674例乳腺导管内乳头状肿瘤的临床病理特征及预后分析  

Analysis of the clinicopathological characteristics and prognosis in 674 cases of breast intraductal papillary tumor

作　　者：王文彦[1] 王昕[2] 高纪东[2] 王杰[2] 刘嘉琦[2] 王翔[2] 赵东兵[1] 

机构地区：[1]国家癌症中心中国医学科学院北京协和医学院肿瘤医院胰胃外科,100021 [2]国家癌症中心中国医学科学院北京协和医学院肿瘤医院乳腺外科,100021

出　　处：《中华肿瘤杂志》2017年第6期429-433,共5页Chinese Journal of Oncology

摘　　要：目的探讨乳腺导管内乳头状肿瘤的临床病理特征和癌变影响因素。方法回顾性分析2010年1月至2015年7月中国医学科学院肿瘤医院收治的674例乳腺导管内乳头状肿瘤患者的临床病理资料。结果674例患者中，乳腺导管内乳头状瘤547例，导管内乳头状癌88例，囊内乳头状癌32例，实性乳头状癌7例。中位随访46个月，547例乳腺导管内乳头状瘤患者中，有13例（2.4%）原手术部位同象限出现导管内乳头状瘤局部复发，10例（1.8%）原手术部位同象限出现乳腺癌。Kaplan－Meier生存分析结果提示，导管内乳头状瘤患者和导管内乳头状瘤伴不典型增生患者的3年无复发生存率分别为97.7%和93.5%，无复发生存曲线的差异有统计学意义（P＝0.011）。Cox多因素分析结果显示，不典型增生是影响乳腺导管内乳头状肿瘤无复发生存的主要因素（P＝0.020）。4例（3.1%）导管内乳头状癌患者出现局部复发。Logistic分析结果显示，年龄〉45岁、临床表现为乳房肿物、肿瘤最大径〉2 cm是恶性乳腺导管内乳头状肿瘤的可能临床表现（均P〈0.05）。 结论乳腺导管内乳头状肿瘤具有一定的复发率，年龄、临床特征及肿瘤大小可能是恶性导管内乳头状肿瘤的预测因素。ObjectiveBreast intraductal papillary tumors are clinically common diseases derived from the ducts. The aim of this study is to investigate the clinicopathological characteristics of intraductal papillary tumors and risk factors for carcinogenesis.MethodsThe clinicopathological data of 674 patients with breast intraductal papillary tumors, who underwent surgery in the National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences from January 2010 to July 2015, were retrospectively analyzed.ResultsThe median follow-up time was 46 months. The 674 cases were classified into 547 intraductal papilloma, 88 cases of intraductal papillary carcinoma, 32 cases of intracystic papillary carcinoma, and 7 cases of solid papillary carcinoma of breast. After a median follow-up time of 46 months, 13 out of 547 （2.4%） intraductal papillomas had local recurrence in the original dissected quadrat, another 10 cases developed breast cancer in the original dissected quadrat. The 3-year recurrence-free survival rates in intraductal papilloma and intraductal papilloma accompanied with atypical ductal hyperplasia were 97.7% and 93.5%, respectively, the recurrence-free survival curves showed a significant difference （P=0.011）. Multivariate analysis indicated that atypical ductal hyperplasia was a major prognostic factor affecting the recurrence-free survival of intraductal papilloma （RR=0.183, 95%CI=0.054 to 0.777, P=0.020）. Four cases （3.1%） of intraductal papillary carcinoma had local recurrence. The logistic analysis showed that patient aged 〉45 years, clinical manifestations of a breast lump, maximum tumor diameter greater than 2 cm are possible clinical manifestation of malignant breast intraductal papillary tumors （RR=1.735, 95%CI=1.007-2.990, P=0.047; RR=2.849, 95%CI=1.207-6.711, P=0.017; RR=3.792, 95%CI=2.162-6.653, P〈0.001）.ConclusionsIntraductal papillary tumors have a certain recurrence rate. Age, clinical features and tumor size may be predictive factors of intraductal papillary carcinoma.

关 键 词：乳腺肿瘤 导管内乳头状肿瘤 复发 预后 

分 类 号：R737.9[医药卫生—肿瘤]