25例乳腺癌肉瘤的临床特征和预后分析  

Clinical features and prognosis of 25 cases of breast carcinosarcoma

作　　者：杨艳芳[1] 刘君[1] 方志沂[1] 顾林[1] 

机构地区：[1]天津医科大学附属肿瘤医院乳腺二科乳腺癌防治教育部重点实验室天津市肿瘤防治重点实验室,300060

出　　处：《中华肿瘤杂志》2012年第8期620-623,共4页Chinese Journal of Oncology

摘　　要：目的探讨乳腺癌肉瘤的临床特征、诊治要点和预后。方法回顾性分析1976年1月至2008年1月收治的25例乳腺癌肉瘤患者的临床和病理资料，并对患者年龄、肿瘤大小、腋淋巴结转移情况和治疗方式等因素与预后的关系进行统计学分析。Kaplan—Meier法计算生存率，Logrank法进行预后单因素分析，Cox比例风险回归模型进行预后多因素分析。结果25例乳腺癌肉瘤患者均为女性，中位年龄56岁。肿瘤平均直径为5．1cm。术前钼靶、超声和空心针吸病理检查误诊率高，主要诊断依据为术后病理组织检查。雌激素受体和孕激素受体、人表皮生长因子受体2的阳性表达率分别为8．3％和7．7％。25例乳腺癌肉瘤中，癌成分以浸润性导管癌为主，占92．3％；肉瘤成分以纤维肉瘤为主，占46．2％。25例患者的5年生存率为57．9％，中位生存时间为86个月。单因素分析结果显示，肿瘤大小（P=0．012）和治疗方式（P=0．028）是影响预后的因素，而患者年龄和腋淋巴结转移情况与预后无关。多因素分析显示，治疗方式是影响预后的独立因素（P=0．047）。结论乳腺癌肉瘤发病率低，临床特征缺乏特异性，确诊主要依据术后病理。肿瘤大小和治疗方式是影响患者预后的因素，以根治性手术为主的综合治疗是乳腺癌肉瘤的最佳治疗方式。乳腺癌肉瘤的ER和PR及HER－2阳性率低，探索新的治疗靶点是今后的研究方向之一。Objective To improve the recognition, appropriate diagnosis and treatment of breast through analysis of their clinical features, diagnosis, management and prognosis. Methods The clinicopathological data from 25 patients with breast carcinosarcoma treated in our hospital between January 1976 and January 2008 were retrospectively reviewed. The correlation between prognosis and age, tumor size, axillary node status, and treatment modality was analyzed using the statistical software SPSS 13.0. The survival rate was calculated by Kaplan-Meier analysis and compared using log-rank test. Univariate and multivariate factors for survival were analyzed using Cox proportional hazards regression model. Results All patients were female and their median age was 56-years. The median tumor diameter was 5. 1 cm. The misdiagnosis rate was high by mammography, B-ultrasound and pathological examination of needle aspiration biopsy before operation. So that the diagnosis primarily depended on postoperative histopathologic examination. The ER/PR and HER-2 positive rate of the breast carcinosarcomas was 8.3% and 7.7% , respectively. Invasive ductal carcinoma was the main malignant component accounting for 92.3% , while the sarcoma element was constitutive of fibrosarcoma with a proportion of 46.2%. The overall 5-year survival rate was 57.9% with a median survival time of 86 months after a median follow-up of 52 months. Univariate factor analysis showed that the tumor size （ P = 0. 012 ） and treatment methods （ P = 0. 028 ） were impact factors, while age and axillary lymph node status were not significantly related with prognosis. Cox multivariate analysis validated that the therapy modality was an independent prognostic factor for breast carcinosarcoma （P = 0. 047）. Conclusions Breast carcinosarcoma is rare and its clinical features are not specific, so that its final diagnosis is mainly based on the postoperative pathology. Tumor size and treatment modality are independent prognostic factors, so the comprehensive therapy mai

关 键 词：乳腺肿瘤 癌肉瘤 诊断 治疗 预后 

分 类 号：R737.9[医药卫生—肿瘤]