乳腺浸润性微乳头状癌与非特殊类型浸润性导管癌的回顾性对比研究  

The comparison of characters between invasive micropapiUary carcinoma and invasive ductal carcinoma not otherwise specified of the breast

作　　者：华彬[1] 陆旭[1] 肖文政[1] 何淑荣 王征[2] Hua Bin Lu Xu Xiao Wenzheng He Shurong Wang Zheng(Breast Center, Beifing Hospital, National Center of Gerontology, Beijing 100730, China)

机构地区：[1]国家老年医学中心北京医院乳腺中心,100730 [2]国家老年医学中心北京医院病理科,100730

出　　处：《中华外科杂志》2017年第10期770-774,共5页Chinese Journal of Surgery

摘　　要：目的 探讨乳腺浸润性微乳头状癌（IMPC）和非特殊类型浸润性导管癌（IDC）临床病理学特点及预后因素的差异.方法 本研究为单中心回顾性对比研究,收集2008年6月至2016年4月北京医院乳腺中心治疗的所有IMPC患者（59例）和IDC患者（1 080例）的临床病理学资料.所有患者接受手术治疗,术后每3～6个月随访一次,直至患者出现疾病进展、死亡或2016年7月31日随访截止.单因素分析采用U检验、x2检验或Fisher精确检验,多因素分析采用Cox比例风险模型,Kaplan-Meier法绘制生存曲线并行Log-rank检验.结果 IMPC组淋巴结阳性比例更高（x2=12.168,P=0.007）,TNM分期更晚（x2=8.950,P=0.011）;IMPC组23.7％（14/45）的患者病理学检查发现脉管内癌栓,高于IDC组的9.1％（98/982）（x2=13.551,P=0.000）.IMPC组雌激素受体、孕激素受体的阳性率高于IDC组（89.8％比76.3％,88.1％比70.7％,x2为5.786、8.332,P值均＜0.05）.多因素分析结果显示,对于IMPC组患者,T分期（T1-2和T3-4,OR=5.217,95％ CI：1.401 ～ 19.430,P=0.014）是无病生存时间的独立预后因素,T分期（OR=3.713,95％CI：1.539～8.959,P=0.004）和淋巴结阳性比例（＜50％和≥50％,OR=2.850,95％CI：1.033 ～7.862,P=0.043）是总体生存时间的独立预后因素.对于IDC组患者,病理分期（Ⅰ～Ⅱ期和Ⅲ～Ⅳ期,OR=1.870,95％ CI：1.262～2.771,P=0.002）、淋巴结阳性比例（OR=2.222,95％ CI：1.561～3.162,P=0.000）、孕激素受体（OR=1.856,95％CI：1.118～3.082,P=0.017）及年龄（＜50岁和≥50岁,OR=0.695,95％CI：0.488 ～0.989,P=0.043）是无病生存时间的独立预后因素,淋巴结阳性比例（OR=2.129,95％CI：1.324～3.425,P=0.002）是总体生存时间的独立预后因素.与IDC组患者相比,IMPC组患者更易出现局部（区域性）复发（P=0.006）;尽管IDC组无病生存的中位时间较IMPC组延长（x2=9.739,P=0.002）,但是两组总体生存时间相近（x2=0.787,P=0.375）.结论 Objective To analyze the differences of clinicopathological characters and prognostic factors between invasive micropapillary carcinoma of the breast （IMPC） and invasive ductal carcinoma （IDC） not otherwise specified of the breast.Methods Patients who were treated from June 2008 to April 2016 in Breast Center of Beijing Hospital were retrospectively analyzed to evaluate the differences between IMPC （n=59） and IDC （n=1 080）.Follow-up was done every 3 to 6 months postoperatively with a deadline of July 31,2016.The curves of disease free survival （DFS） and overall survival （OS） were drawn by Kaplan-Meier method,and survival rates were compared by means of the Log-rank test.Potential prognostic variables which were identified on univariate analysis were analyzed with Cox＇s proportional hazards regression model for multivariate analysis.Results More lymph nodes were involved in IMPC group （x2 =12.168,P=0.007） which led to more later stage in this group （x2 =8.950,P=0.011）.IMPC group displayed a significantly increased rate of lymphovascular invasion （LVI） compared to IDC group （x2 =13.511,P =0.001）.The expression rate of estrogen receptor （ER） and progesterone receptor （PR） was higher in IMPC group than that in IDC group （89.8% vs.76.3% and 88.1% vs.70.7%,respectively,x2=5.786,8.332,all P〈0.05）.In multivariate analysis performed with the variables found significant in univariate analysis,the only variable found significantly affecting DFS of IMPC group was the T stage （T1-2and T3-4, OR =5.217,95% CI：I.401 to 19.430,P =0.014）,while in IDC group,pathological stage （stage Ⅰ to Ⅱ and stage Ⅲ to Ⅳ,OR=1.870,95% CI：1.262 to 2.771,P=0.002）,lymph node positive ratio （LNR） （OR=2.222,95%CI：1.561 to 3.162,P=0.000）,PR （OR=1.856,95%CI：1.118 to 3.082,P=0.017）,and age （〈50 years old and ≥ 50 years old,OR =0.695,95%CI：0.488 to 0.989,P =0.043） were prognostic factors.There were two variables found significantly affecting OS of IM

关 键 词：乳腺肿瘤 癌 乳头状 预后 

分 类 号：R737.9[医药卫生—肿瘤]