MRI無法改善乳管原位癌的結果


  【24drs.com】根據一篇新的單一中心研究,乳管原位癌(DCIS)婦女手術前後例行性使用MRI,並不是恰當的臨床策略,因為它無法改善長期結果。
  
  紐約市Sloan-Kettering紀念癌症中心的研究者進行的這篇回溯研究認為,對於DCIS病患,MRI所提供的好處並未優於標準影像檢查(乳房X光檢查合併或未合併超音波)。
  
  第一作者Melissa Pilewskie醫師等人結論指出,MRI對於DCIS手術前後的幫助依舊不確定。
  
  Pilewskie醫師在即將於舊金山舉辦之2013年乳癌研討會的會前記者會中表示,目前,對於DCIS病患檢查時使用MRI這方面並無指引;這次的會前記者會由美國臨床腫瘤協會(ASCO)主辦,該協會與其他5個專業組織協辦此次研討會;美國約有三分之一的醫師會對DCIS婦女開立MRI醫囑。
  
  ASCO發言人、洛杉磯Beverly Hills癌症研究中心、主持會前記者會的Steven O'Day醫師表示,不論術前術後、侵犯性或非侵犯性乳癌,MRI的使用比率大幅增加;理論上,DCIS手術期間使用MRI可以幫助找到其他病灶,特別是乳房腫瘤切除婦女。
  
  研究者檢視了1997-2010年間在Sloan-Kettering紀念癌症中心進行乳房腫瘤切除以治療DCIS的2,321名女性,其中,596人在術前或術後立即進行MRI,1,725人未進行。
  
  5年後,進行MRI和未進行MRI兩組之間的局部復發率並無顯著差異(8.5% vs 7.2%;P= .52);8年後,有差異但未達統計上的顯著意義(14.6% vs 10.2%);即便控制9個病患變項,如年紀、停經狀態、家族史、使用放射線或內分泌治療之後,局部復發風險並無顯著差異。
  
  Pilewskie醫師解釋,這個多變項分析是重要的,因為進行MRI的婦女一般是風險比較高的患者,本研究看來確實如此。
  
  Pilewskie醫師在媒體聲明稿中表示,進行MRI的婦女有比較多風險因素的這個事實,或許可解釋該組的復發率略高於僅進行標準影像檢查組的原因。
  
  O'Day醫師指出,該研究包括另一個終點:研究對象發生對側乳癌,兩側乳房都進行MRI。
  
  但是,結果再次顯示這個研究終點並無統計上的顯著差異。MRI組和非MRI組的對側乳癌率在5年(3.5% vs 3.5%)和8年(3.5% vs 5.1%)時都相似。
  
  沒有進行放射線治療的次組病患中,不論是對側乳癌或局部區域復發,MRI和改善長期結果無關。
  
  O'Day醫師總結表示,此次回溯研究中,例行性使用MRI並不會改善這兩個結果。不過,他並未減少對DICS病患使用MRI。他解釋,不是不能用MRI,而是在這樣的情況下,應該有MRI用於手術前後之更充分資訊,以增加敏感性。
  
  O'Day醫師指出,不過,對我們而言,這是個很重要的引導研究,後續需要前瞻研究以改進MRI的使用。
  
  資料來源:http://www.24drs.com/professional/list/content.asp?x_idno=7007&x_classno=0&x_chkdelpoint=Y
  

MRI Does Not Improve DCIS Outcomes

By Nick Mulcahy
Medscape Medical News

Routine use of MRI before or after surgery in women with ductal carcinoma in situ (DCIS) is not likely a sound clinical strategy because it does not improve long-term outcomes, according to a new single-center study.

The retrospective study, conducted by researchers from the Memorial Sloan-Kettering Cancer Center in New York City, suggests that MRI offers no advantage over standard imaging (mammography with or without ultrasound) in DCIS patients.

"The benefit of perioperative MRI for DCIS remains uncertain," conclude lead author Melissa Pilewskie, MD, and colleagues.

"Currently, there are no guidelines for the use of MRI in the work-up of women with DCIS," Dr. Pilewskie told reporters at a presscast in advance of the 2013 Breast Cancer Symposium, which will be held later this week in San Francisco. The presscast was organized by the American Society of Clinical Oncology (ASCO), which is sponsoring the symposium along with 5 other professional bodies.

About one third of surgeons in the United States will order an MRI for women with DCIS, she said.

"There's been a tremendous increase in the use of MRI, perioperatively and postoperatively, in invasive and noninvasive breast cancer," said Steven O'Day, MD, from the Beverly Hills Cancer Institute in Los Angeles, who moderated the presscast. He is also an ASCO spokesperson.

Theoretically, using MRI around the time of surgery in patients with DCIS can help find additional areas of disease, especially in women treated with lumpectomy alone, Dr. Pilewskie explained.

The researchers identified 2321 women who had undergone lumpectomy for DCIS between 1997 and 2010 at Memorial Sloan-Kettering. Of these patients, 596 received an MRI either before or immediately after surgery and 1725 did not.

After 5 years, local recurrence rates were not significantly different between the MRI and no-MRI groups (8.5% vs 7.2%; P = .52). After 8 years, the lack of a statistically significant difference held (14.6% vs 10.2%). Even after controlling for 9 patient variables, such as age, menopausal status, family history, and use of radiation or endocrine therapy, there was no significant difference in risk for local recurrence.

This multivariable analysis is important because women who undergo MRI will typically have a higher risk profile, and that was the case in this study, explained Dr. Pilewskie.

The fact that the women who underwent MRI had more risk factors might explain the slightly higher recurrence rates in that group than in the group that underwent only standard imaging, Dr. Pilewskie said in a press statement.

Contralateral Breast Cancer Findings

The study included another end point: the development of contralateral breast cancer in the study participants. "MRIs look at both breasts," Dr. O'Day noted.

But again, the results showed that there was no statistically significant difference in this end point. Contralateral breast cancer rates in the MRI and no-MRI groups were the same at 5 years (3.5% vs 3.5%) and similar at 8 years (3.5% vs 5.1%).

In the subgroup of patients who did not receive radiation therapy, MRI was not associated with improved long-term outcomes for either contralateral breast cancer or local regional recurrence.

The "routine use" of MRI did not improve these 2 outcomes in this retrospective study, summarized Dr. O'Day.

However, he did not discount any use of MRI in DCIS patients. "It's not that MRI can't be used," he explained. "There are cases where it is important to obtain information perioperatively or postoperatively with the additional sensitivity that MRI may give."

However, "this is an important study to ground us," Dr. O'Day added. Further prospective study is needed to refine the use of MRI, he said.

Dr. Pilewskie has disclosed no relevant financial relationships. Dr. O'Day reports acting as consultant or advisor for Bristol-Myers Squibb, Delcath, Eisai, Genentech, GlaxoSmithKline, and Roche; accepting honoraria from Bristol-Myers Squibb; and receiving research funding from Bristol-Myers Squibb, Eisai, GlaxoSmithKline, Lilly, and Roche/Genentech.

2013 Breast Cancer Symposium: Abstract 57. To be presented September 7, 2013.

    
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