?????????? ????????? In Situ (DCIS)

1
?????????? ????????? In Situ (DCIS)

• ??. ??? ??? ???????? Jo Anne Zujewski
• ????????? ?????? ???????? ??????? ??????????????
  ???????????
• ????????? ??????????? ? ??????? ??????????????
  ???????????
• ???????????? ???????? ????, ???
• ???????, ?????????? - ???, 2011 ???

2
???????

• ??? DCIS ?????????? ?? ??? I ??????
• ???? DCIS, ???????? ?? ??????? ??? DCIS /
  ???????? ???
• ????????? ?????????????? ????? ???????????
  ?????????????, ???????????? ????? ??????????? ?
  ???????????
• ????? ?? ?? ???????? ??????????? ??? ?????? ??? ?
  ??????? ??????????? ??????????

3
????????????????? ?????????, ????????? ? DCIS
Burstein H et al. N Engl J Med 20043501430-1441
4
DCIS ??????????
Comedo
Cribiform, ??????? ??????????????
Solid, ?????? ??????????????
Rosens Breast Pathology, 1997
5
DCIS ????????? ??????? ???????????
Rosens Breast Pathology, 1997
6
SEER ????????? ???????? ?????? in situ5-??????
???????????? 1992-1999
??? lt 50 50
??? 100.0 99.9 100.0
????? 100.0 100.0 100.0
?????? 100.0 99.5 100.0
7
???????????? DCIS RCT
NSABP B17 EORTC UKANZ CTG NSABPB24
N 813 1002 1694 1798
????????? 17 (2.1) 24 (2.4) 11 (0.6)
?????? ?? ??? 27 (3.3) 15 (1.5) 23 (1.4) 15 (0.8)
???? ?????????? 10.8 4.3 4.4 6.9
8
???????????? ???????

• 25 ??????? ?????????? ????????? ? 16-??????
  ???????????
• 28 ???????? ?????????? ???
• 11-??????? ???? ?????????????? ????? ? ?????????
  ? ??????????? ???????
• ????????????????? ????????????? ???? relative
  risk 2-3

Page et al ??? 1985552698-708
9
???? ?????? ???????????
??? No. ??????? ??????????
Ashikari 1971 182 0.9
Rosner 1980 182 2.0
Farrow 1970 181 2.0
Silverstein 1996 228 0
Bradley 1990 588 1.7
10
????????

• ??????????? ?? ??????????? ? ????????? ? ????????
  ??? ? ????????????????? ????????????? DCIS
• ?????? ?? ??? ? ??????? 10 ??? ????? ???????????
  DCIS ????????? ? 1-2 ???????, ??? ??????????? ??
  ???? ????????

11
??????? DCIS ????????? ?? ??????? ??????? ?????
???????????? ????????

• ??? ?????????? ?????????????? ?????????????????
  ???????????? ??????????, ??? ????????? ?????????
  ?????????? ??????? ????????? ????? ????????????
  ???????? ????? ?? 50
• ????????, ??????? ????? ?? ????????? ???????
  ???????, ?? ???? ?????????? ?????????? ?? ? ?????
  ??????????? ???????????? (1999 DCIS Consensus
  Conference Statement, ???, 2000)

Slide courtesy of L. Solin
12
??????????? ????? ????????????????? ????????????
??????????? ??????? ??????? ??????? BCSRT
??? DCIS
Presented NIH DCIS Conference, 2009 Darby, JNCI
Monograph, 2010
13
ECOG ???????????? E5194 (n 670)
??????????? ????????? DCIS ????? ???????
???????? ??? ????????? ? ?????? ???????? ??????
?????????? ??????? gt 3 ?? Tamoxifen
(?????????????)??? ?????? ????????? (??
?????????????????) ??????? 1-2, non-comedo,
?????? lt 2.5 c? ??????? 3, comedo, ?????? lt 1.0
c?
14
ECOG E5194 ???????? ??? ???????? (/-TAM)
??????? ???????
?????? ??? ??????? ???????
15
Year
Hughes, JCO, 2009
15
????????? ??????? ?? ????????? ??????????
??????????? ??????? ???????
??????????? ??????
Solin, JCO, 1996
Slide courtesy of L. Solin
Balleine, Clin ??? Res, 2008
16
DCIS NSABP B-24???? ???????????
Fisher, B, Lancet 3531993-2000, 1999
17
DCIS NSABP B-24????????? ???? ?????????? 7 ???
??????? ??????? ?????????? ?????????? P-????.
??? ??? 145 16 84 9.3
????????-??????? 100 11.1 72 7.7 0.02
????????-????????? 45 4.9 25 2.3 0.01
???????????? 95 95
Fisher, B et al, Semin Oncol 28400-18, 2001
18
NSABP B-24 ??????????

• ?????????? ????????? ???? ???????? ??? ?? 40
• ??? ???????? ? ??????????? ????? ????????????

19
???? ???????????????? ??? ?????????????????? ???
? ????????? ? DCIS, ???????? ?????? ?????????
?????????? ???????? ? ??????? ??????? ??????????
????????, ??????? ??????? ? ??????????? ?
?????????? ????????, ??????? ??????? ? ???????
Burstein H et al. N Engl J Med 20043501430-1441
20
DCIS ??????

• ????????? ???????
• ???????????
• ??????????? ????? ???????? ??????? ???????
• ??????? ?? ????????????, ????
• ???????? ???? ?????
• ??????? ????????????? ???????????
• ??????? ??????? T?????????
• ???????????????? ?????????????
• ?????????? ?????????????? ???? / ??????

21
??? ?? ?????? ????????????? ??????

• ????????????? ??????????? ?? lt1, ???????
  ????????? ????????? ??????????? ?? ??
  ?????????????
• ??????? ??????????? ???
• ?? ????????????? ??-?? ??????? ????? ???????????,
  ?? ??????????? ???????, ????? ????????
  ??????????? (? ?????? ??????????? ???????????
  ?????????)
• ?????? ???????? ?????? ????????? DCIS ???
  ???????????? ????? (?????????? ???????????
  ??????????? ??????????? ????)

22
????????????? ??????

• ??????? ??????????? ?? ?? ????? ??????????????
  ????????????? ???????? ???????? 2-?? ???????? ?
  2-21 ?????????, ??????? IDC ?? ?????? ????????
• ???????? ?????????? ?????? ?????????, ???????
  ????? ?????? ????????? ???????

23
????? ??? ??????? ??????????? ?? (????) ?
????????? ? DCIS

• ???????? ??????? ???????????? ????????? ???????
  ?????????, ??????????????? ????????? ??? ?????
• ????? ?????????? ????
• ?????????????, ????????????, ????????? ?????????
  ? ?????? (??????), ??????????, ???????????,
  ????????? (3)
• ????? ?????? ????????? ??????????? ?? ?? 13
• ????? ????????? ?????????????
• ????????? ????? ???????????????

24

• ??????????? ???????? ??????????? ?????????? ???
  ????????? DCIS ? ????????? ?????. ??? ?????
  ?????? ? ????????? ???????????? ??????????? DCIS,
  ???????? ? ??????? ???????????????????????? DCIS

25
DCIS ???????????? ?? ????? ???? ???????????????
??? ???????????? ??? ?????????? ?????????
????????? ?????????
??????????? (comedo)
26
M?? ?????????? ????????????? ?????????..
???????????????? ?????????? ????????
??????????????? ??????????
???????????, ???????????? ? ????????? ????????,
?????????? ???????
DCIS consensus conference. C. Lehman
27
DCIS, ????????????????? ? ????????? ? ???????
?????? ?? ????? ???????????? ??? ??? ??????????
???????????? ?a????????? ?????? ??????????,
????????c?? NMLE ??? ?????????? ?????????????
DCIS consensus conference. C. Lehman
28
ACR-ASS-CAP-SSO 2006 ???????????? ???????????

• ???? ?????? ???????????, ? ??????????? ???,
  ?????? ???? ????? ??????????? ??????? ??? DCIS.
• Berg ?????????, ??? ??? ???? ?????
  ???????????-???, ??? ??????????? ? ?????????? ???
  ???????????????? DCIS ??????, ??????????????????
  ??????????? ???? ???????????? ? 50 ??????????
  ???????? ?????.
• ??????? ??? ?? ??????????? ??????????, ????? ???
  ????????? ??????? ? ??????????? ?????, ??? ??????
  ???? ??????????????????.

29
???????? ??????? ??? ??????? DCIS
??????
1. ??????? ?? ????????? ?????????, ? ??????? ???? ???????? ???????? ?????????? ?????, ????? ??????????? ????/?????? ??????????? ???????????? ??????? ???????? ????????
2. ???? ??? ???, ?? ????? ?? ???????????? ?????????? ?????? ????????? ??? ??????? ?????? ????????? (??? ????????)? ???
3. ????? ??????????? ?????? ?? (?????) ??? ???????? ???????? ???????????? ??????? ??? ?????????? ????? ???????? ????????? - ??????? ??????? - ??????????, ???? ??/?? ?????????? ?? ??
Courtesy of L. Solin 2010