乳腺浸润性微乳头状癌临床病理特征及预后分析  

Analysis of clinicopathological characteristics and prognosis of invasive micropapillary carcinoma of the breast

作　　者：王仲照[1] 黄文亭[2] 王年昌 郑闪[2] 石素胜[2] 高纪东[1] 王翔[1] 宣立学[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乳腺外科,北京100021 [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病理科,北京100021

出　　处：《中华肿瘤防治杂志》2017年第9期615-620,共6页Chinese Journal of Cancer Prevention and Treatment

摘　　要：目的乳腺浸润性微乳头状癌(invasive micropapillary carcinoma,IMPC)是一种特殊类型的乳腺浸润性癌,易发生淋巴管、血管侵犯,但对其预后的认识仍存在分歧。本研究拟探讨IMPC的临床病理特征及预后相关性,为临床治疗提供指导。方法采用回顾性分析的方法,形态学观察并评估2006-06-19-2015-10-28国家癌症中心中国医学科学院肿瘤医院病理确诊的89例乳腺IMPC中微乳头状结构的比例,应用免疫组化方法检测ER、PR、HER2及Ki-67的表达,并对各临床病理因素进行生存分析。结果肿瘤内微乳头状癌比例>50%组ER阳性率为85.7%,高于微乳头状癌比例25%~50%组(57.1%)和<25%组(40%),P=0.013;单纯性IMPC组伴脉管瘤栓比率为58.8%,高于混合性IMPC组的32.4%,P=0.018。随访资料显示,微乳头状癌比例>50%组复发/转移率为9.1%,低于微乳头状癌比例25%~50%组(28.6%)和<25%组(40.0%),P=0.047。Kaplan-Meier单因素生存分析显示,微乳头状癌成分>50%组无瘤生存期长于微乳头状癌成分25%~50%组与<25%组,χ~2=4.296,P=0.038;ER阳性组无瘤生存期长于ER阴性组,χ~2=5.324,P=0.021;原发肿瘤T1组无瘤生存期长于T2组,χ~2=7.302,P=0.026。Cox多因素生存分析未发现,影响乳腺IMPC无瘤生存时间的独立预后因素。结论乳腺IMPC虽然易于发生脉管侵犯,但其侵袭性、转移能力及恶性度并不因而增高;原发肿瘤大小、ER状态、微乳头癌比例可能与其预后相关,但有待扩大样本及更长期随访数据的支持。OBJECTIVE Invasive micropapillary carcinoma of breast（IMPC）is a special type of breast cancers.Although it is prone to involve lymphatic and vessel invasion,the prognosis is still controversial.We investigated the clinicopathological characteristics of breast IMPC and analyzed its relationship with prognosis,in order to guide the clinical treatment.METHODS Totally 89 cases of breast IMPC diagnosed between Jun 19,2006 and Oct 28,2015 in National Cancer Center/Cancer Hospital,Chinese Academy of Medical Sciences were retrospectively analyzed.The percentage of micropapillary component in the tumor was evaluated by histological observation.ER,PR,HER2 and Ki-67 were detected by immunohistochemistry.The prognostic value of each clinicopathological parameter was assessed.RESULTS ER positive rate was higher in the group of IMPC component50%（85.7%）than the groups of IMPC component 25%-50%（57.1%）and 25%（40.0%,P=0.013）.Vascular invasion was more frequently seen in pure IMPC group（58.8%）than in mixed group（32.4%,P=0.018）.Follow-up data showed that the recurrence/metastatic rate was lowerin the group of IMPC component50%（9.1%）than the groups of IMPC component 25%-50%（28.6%）and 25%（40.0%,P=0.047）.In Kaplan-Meier univariate analysis,micropapillary component 50%,ER positive and small tumor size were correlated with better disease-free survival（χ2=4.296,P=0.038;χ2=5.324,P=0.021;χ2=7.302,P=0.026,respectively）.In Cox multivariate analysis,there was no independent factor for disease-free survival of breast IMPC.CONCLUSIONS Although IMPC of breast was prone to invade vessels,its ability of invasion and metastasis was not very strong and the malignancy was not very high.Tumor size,ER status,and IMPC component ratio may be potential prognostic factors,but more cases and longer follow-up data are needed.

关 键 词：乳腺癌 浸润性微乳头状癌 临床病理特征 预后 

分 类 号：R737.9[医药卫生—肿瘤]