乳腺原发神经内分泌癌与浸润性导管癌非特殊类型的对比研究  

The features of primary neuroendocrine breast carcinomas compared with invasive ductal carcinomas of no special type: a retrospective clinical study

作　　者：华彬[1] 杨鑫[1] 何淑蓉[2] 张伟[2] 牛小娟[1] HUA Bin;YANG Xin;HE Shu-rong;ZHANG Wei;NIU Xiao-juan(Breast Center,Beijing Hospital,National Center of Gerontology,Beijing 100730,China;Department of Pathology,Beijing Hospital,National Center of Gerontology,Beijing 100730,China)

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

出　　处：《中国医刊》2020年第1期64-67,共4页Chinese Journal of Medicine

基　　金：北京市科技计划课题(D161100000816005)

摘　　要：目的通过病例对照研究探讨乳腺原发神经内分泌癌的临床病理特点。方法回顾性分析2008年6月至2017年6月北京医院乳腺中心收治的27例乳腺原发神经内分泌癌和1025例非Ⅳ期乳腺浸润性导管癌非特殊类型患者的病例资料,比较两种病理类型乳腺癌的临床病理资料以及随访结果,分析乳腺原发神经内分泌癌的临床病理特征。结果本组乳腺原发内分泌癌占所有浸润性乳腺癌的比例为1.4%(27/1923),神经内分泌特异性免疫组织化学标记物检测结果显示88%(22/25)的病例表达嗜铬素A,72.7%(16/22)的病例表达突触素,嗜铬素A和突触素的表达与预后未见明确相关性(P>0.05)。与非Ⅳ期浸润性导管癌非特殊类型相比,乳腺原发神经内分泌癌的发病年龄更高(中位年龄分别为71岁、56岁,P<0.001),雌激素受体和孕激素受体的阳性表达比例有增高趋势(雌激素受体阳性率分别为92.6%、77.6%,P=0.063;孕激素受体阳性率分别为85.2%、73.9%,P=0.184)。两组患者5年无病生存率和总生存率相似,差异无显著性(P>0.05)。结论乳腺神经内分泌癌免疫组化标记物表达的差异可能影响其检出率;雌孕激素受体的高表达预示内分泌治疗可作为乳腺原发神经内分泌癌的重要治疗手段。Objective To well understand the characteristics of neuroendocrine breast carcinoma(NEBC) by compared with invasive ductal carcinoma of no special type(IDC). Method From June 2008 to June 2017, there were 27 patients with NEBC and 1025 non-metastatic patients with IDC were admitted in Breast center of Beijing Hospital, Beijing, China. We retrospectively collected all the data of patients with NEBC and IDC. Result The proportion of NEBC from all invasive breast carcinoma in our center was 1.4%(27/1923). The expression of specific immunohistochemical markers of NEBC was different: 88% cases showed the expression of chromogranin A(22/25), and synaptophysin was positive in 72.7%cases(16/22). The expression of chromogranin A and synaptophysin was not associated with other clinical prognostic factors significantly in this group of patients(P>0.05). Compared with non-metastatic IDC(n=1025), NEBC occurred in older patients(median age,71 vs. 56, P<0.001), and had relatively higher hormone receptor expression(estrogen receptor, 92.6% vs. 77.6%, P=0.063;progesterone receptor, 85.2% vs. 73.9%, P=0.184). The estimates of the 5-year rates of disease free survival(DFS) and overall survival(OS) were 88.8%±7.5% and 87.8%±8.1% in NEBC group, comparable to those in IDC group(DFS, 83.8%±1.5%;OS, 93.7%±0.9%;both P>0.05). Conclusion There is remarkable variation in the incidence of NEBC which can be explained by different expression of neuroendocrine marker immunostainings. Higher positive rates of hormone receptor in NEBC group indicate endocrine therapy is a major remedy for this group of patients.

关 键 词：乳腺原发神经内分泌癌 乳腺浸润性导管癌非特殊类型 临床病理学 预后 

分 类 号：R737.9[医药卫生—肿瘤]