1190例乳腺癌患者乳头浸润相关因素分析  

Nipple involvement in early breast cancer: retrospective analysis of 1,190 consecutive mastectomy specimens

作　　者：杨后圃[1] 王伟琦[2] 王殊[1] 谢菲[1] 郭嘉嘉[1] 曹迎明[1] 佟富中[1] 刘鹏[1] 刘媛媛[3] 

机构地区：[1]北京大学人民医院乳腺中心,北京市100044 [2]航天中心医院普通外科 [3]北京市昌平区妇幼保健院乳腺外科

出　　处：《中国肿瘤临床》2016年第2期67-71,共5页Chinese Journal of Clinical Oncology

摘　　要：目的：探讨早期乳腺癌侵犯乳头的概率和相关危险因素。方法：收集北京大学人民医院2008年10月至2014年3月行乳腺癌标准乳房切除术病例1 190例,比较临床乳头异常组（54例）与无明显异常组（1 136例）乳头浸润率差异,分析相关临床病理因素与隐匿性乳头浸润的相关性。将单因素分析具有统计学意义的指标纳入二元Logistic回归模型行多因素分析,筛选独立预测因子。结果：所有标本乳头浸润率为6.0%（71/1 190）,其中临床乳头异常组为40.7%（22/54）显著高于无明显异常组的4.3%（49/1 136）（χ-2=121.9,P〈0.001）。单因素分析显示病变位置（中央象限、外周象限）、肿瘤至乳头距离（≤2 cm、〉2 cm）、脉管癌栓、肿瘤（包括原位癌）长径（≤3.5 cm、〉3.5 cm）、T分期、N分期和TNM分期与隐匿性乳头浸润有关。多因素分析显示病变位置、肿瘤至乳头距离、T分期和N分期是乳头浸润的独立预测因子。结论：临床乳头无明显异常者乳头浸润概率较低。肿瘤位于外周、至乳头距离〉2 cm、T1-T2、N0-N1的病例保留乳头风险更低。Objective：To evaluate the frequency and predictive factors of nipple involvement in a large contemporary cohort of pa-tients and to improve patient selection for the preservation of the nipple- areolar complex. Methods：This retrospective study re-viewed the medical charts of1,190 patients who underwent traditional mastectomy in Peking University People＇s Hospital between October2008and March 2014. Nipple involvement incidence was compared between the cases of clinically abnormal and clinically normal breasts. Other clinicopathological features and nipple status were analyzed to evaluate the association between these factors and occult nipple involvement. Univariate and multivariate analyses were conducted to identify predictive factors. Results：Nipple in -volvement was detected in6. 0% of the mastectomy specimens. Meanwhile, incidence was 40. 7% （22out of 54） in clinically abnormal nipple cases and 4. 3% （49out of 1,136 ） in clinically normal nipple cases （ χ^2=121 . 9, P〈0. 001 ）. Univariate analysis revealed that tumor lo -cation, tumor to nipple distance （ ≤ 2 and 〉2 cm）, lymphovascular invasion, diameter （including carcinoma in situ; ≤ 3. 5 and 〉3. 5 cm）, T stage, N stage, and TNM stage were associated with occult nipple involvement. By logistic regression analysis, tumor location, tumor to nipple distance, T stage, and N stage were determined to be the independent predictors of nipple involvement. Conclusion： Clinical abnormalities of the nipples are reliable and potent predictors of nipple pathology. The cases with peripheral tumor, T1-T2 stage, and N0-N1 stage have lower probability of occult nipple involvement.

关 键 词：乳腺肿瘤 乳房切除术 乳头浸润 预测因子 

分 类 号：R737.9[医药卫生—肿瘤]