Annals of surgical oncology · 2025
Patient-reported Outcomes After Routine Treatment of In Situ/Atypical Lesions: The PORTAL Study.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Rosenberg Shoshana M, Rushing Christel, Schreiber Kristin L, Crowell Kerri-Anne, Bedrosian Isabelle, Hughes Kevin S, Lynch Thomas, Basila Desiree, Collyar Deborah, Frank Elizabeth S, Darai Sonja, Lanahan Conor, Marks Jeffrey R, Plichta Jennifer K, Hyslop Terry, Thompson Alastair M, Partridge Ann H, Hwang E Shelley
Аннотация
BACKGROUND: Guideline concordant care (GCC) for ductal carcinoma in situ (DCIS) includes some combination of surgery, radiation, and/or endocrine treatment. Active monitoring (AM) is a common approach for high-risk breast histologies (e.g., atypical ductal hyperplasia [ADH] lobular intraepithelial neoplasias [LIN]) and has been proposed as an alternative to GCC for some low-risk DCIS. We compared patient-reported outcomes in women with DCIS who received GCC with those with other high-risk breast histologies in an active monitoring-proxy group (AM-P).
METHODS: Women diagnosed with DCIS (GCC) or ADH/LIN (AM-P) from 2012 to 2017 at four cancer centers were surveyed regarding surgical-area pain, severity, and burden, generalized pain, anxiety, depression, and quality of life (QOL). The primary comparison was GCC versus AM-P. Multivariable logistic regression was used to model odds of reporting surgical-area pain. Multivariable marginal zero-inflated negative binomial models estimated mean scores and differences by group.
RESULTS: A total of 912 women completed the survey (GCC, n = 538; AM-P, n = 374). At a median of 45.4 months following diagnosis, the AM-P group had lower odds of pain in the past month (0.35, 95% CI 0.25-0.49) and clinically significant pain (0.43, 95% CI 0.28-0.68). Adjusted mean pain severity index, surgical area sensory disturbance, pain-related cognitive/emotional impact scores were lower in the AM-P versus GCC group. Generalized pain, QOL, anxiety, and depressive symptoms were similar between groups.
CONCLUSIONS: Women with DCIS treated with GCC experienced more breast/chest wall pain than women in the AM-P group, although QOL was similar. Understanding these trade-offs can inform surgical de-escalation for high-risk lesions, including low-risk DCIS.
METHODS: Women diagnosed with DCIS (GCC) or ADH/LIN (AM-P) from 2012 to 2017 at four cancer centers were surveyed regarding surgical-area pain, severity, and burden, generalized pain, anxiety, depression, and quality of life (QOL). The primary comparison was GCC versus AM-P. Multivariable logistic regression was used to model odds of reporting surgical-area pain. Multivariable marginal zero-inflated negative binomial models estimated mean scores and differences by group.
RESULTS: A total of 912 women completed the survey (GCC, n = 538; AM-P, n = 374). At a median of 45.4 months following diagnosis, the AM-P group had lower odds of pain in the past month (0.35, 95% CI 0.25-0.49) and clinically significant pain (0.43, 95% CI 0.28-0.68). Adjusted mean pain severity index, surgical area sensory disturbance, pain-related cognitive/emotional impact scores were lower in the AM-P versus GCC group. Generalized pain, QOL, anxiety, and depressive symptoms were similar between groups.
CONCLUSIONS: Women with DCIS treated with GCC experienced more breast/chest wall pain than women in the AM-P group, although QOL was similar. Understanding these trade-offs can inform surgical de-escalation for high-risk lesions, including low-risk DCIS.