Ductal carcinoma in situ (DCIS) is the most common form of non-invasive breast cancer and a recognized precursor to invasive ductal carcinoma (IDC). Although DCIS itself is confined to the milk duct and not immediately life-threatening, its potential for progression to invasive disease necessitates careful clinical management. The increased detection of DCIS due to advancements in imaging and widespread screening programs has raised critical questions regarding its classification, prognosis, and optimal treatment strategies. While most cases exhibit indolent behavior, others harbor molecular characteristics that drive malignant transformation. A key challenge lies in distinguishing low-risk DCIS, which may never progress, from aggressive cases requiring intervention. Tumor microenvironment dynamics, immune cell infiltration, and molecular alterations, including hormone receptor (HR) status, human epidermal growth factor 2 (HER2) expression, and genetic mutations, play crucial roles in determining disease trajectory. This review explores the biological and molecular mechanisms underlying DCIS progression, with an emphasis on myoepithelial cells, tumor-infiltrating lymphocytes, and microenvironmental factors. By integrating recent findings, this article aims to refine risk stratification approaches and guide future strategies for personalized DCIS management. Improved prognostic biomarkers and targeted therapeutic interventions could help optimize treatment decisions, balancing the need for effective cancer prevention while minimizing overtreatment in low-risk patients.
导管原位癌（DCIS）是最常见的非浸润性乳腺癌类型，也是公认的浸润性导管癌（IDC）前驱病变。尽管DCIS本身局限于乳腺导管内且不直接危及生命，但其进展为浸润性疾病的潜在风险需要谨慎的临床管理。随着影像学技术的进步和筛查项目的普及，DCIS检出率不断提高，这引发了关于其分类、预后和最佳治疗策略的关键问题。虽然多数病例表现为惰性病程，但部分病例携带驱动恶性转化的分子特征。当前的核心挑战在于区分可能永不进展的低风险DCIS与需要干预的侵袭性病例。肿瘤微环境动态变化、免疫细胞浸润以及分子改变（包括激素受体状态、人表皮生长因子2表达和基因突变）在决定疾病进展轨迹中起着关键作用。本综述探讨DCIS进展的生物学和分子机制，重点关注肌上皮细胞、肿瘤浸润淋巴细胞及微环境因素。通过整合最新研究进展，本文旨在完善风险分层方法，为未来个体化DCIS管理策略提供指导。改进的预后生物标志物和靶向治疗干预措施将有助于优化治疗决策，在实现有效癌症预防的同时，最大限度减少低风险患者的过度治疗。
DCIS Progression and the Tumor Microenvironment: Molecular Insights and Prognostic Challenges
肿瘤(癌症)患者之家