乳腺浸润性微乳头状癌(IMPC)29例临床分析  

Clinicopathological analysis of 29 cases of invasive micropapillary carcinoma of the breast(IMPC)

作　　者：陈宏亮[1] 丁昂[1] 王富文[1] 宋晖[1] 孙建[1] 殷初阳[1] 

机构地区：[1]复旦大学附属妇产科医院乳腺外科,上海200011

出　　处：《复旦学报（医学版）》2015年第1期43-49,56,共8页Fudan University Journal of Medical Sciences

摘　　要：目的研究乳腺浸润性微乳头状癌(invasive micropapillary carcinoma of the breast,IMPC)的临床病理特征以及生存预后分析。方法选择2006年6月至2013年6月在本院收治的IMPC 29例,中位随访42个月,分析其临床病理特点、局部复发率、远处转移率及总生存率(overall survival,OS)等生存预后指标;与320例浸润性导管癌(invasive ductal carcinoma,IDC)病例进行对照,分析比较两组间的临床病理特点及生存预后指标。为进一步探讨IMPC病理类型对于生存预后的影响,将58例IDC与29例IMPC进行2∶1配对对照研究,分析比较两组间的生存预后指标。结果 29例IMPC中23例(79.3%)发生淋巴结转移,其中4枚及以上淋巴结转移的有15例(51.7%),18例(62.1%)伴有脉管侵犯。分子分型以Luminal B型为主(21例)。3年无局部复发生存率(local recurrence free survival,LRFS)、无转移生存率(metastasis free survival,MFS)、OS分别为:74%、86%、90%。Cox回归分析得出淋巴结转移个数是IMPC局部复发的影响因素(P=0.048)。与IDC组比较,IMPC组肿瘤体积大(3.70cmvs.2.81cm,P=0.007),淋巴结转移率高(79.3%vs.45.0%,P<0.001),淋巴结转移个数多(5.90 vs.2.16,P=0.003),淋巴结分级高分级比例较高(N2:24.1%vs.7.5%,N3:27.6%vs.6.9%,P<0.001),脉管侵犯率高(62.1%vs.20.0%,P<0.001),手术方式中标准根治术比例高(24.2%vs.3.1%,P<0.001),化疗方式中新辅助化疗比例高(31.0%vs.9.1%,P<0.001),其余方面差异无统计学意义。Log Rank检验生存分析得出IMPC组的LRFS显著低于IDC组(P=0.001),但两组间的MFS及OS差异无统计学意义(P=0.074及0.106)。将58例IDC与29例IMPC进行配对对照研究,Log Rank检验生存分析得出两组间的LFRS、MFS与OS差异均无统计学意义(P=0.586、0.965、0.920)。结论乳腺IMPC是一类预后较差的特殊类型乳腺癌,其较高的淋巴脉管侵犯性而非这一病理类型,与肿瘤的生存预后相关。Objective To evaluate the ctinicopathological characteristics of invasive micropapillary carcinoma of the breast （IMPC） and make its survival analysis. Methods Twenty-nine eases of IMPC treated in our hospital between June 2006 and June 2013 were included in our study. We analyzed the clinicopathological characteristics and the local recurrence free survival rate （LRFS）, metastasis free survival rate （MFS） and overall survival rate（OS） after a median follow-up of 42 months. They were compared with 321） cases of invasive ductal carcinoma of breast （IDC） on clinicopathological characteristics. Finally,58 cases of IDC were compared with 29 cases of IMPC in a 2：1 matched case- control study to evaluate the effect of the 1MPC histotype on the prognosis. Results Twenty-three cases out of 29 IMPC cases （79.30//00） had lymph node metastasis of which 15（51.7%） cases had 4 or more lymph nodes invaded, 18 cases （62. 1% ） had vascular invasion. Most of the cases （21 cases） were Luminal B type. Three-year local recurrence free survival （I.RFS） ,metastasis free survival （MFS） and overall survival （OS） were 74%,86% and 90%. The number of lymph nodes invaded was the significant negative factor of LRFS （P = 0. 048） by Cox analysis. There were significant differences in tumor size （3.7（3 cm vs. 2.81 cm, P = 0. 007）, positivity of lymph node （79.3% vs. 45.0%, P〈 0. 001） , mean number of metastatic lymph nodes （5.90 vs. 2.16,P=0.003）,lymph node metastasis level （N2：24. 1% vs. 7. 5%,N3：27. 6% vs. 6. 9%,P〈0. 001）,vascular invasion （62. 1% vs. 20.0 %, P〈0. 001 ）, the proportion of standard radical mastectomy （24.2 % vs. 3.1%, P〈0. 001 ） and neoadjuvant chemotherapy （31. 0% vs. 9. 1%,P〈0. 001） between IMPC and IDC group. LRFS of IMPC was significant lower than that of IDC （P = 0. 001 ）. Log Rank survival analysis showed that LRFS was lower in IMPC group than in IDC group （P = 0. 001 ）, while MFS and OR were not significantly diffe

关 键 词：乳腺浸润性微乳头状癌(IMPC) 浸润性导管癌(IDC) 临床病理 生存预后 

分 类 号：R737.9[医药卫生—肿瘤]