy and radiation therapy (43.0%), followed by lumpectomy alone (26.5%) and unilateral (23.8%) or bilateral mastectomy (4.5%) with significant shifts over time. The rate of sentinel lymph node biopsy increased from 9.7% to 67.1% for mastectomy and from 1.4% to 17.8% for lumpectomy. Compared with mastectomy, OS was higher for lumpectomy with radiation (hazard ratio [HR] = 0.79, 95% confidence interval [CI] = 0.76 to 0.83,
We identified substantial shifts in treatment patterns for DCIS from 1991 to 2010. When outcomes between locoregional treatment options were compared, we observed greater differences in OS than DSS, likely reflecting both a prevailing patient selection bias as well as clinically negligible differences in breast cancer outcomes between groups.
Url:
DOI: 10.1093/jnci/djv263
PubMed: 26424776
PubMed Central: 4707192
Affiliations:
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Trends in Treatment Patterns and Outcomes for Ductal Carcinoma in Situ</title><author><name sortKey="Worni, Mathias" sort="Worni, Mathias" uniqKey="Worni M" first="Mathias" last="Worni">Mathias Worni</name></author><author><name sortKey="Akushevich, Igor" sort="Akushevich, Igor" uniqKey="Akushevich I" first="Igor" last="Akushevich">Igor Akushevich</name></author><author><name sortKey="Greenup, Rachel" sort="Greenup, Rachel" uniqKey="Greenup R" first="Rachel" last="Greenup">Rachel Greenup</name></author><author><name sortKey="Sarma, Deba" sort="Sarma, Deba" uniqKey="Sarma D" first="Deba" last="Sarma">Deba Sarma</name></author><author><name sortKey="Ryser, Marc D" sort="Ryser, Marc D" uniqKey="Ryser M" first="Marc D." last="Ryser">Marc D. Ryser</name></author><author><name sortKey="Myers, Evan R" sort="Myers, Evan R" uniqKey="Myers E" first="Evan R." last="Myers">Evan R. Myers</name></author><author><name sortKey="Hwang, E Shelley" sort="Hwang, E Shelley" uniqKey="Hwang E" first="E. Shelley" last="Hwang">E. Shelley Hwang</name></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">26424776</idno><idno type="pmc">4707192</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4707192</idno><idno type="RBID">PMC:4707192</idno><idno type="doi">10.1093/jnci/djv263</idno><date when="2015">2015</date><idno type="wicri:Area/Pmc/Corpus">002F65</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">002F65</idno><idno type="wicri:Area/Pmc/Curation">002F64</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">002F64</idno><idno type="wicri:Area/Pmc/Checkpoint">000D51</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">000D51</idno><idno type="wicri:Area/Ncbi/Merge">007969</idno><idno type="wicri:Area/Ncbi/Curation">007969</idno><idno type="wicri:Area/Ncbi/Checkpoint">007969</idno><idno type="wicri:doubleKey">0027-8874:2015:Worni M:trends:in:treatment</idno><idno type="wicri:Area/Main/Merge">001666</idno><idno type="wicri:Area/Main/Curation">001664</idno><idno type="wicri:Area/Main/Exploration">001664</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Trends in Treatment Patterns and Outcomes for Ductal Carcinoma in Situ</title><author><name sortKey="Worni, Mathias" sort="Worni, Mathias" uniqKey="Worni M" first="Mathias" last="Worni">Mathias Worni</name></author><author><name sortKey="Akushevich, Igor" sort="Akushevich, Igor" uniqKey="Akushevich I" first="Igor" last="Akushevich">Igor Akushevich</name></author><author><name sortKey="Greenup, Rachel" sort="Greenup, Rachel" uniqKey="Greenup R" first="Rachel" last="Greenup">Rachel Greenup</name></author><author><name sortKey="Sarma, Deba" sort="Sarma, Deba" uniqKey="Sarma D" first="Deba" last="Sarma">Deba Sarma</name></author><author><name sortKey="Ryser, Marc D" sort="Ryser, Marc D" uniqKey="Ryser M" first="Marc D." last="Ryser">Marc D. Ryser</name></author><author><name sortKey="Myers, Evan R" sort="Myers, Evan R" uniqKey="Myers E" first="Evan R." last="Myers">Evan R. Myers</name></author><author><name sortKey="Hwang, E Shelley" sort="Hwang, E Shelley" uniqKey="Hwang E" first="E. Shelley" last="Hwang">E. Shelley Hwang</name></author></analytic><series><title level="j">JNCI Journal of the National Cancer Institute</title><idno type="ISSN">0027-8874</idno><idno type="eISSN">1460-2105</idno><imprint><date when="2015">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background:</title><p>Impact of contemporary treatment of pre-invasive breast cancer (ductal carcinoma in situ [DCIS]) on long-term outcomes remains poorly defined. We aimed to evaluate national treatment trends for DCIS and to determine their impact on disease-specific (DSS) and overall survival (OS).</p></sec><sec><title>Methods:</title><p>The Surveillance, Epidemiology, and End Results (SEER) registry was queried for patients diagnosed with DCIS from 1991 to 2010. Treatment pattern trends were analyzed using Cochran-Armitage trend test. Survival analyses were performed using inverse probability weights (IPW)–adjusted competing risk analyses for DSS and Cox proportional hazard regression for OS. All tests performed were two-sided.</p></sec><sec><title>Results:</title><p>One hundred twenty-one thousand and eighty DCIS patients were identified. The greatest proportion of patients was treated with lumpectomy and radiation therapy (43.0%), followed by lumpectomy alone (26.5%) and unilateral (23.8%) or bilateral mastectomy (4.5%) with significant shifts over time. The rate of sentinel lymph node biopsy increased from 9.7% to 67.1% for mastectomy and from 1.4% to 17.8% for lumpectomy. Compared with mastectomy, OS was higher for lumpectomy with radiation (hazard ratio [HR] = 0.79, 95% confidence interval [CI] = 0.76 to 0.83, <italic>P</italic> < .001) and lower for lumpectomy alone (HR = 1.17, 95% CI = 1.13 to 1.23, <italic>P</italic> < .001). IPW-adjusted ten-year DSS was highest in lumpectomy with XRT (98.9%), followed by mastectomy (98.5%), and lumpectomy alone (98.4%).</p></sec><sec><title>Conclusions:</title><p>We identified substantial shifts in treatment patterns for DCIS from 1991 to 2010. When outcomes between locoregional treatment options were compared, we observed greater differences in OS than DSS, likely reflecting both a prevailing patient selection bias as well as clinically negligible differences in breast cancer outcomes between groups.</p></sec></div></front></TEI><affiliations><list></list><tree><noCountry><name sortKey="Akushevich, Igor" sort="Akushevich, Igor" uniqKey="Akushevich I" first="Igor" last="Akushevich">Igor Akushevich</name><name sortKey="Greenup, Rachel" sort="Greenup, Rachel" uniqKey="Greenup R" first="Rachel" last="Greenup">Rachel Greenup</name><name sortKey="Hwang, E Shelley" sort="Hwang, E Shelley" uniqKey="Hwang E" first="E. Shelley" last="Hwang">E. Shelley Hwang</name><name sortKey="Myers, Evan R" sort="Myers, Evan R" uniqKey="Myers E" first="Evan R." last="Myers">Evan R. Myers</name><name sortKey="Ryser, Marc D" sort="Ryser, Marc D" uniqKey="Ryser M" first="Marc D." last="Ryser">Marc D. Ryser</name><name sortKey="Sarma, Deba" sort="Sarma, Deba" uniqKey="Sarma D" first="Deba" last="Sarma">Deba Sarma</name><name sortKey="Worni, Mathias" sort="Worni, Mathias" uniqKey="Worni M" first="Mathias" last="Worni">Mathias Worni</name></noCountry></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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