乳腺鳞状细胞癌和乳腺腺鳞癌临床病理特征、治疗和预后因素分析  

Analysis of clinicopathological features,treatment,and prognostic factors of breast squamous cell carcinoma and breast adenosquamous carcinoma

作　　者：苏小涵 李金穗[1,2] 谭巧 侯令密 黎君彦[3] SU Xiaohan;LI Jinsui;TAN Qiao;HOU Lingmi;LI Junyan(Department of Breast and Thyroid Surgery,Biological Targeting Laboratory of Breast Cancer,Academician(expert)Work Station,Affiliated Hospital of North Sichuan Medical College,Sichuan Nanchong 637000,China;Sichuan Key Laboratory of Medical Imaging,Sichuan Nanchong 637000,China;Chengdu Fifth People's Hospital,Sichuan Chengdu 610000,China)

机构地区：[1]川北医学院附属医院甲状腺乳腺外科,乳腺癌生物靶向研究室,院士(专家)工作站,四川南充637000 [2]四川省医学影像重点实验室,四川南充637000 [3]成都市第五人民医院,四川成都610000

出　　处：《现代肿瘤医学》2023年第19期3593-3599,共7页Journal of Modern Oncology

基　　金：四川省自然科学基金面上项目(编号:2022NSFSC0775);四川省中医药管理局中医药基础项目(编号:2020JC0055);四川省南充市市校合作科研创新团队建设专项(编号:20SXCXTD0001)。

摘　　要：目的:探讨和比较乳腺鳞状细胞癌和乳腺腺鳞癌患者的临床病理特征、治疗和预后因素的差异。方法:依据纳入、排除标准提取美国综合国立癌症研究所监测、流行病学和结果(The Surveillance,Epidemiology,and End Results,SEER)数据库2000年至2018年诊断为乳腺浸润性导管癌(invasive ductal carcinom,IDC)、乳腺鳞状细胞癌(squamous cell carcinoma,SCC)和乳腺腺鳞癌(adenosquamous carcinoma,ASC)患者资料,分析人群的临床病理特征及治疗差异,采用Cox回归模型评估SCC和ASC患者乳腺癌特异性生存期(breast cancer-specific survival,BCSS)和总生存期(overall survival,OS)的独立预后因素并计算风险比(HR)和95%置信区间(CI),通过倾向性评分匹配法(propensity score matching,PSM)均衡组间混杂因素,并用Kaplan-Meier法绘制生存曲线,用Log-rank检验分析预后差异。结果:SEER数据库中共有813451例IDC、579例SCC和397例ASC患者被纳入研究,IDC较SCC和ASC的诊断年龄更早,肿瘤直径更小,TNM分期更早,组织学分级更好,Lumina亚型比例更多,预后更好;多因素Cox回归分析显示,针对SCC,诊断年龄、种族、T分期、N分期、M分期、手术方式是BCSS的独立预后因素;诊断年龄、种族、T分期、N分期、手术方式是OS的独立预后因素。针对ASC,诊断年龄、T分期和N分期是BCSS的独立预后因素;诊断年龄、T分期和N分期是OS的独立预后因素。结论:SCC和ASC较IDC更具侵袭性,预后更差,排除混杂变量影响后,IDC、SCC和ASC对预后的影响无显著差别。预后更差的原因是肿瘤分期更晚,三阴性乳腺癌比例更高,而非病理类型本身,临床上对于SCC和ASC的治疗应该更加规范。Objective:To investigate and compare the clinicopathological features,treatment and prognostic factors of squamous cell carcinoma of breast and adenosquamous carcinoma of breast.Methods:According to the inclusion and exclusion criteria,we extract the patient data of invasive ductal carcinoma(IDC),squamous cell carcinoma(SCC),and adenosquamous carcinoma(ASC)of the breast in 2000 to 2018 from The Surveillance,Epidemiology,and End Results(SEER)database of the National Cancer Institute of the United States.We analyze the clinicopathological characteristics and treatment differences of the population.Univariate and multivariate Cox regression models were used to evaluate breast cancer-specific survival(BCSS)and overall survival(OS)in SCC and ASC patients.Hazard ratio(HR)and 95%confidence interval(CI)were calculated.Propensity score matching(PSM)balanced confounding factors between groups,and survival curves were plotted using the Kaplan-Meier method.The difference in prognosis was analyzed by Log-rank test.Results:A total of 813451 IDC,579 SCC,and 397 ASC patients were included in the SEER database.In comparison,IDC showed an earlier age of diagnosis,smaller tumor diameter,earlier TNM stage,better histological grade,more Lumina subtypes,and better prognosis compared to SCC and ASC.Multivariate Cox regression analysis revealed that for SCC,age at diagnosis,race,T stage,N stage,M stage,and surgery method were independent prognostic factors for both BCSS and OS.Similarly,for ASC,age at diagnosis,T stage,and N stage were identified as independent prognostic factors for both BCSS and OS.Conclusion:Compared to IDC,SCC and ASC exhibit more aggressive behavior and have a worse prognosis.However,after accounting for confounding variables,IDC,SCC,and ASC show no significant difference in prognosis.The poorer prognosis observed in SCC and ASC is primarily attributed to the later tumor stage and a higher proportion of triple-negative subtypes,rather than the pathological type itself.It is important to note that the clinical treat

关 键 词：乳腺癌 鳞状细胞癌 腺鳞癌 预后 SEER 

分 类 号：R737.9[医药卫生—肿瘤]