乳腺浸润性微乳头状癌淋巴结转移的高危因素及对预后的影响  

High Risk Factors of Lymph Node Metastasis in Invasive Micropapillary Carcinoma of the Breast and Its Influence on Prognosis

作　　者：冯爱强[1] 汪杰 张彦武[1] 牛耀东[1] 吕以东[1] 王璐[1] 

机构地区：[1]郑州大学第三附属医院乳腺科,河南郑州450052

出　　处：《中外医疗》2017年第29期7-10,13,共5页China & Foreign Medical Treatment

摘　　要：目的探讨乳腺浸润性微乳头状癌(Invasive micropapillary carcinoma of,IMPC)患者淋巴结转移的高危因素及对预后的影响。方法方便选取2007年1月—2013年10月在郑州大学第三附属医院确诊并接受治疗的40例乳腺IMPC患者,收集其一般临床资料、临床病理及免疫组化学特征和预后情况,并分析乳腺IMPC患者淋巴结转移的高危因素及对预后的影响。结果该研究中有26例(65%)出现淋巴结转移。单因素Logistic回归分析结果显示:组织学分级、肿瘤大小、Ki-67表达均与淋巴结转移相关(P<0.05),但确诊时年龄、PR、ER、Her-2以及乳腺IMPC所占比例与淋巴结转移均不相关(P>0.05)。多因素Logistic回归分析结果显示:乳腺IMPC患者的淋巴结转移和肿瘤大小(β:1.484,标准误:0.797,P=0.063)及Ki-67(β:1.497,标准误:1.358,P=0.278)均无相关性,只有组织学分级(β:2.392,标准误:1.105,P=0.030)是淋巴结转移的独立危险因素。预后情况:乳腺IMPC患者的5年总生存率为88.4%,淋巴结转移率与总生存率无相关性。结论乳腺IMPC的淋巴结转移率高、侵袭性强,预后较差的一种乳腺浸润性癌,肿瘤的组织学分级是淋巴结转移的独立危险因素。在临床治疗时应充分重视这些因素,制定合理的治疗计划,提高患者的生存率。Objective This paper tries to explore the high risk factors of lymph node metastasis in invasive micropapillary carcinoma（IMPC） of the breast and its influence on prognosis. Methods From January 2007 to October 2013, 40 cases of IMPC were diagnosed and treated in this hospital and their general clinical data, clinical pathological and immunohistochemical features and prognosis were convenient collected. The high risk factors of lymph node metastasis in IMPC and its influence on prognosis were analyzed. Results 26 patients（65%） had lymph node metastasis in this research. The results of univariate logistic regression analysis showed that histological grading, tumor size and the expression of Ki-67 were correlated with lymph node metastasis（P〈0.05）. However, age, PR, ER, HER-2 and proportion of IMPC had no effect on lymph node metastasis（P〉0.05）. The results of multivariate logistic regression analysis showed that tumor size（β=1.484, standard error=0.797, P=0.063） and the expression of Ki-67（β=1.497, standard error=1.358, P=0.278） had no correlation with lymph node metastasis, which was associated with histological grading（β=2.392, standard error=1.105, P=0.030）. Prognosis： overall survival rate of the patients was 88.4% at 5 years, and there was no correlation between lymph node metastasis rate and overall survival rate. Conclusion This kind of breast IMPC always has higher histologic grade, stronger invasion and poor prognosis. Histologic grading of the tumor is an independent risk factor for lymph node metastasis. In clinical treatment,these factors should be paid full attention to, and the reasonable treatment plan should be made to improve the survival rate.

关 键 词：乳腺浸润性微乳头状癌 病理特征 淋巴结转移 预后 

分 类 号：R737.9[医药卫生—肿瘤]