乳腺交界性及恶性叶状肿瘤患者临床病理特征及预后分析  

Clinical characteristics and prognostic analysis of patients with borderline phyllodes tumors or malignant phyllodes tumor of the breast

作　　者：高然 方仪 高纪东 Gao Ran;Fang Yi;Gao Jidong(Department of Breast Surgical Oncology,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China;Department of Breast Surgical Oncology,National Cancer Center/National Clinical Research Center for Cancer/Shenzhen Center Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Shenzhen,Guangdong 518116,China)

机构地区：[1]国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院乳腺外科,北京100021 [2]国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院深圳医院乳腺外科,广东深圳518127

出　　处：《中国医刊》2024年第6期602-605,共4页Chinese Journal of Medicine

基　　金：中国癌症基金会北京希望马拉松专项基金(LC2019L07)。

摘　　要：目的探讨乳腺交界性叶状肿瘤(BPT)及恶性叶状肿瘤(MPT)的临床病理特征及预后影响因素。方法回顾性选取2017年7月至2023年6月中国医学科学院肿瘤医院收治的111例乳腺BPT及MPT患者的临床资料,分析其临床病理特征、复发转移情况及无复发生存率的影响因素。结果111例患者中,20例出现局部复发,4例发生远处转移。接受非全切手术的88例患者中,行肿物区段切除术(无切缘检查)和肿物扩大切除术(有切缘检查)的患者复发率分别为31.0%和10.9%,差异有统计学意义(P=0.020)。单因素生存分析显示,BPT及MPT患者的无复发生存率与组织学类型有关(P=0.004),与初治肿瘤最大径(P=0.080)、平均核分裂象计数(P=0.153)及手术方式(P=0.204)无明显相关性。Cox多因素分析结果显示,MPT患者的复发风险是BPT患者的4.894倍(95%CI 1.857~12.901,P=0.001)。结论乳腺MPT较BPT具有更高的复发风险。手术治疗应在保证完整切除肿瘤的基础上适当扩大切除范围,并至少保证切缘阴性。Objective To explore the clinicopathological characteristics and prognostic factors of patients with borderline phyllodes tumors(BPT)and malignant phyllodes tumors(MPT)of the breast.Method The clinical and pathological data of 111 patients with breast BPT or MPT enrolled in Cancer Hospital,Chinese Academy of Medical Sciences were retrospectively analyzed.χ2 test,Kaplan-Meier analysis and Cox proportional hazards regression model were used to analyze the factors affecting the recurrence-free survival(RFS).Result Among 111 patients,20 patients developed local recurrence and 4 patients developed distant metastasis.Among the 88 patients who underwent non-mastectomy,there was a significant difference in the recurrence rate between the segmental resection(without margin examination)group and the extended resection(with margin examination)group(P=0.020).Kaplan-Meier survival analysis showed that histological type was associated with RFS in BPT and MPT patients(P=0.004)while tumor size,average mitotic count and surgical method had no significant relationship with RFS(P=0.080,P=0.153 and P=0.204).Cox multivariate analysis results showed that histological type is an independent impact factor for the recurrence-free survival of BPT and MPT(P=0.001).Conclusion MPT has a higher risk of recurrence than BPT.The surgeon should appropriately expand the scope of resection while ensuring complete tumor resection,and at least ensure a negative margin examination.

关 键 词：乳腺肿瘤 交界性叶状肿瘤 恶性叶状肿瘤 无复发生存 预后分析 

分 类 号：R737.9[医药卫生—肿瘤]