乳腺小叶原位癌:16例患者的临床特征、诊治及预后  

Breast lobular carcinoma in situ:Clinical features,diagnosis,treatment and prognosis of 16 cases

作　　者：常利利[1] 张丽娜[1] 顾林[1] 

机构地区：[1]天津医科大学肿瘤医院乳腺二科,国家肿瘤临床医学研究中心,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,天津300060

出　　处：《肿瘤》2016年第4期424-429,451,共7页Tumor

基　　金：国家自然科学基金项目(编号:81202275);天津市自然科学基金青年项目(编号:13JCQNJC11000);天津医科大学科学基金项目(编号:2011KY11)~~

摘　　要：目的：探讨乳腺小叶原位癌的临床病理特征、诊疗及预后。方法：回顾性分析1994年7月—2014年4月确诊的16例乳腺小叶原位癌患者的临床病历及随访资料,应用Kaplan-Meier法进行生存分析,并进行预后的相关因素分析。结果：16例患者均为女性,中位发病年龄为46岁,绝经前患者占75.0%（12/16）。术前影像学检查和空芯针穿刺检查的误诊率较高,确诊仍需依靠术后病理组织学诊断。免疫组织化学检查结果显示雌激素受体、孕激素受体和人类表皮生长因子受体2阳性表达率分别为90.9%（10/11）、81.8%（9/11）和18.2%（2/11）。中位随访时间为66个月（范围：1~210个月）,5年生存率为92.3%。单因素分析结果显示,癌症家族史、绝经状况、肿瘤最大径、腋窝淋巴结转移情况、激素受体表达情况及术后辅助治疗均与预后无明显相关性（P值均〉0.05）。结论：乳腺小叶原位癌的临床表现缺乏特异性,其发病率低,预后好;激素受体阳性率较高,但人类表皮生长因子受体2阳性率较低;局部手术切除、临床随访和三苯氧胺治疗是当前主要的治疗模式。Objective：To investigate the clinicopathological features,appropriate diagnosis,treatment and prognosis of patients with breast lobular carcinoma in situ（LCIS）.Methods：The clinical records and follow-up information of 16 patients with pathologically identified breast LCIS between July1994 and April 2014 were reviewed retrospectively.The survival was analyzed by Kaplan-Meier method.The prognostic factors were evaluated.Results：The median age of sixteen female patients was 46years,and the premenopausal patients accounted for 75.0% of all the patients（12/16）.The misdiagnostic rates of preoperative imaging and core needle biopsy（CNB） were high,therefore the definite diagnosis still needed to rely on postoperative pathological examination.The result of immunohistochemistry showed that the positive expression rates of estrogen receptor（ER）,progesterone receptor（PR） and human epidermal growth factor receptor-2（HER-2） were 90.9%（10/11）,81.8%（9/11） and 18.2%（2/11）,respectively.The median follow-up time was 66 months（range：1-210 months）,and the 5-year overall survival rate was 92.3%.The result of univariate analysis showed that family history of cancer,menopausal status,tumor size,lymph node metastasis,expression of hormone receptors and adjuvant therapy were not associated with the prognosis（all P 0.05）.Conclusion：The clinical features of breast LCIS are in lack of particularity,it has a low incidence rate and the prognosis is good.The positive rates of hormone receptors are high,but which of HER-2 is low.Currently,regional resection,clinical follow-up combined with tamoxifen therapy is the main therapeutic mode.

关 键 词：乳腺肿瘤 小叶原位癌 临床特征 诊断 治疗 预后 

分 类 号：R737.9[医药卫生—肿瘤]