乳腺髓样癌临床病理特征、治疗及预后的分析  

Analysis of clinicopathological features,treatment and prognosis of breast medullary carcinoma

作　　者：谭巧 苏小涵 侯令密[1,2] 黎君彦 TAN Qiao;SU Xiaohan;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》2024年第15期2767-2776,共10页Journal of Modern Oncology

基　　金：四川省自然科学基金面上项目(编号:2022NSFSC0775)。

摘　　要：目的:探讨和比较乳腺髓样癌(medullary breast carcinoma, MBC)与浸润性导管癌(invasive ductal carcinom, IDC)患者的临床病理特征、治疗和预后差异。方法:回顾性分析SEER数据库以及真实世界多中心(包括:四川省三家医院)2000年至2018年诊断为MBC和IDC的患者资料,对比分析临床病理特征、治疗及预后差异。结果:MBC与IDC患者相比,发病年龄更小、肿瘤直径更大、组织学分级更高、三阴型占比更多、TNM分期更晚、预后更好;单因素Cox回归分析显示,发病年龄、组织学分级、肿瘤大小、T分期、N分期、M分期、TNM分期、是否手术、手术方式、是否放疗及化疗与总生存率(overall survival, OS)具有相关性;发病年龄、种族、肿瘤大小、T分期、N分期、M分期、TNM分期、是否手术、手术方式及是否放疗与乳腺癌特异性生存率(breast cancer-specific survival, BCSS)具有相关性。多因素Cox模型校正后显示,发病年龄、T分期、N分期、M分期、肿瘤大小、是否手术及是否化疗是OS、BCSS的独立预后因素。MBC患者的10年OS和10年BCSS分别为83.0%和91.8%,与IDC相比差异有统计学意义(P<0.001)。PSM分析结果显示,无论是SEER数据还是真实世界多中心临床数据,MBC患者的OS、BCSS均较IDC患者好,差异有统计学意义。结论:MBC较IDC更具侵袭性,预后却更好;排除混杂变量影响后,SEER数据分析显示MBC预后仍较IDC好,差异具有统计学意义,预后更好的原因是MBC的独特病理类型及规范化诊疗,因此临床上更应该注重规范化诊疗。Objective:To investigate and compare the clinicopathologic features,treatment and prognosis between medullary breast carcinoma(MBC)and invasive ductal carcinoma(IDC).Methods:The data of patients with MBC and IDC diagnosed in SEER database and real-world multicenter(including:Three hospitals in Sichuan Province)from 2000 to 2018 were analyzed retrospectively,the clinical and pathological features,treatment and prognosis were compared and analyzed.Results:Compared with IDC patients,MBC patients had younger onset age,larger tumor diameter,higher histological grade,more triple negative type,later TNM stage and better prognosis.The univariate Cox regression analysis showed,the age of onset,histological grade,tumor size,T stage,N stage,M stage,TNM stage,surgical treatment or not,operation mode,radiotherapy and chemotherapy were correlated with OS.Age of onset,race,tumor size,T stage,N stage,M stage,TNM stage,surgical treatment or not,operation mode and radiotherapy were correlated with BSCC.Multivariate Cox model correction showed that age of onset,T stage,N stage,M stage,tumor size,surgery and chemotherapy were independent prognostic factors for OS and BCSS.The 10-year OS and 10-year BCSS of MBC patients were 83.0%and 91.8%,respectively,which were significantly different with IDC(P<0.001).The results of PSM analysis showed that the OS and BCSS of MBC patients were better than those of IDC patients in both SEER data and real-world multicenter clinical data. Conclusion: MBC is more invasive than IDC,but the prognosis of MBC is better than that of IDC.SEER data analysis showed that the prognosis of MBC is still better than that of IDC,and the difference was statistically significant.The reason for the better prognosis is the unique pathological type and standardized diagnosis and treatment of MBC,so we should pay more attention to the standardized diagnosis and treatment.

关 键 词：乳腺癌 髓样癌 浸润性导管癌 预后 SEER 

分 类 号：R737.9[医药卫生—肿瘤]