乳腺浸润性导管/小叶混合癌的临床病理特征和预后分析  

Clinicopathological features and prognosis analysis of mixed invasive ductal-lobular carcinoma

作　　者：陈舒婕 籍敏[1] 何奇[1] Chen Shujie;Ji Min;He Qi(Department of Breast Surgery,the International Peace Maternity&Child Health Hospital of China Welfare Institute,Shanghai Jiaotong University School of Medicine,Shanghai 200030,China)

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

出　　处：《现代肿瘤医学》2020年第3期415-421,共7页Journal of Modern Oncology

摘　　要：目的:探讨乳腺浸润性导管/小叶混合癌(IDC-L)与浸润性小叶癌(ILC)及浸润性导管癌(IDC)临床病理特征以及预后的差异。方法:回顾性分析2009年1月至2015年12月上海交通大学乳腺癌数据库中有完整临床病理资料与随访资料的IDC-L、ILC与IDC患者的临床病理特征以及预后的差异。结果:共2957例乳腺癌患者入组,其中IDC-L、ILC与IDC分别有109、177和2671例。多因素分析显示,与IDC-L相比,IDC患者多中心病灶和脉管浸润较少,而HER2阳性和Ki-67高表达较多(P<0.05);ILC患者发病年龄较大、脉管浸润较少(P<0.05)。IDC-L患者的5年无乳腺癌生存率(BCFI)(82.1%vs 90.7%,P=0.040)和总生存率(OS)(91.0%vs 94.4%,P=0.029)比IDC患者差;但与ILC患者(BCFI:84.1%,P=0.803,OS:92.6%,P=0.803)无明显差异。多因素生存分析显示,病理类型、肿瘤大小、淋巴结状态以及分子分型是影响患者BCFI和OS的独立因素(P<0.05),IDC-L较IDC患者有较差的BCFI(HR=1.67,95%CI:1.02~2.70,P=0.042)及OS(HR=1.89,95%CI:1.04~3.45,P=0.037)。结论:IDC-L临床病理特征与ILC相似,但与IDC有较多不同;IDC-L预后劣于IDC,与ILC无明显差异,有待进一步研究证实。Objective:To investigate the differences of clinicopathological features and prognosis in mixed invasive ductal-lobular carcinoma(IDC-L),invasive lobular carcinoma(ILC)and invasive ductal carcinoma(IDC).Methods:We retrospectively analyzed the differences of clinicopathological features and prognosis between IDC-L,ILC and IDC patients which had complete clinicopathological and follow up data from Shanghai Jiaotong University Breast Cancer Database(SJTU-BCDB)between January 2009 and December 2015.Results:A total of 2957 patients were enrolled,in which 109 were IDC-L,177 were ILC,and 2671 were IDC.Multivariate analysis showed that compared to IDC-L,IDC patients were less likely to have multicenter lesion and lymphovascular invasion,and more likely to be HER2 positive and high expression of Ki-67(P<0.05).Compared to IDC-L,ILC had older patients and less lymphovascular invasion(P<0.05).IDC-L patients were associated with decreased breast cancer-free interval(BCFI)and overall survival(OS)compared to IDC patients(BCFI:82.1%vs 90.7%,P=0.040,OS:91.0%vs 94.4%,P=0.029),while IDC-L patients had similar BCFI(82.1%vs 84.1%,P=0.803)and OS(91.0%vs 92.6%,P=0.803)with ILC patients.Multivariate analysis revealed that BCFI and OS were significantly associated with pathological type,tumor size,lymph node status and molecular subtype(P<0.05).IDC-L patients had worse BCFI(HR=1.67,95%CI:1.02~2.70,P=0.042)and OS(HR=1.89,95%CI:1.04~3.45,P=0.037)than IDC patients.Conclusion:The clinicopathological features of IDC-L patients are similar to those of ILC patients,but different from IDC patients.The prognosis of IDC-L is worse than that of IDC,but has no significant difference from ILC,which needs further study.

关 键 词：乳腺癌 乳腺浸润性混合癌 浸润性小叶癌 浸润性导管癌 临床病理 预后 

分 类 号：R737.9[医药卫生—肿瘤]