乳腺浸润性微乳头状癌与浸润性导管癌临床病理特征比较分析  

Clinico-pathological features and prognosis of invasive micropapillary carcinoma compared to invasive ductal carcinoma of not otherwise specified

作　　者：周晓云[1] 何奇[1] 王杰[1] 杨莉[1] 叶欣[1] ZHOU Xiao-yun;HE Qi;WANG Jie;YANG Li;YE Xin(Department of Breast Surgery, The International Peace Maternity ＆ Child Health Hospital of China Welfare Institute,Shanghai Jiao Tong University School of Medicine ,Shanghai 200030 , P. R. Chin)

机构地区：[1]上海交通大学医学院附属国际和平妇幼保健院乳腺科,上海200030

出　　处：《中华肿瘤防治杂志》2017年第19期1366-1372,共7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)作为浸润性乳腺癌的一种特殊类型,具有易于淋巴管侵犯、腋窝淋巴结转移率高及预后差等特点。本研究旨在探讨IMPC患者与乳腺非特殊类型浸润性导管癌(invasive ductal carcinoma,not otherwise specified,IDC-NOS)患者的临床病理特征及预后的差异。方法回顾性分析2010-01-01-2013-12-31上海交通大学医学院附属国际和平妇幼保健院诊治并行手术治疗的892例乳腺癌患者。其中,IMPC患者21例,剔除1例行新辅助化疗者,共纳入首次治疗为手术的20例IMPC患者和首次治疗为手术的413例IDC-NOS患者进行临床病理学特征的回顾性分析,并随访两者的复发、转移及死亡情况,比较两者的发病年龄、肿瘤组织大小、淋巴结转移个数、淋巴结转移率、淋巴管内癌浸润、血管内癌浸润、神经管内癌浸润、雌激素受体(estrogen receptor,ER)表达、孕激素受体(progesterone receptor,PR)表达、人类表皮生长因子受体2(human epidermal growth factor receptor-2,HER2)表达、Ki-67、病理分期、分子分型、及复发转移和总生存率,分析两者临床病理特征及预后的差异。结果IMPC患者占同期乳腺癌患者的2.35%(21/892)。纳入研究的IMPC患者与IDC-NOS患者的平均年龄分别为(50.65±9.38)岁和(51.17±10.83)岁,P=0.526;肿瘤组织直径中位数分别为1.75cm(0.8~6cm)和2cm(0.3~5cm),P=0.794;淋巴结转移个数中位数分别为2个(0~16个)和0个(0~36个),P=0.192;淋巴结转移率分别为65.00%和34.78%,P=0.18。IMPC患者中淋巴管内癌浸润及血管内癌浸润的发生率均显著性高于IDC-NOS患者,P=0.002,P=0.002。IMPC患者与IDC-NOS患者中,ER阳性率分别为75.00%和66.00%,P=0.012;PR阳性率分别为80.00%和66.30%,P=0.003;HER2阳性率分别为20.00%和13.07%,P=0.007;Ki-67表达率的平均值分别为(15.00±19.08)%和(21.32±22.59)%,P=0.105。pTNM分期中IMPC患者Ⅰ期为30.00%(6/20),Ⅱ期为40.00%(8/20),OBJECTIVE Invasive micropapillary carcinoma（IMPC）of the breast is a special type of invasive breast cancer,which has the characteristics of high lymphatic invasion,high axillary lymph node metastasis and poor prognosis.The aim of this study is to investigate the clinico-pathological features and prognosis of IMPC compared to invasive ductal carcinoma of not otherwise specified（IDC-NOS）.METHODS Retrospective analysis of 892 breast cancer cases whom were diagnosed and treated by operation during the period from 2010-01-01 to 2013-12-31.Among these,21 cases of IMPC patients,excluding 1 neoadjuvant chemotherapy case,were included 20 cases of IMPC patients first treated by operation and 413 cases of IDC-NOS patients first treated by operation to retrospectively analyze the clinical pathological characteristics.Follow up the metastasis,recurrence and death.Compare the age,tumor size,the number of lymph node metastasis,the incidence of lymph node metastasis,lymphatic invasion,vascular invasion,neural tube invasion,estrogen receptor（ER）expression,progesterone receptor（PR）expression,human epidermal growth factor receptor 2（HER2）expression,Ki-67,pathology stage,molecular subtypes,recurrence and overall survival.The differences of pathological features and prognosis between two groups were analyzed.RESULTS IMPC patients accounted for 2.35%（21/892）of all breast cancer patients during the same period.Included study,the average age of IMPC patients and IDC-NOS patients was（50.65±9.38）y,（51.17±10.83）y,P=0.526;the median tumor size was 1.75 cm（0.80-6 cm）,2 cm（0.30-5 cm）,P=0.794;the median number of lymph node metastasis was 2（0-16）,0（0-36）,P=0.192;the incidence of lymph node metastasis was 65.00%,34.78%,P=0.18.In IMPC patients,the incidences of lymphatic invasion and vascular invasion were significantly higher than those in patients with IDC-NOS,P=0.002,P=0.002.The positive incidence of ER in IMPC patients and IDC-NOS patients was 75.00%,66.00%,P=0.012.The positive incidence of P

关 键 词：浸润性微乳头状癌 临床病理学 淋巴转移 预后 

分 类 号：R737.9[医药卫生—肿瘤]