乳腺浸润性小叶癌与浸润性导管癌临床病理特征的倾向性匹配分析  

Propensity-matched analysis of clinicopathological characteristics matching between invasive lobular carcinoma and invasive ductal carcinoma of the breast

作　　者：张旭冉 高润芳[1] ZHANG Xuran;GAO Runfang(Department of Breast,Shanxi Provincial People’s Hospital,Shanxi Province,Taiyuan030012,China)

机构地区：[1]山西省人民医院乳腺科,山西太原030001

出　　处：《中国医药导报》2024年第30期120-128,共9页China Medical Herald

摘　　要：目的探讨乳腺浸润性小叶癌(ILC)与浸润性导管癌(IDC)患者的临床病理特征以及生存相关因素。方法本研究回顾性选取2003年1月至2016年12月山西省人民医院乳腺科421例乳腺浸润性小叶癌及3000例乳腺浸润性导管癌患者的病历资料和随访资料,采用R软件进行倾向性匹配(PSM)分析平衡两组患者基线特征差异造成的混杂偏倚,按年龄、肿瘤大小、淋巴结状态、雌激素受体(ER)、孕激素受体(PR)、人表皮生长因子受体2(HER-2)状态按1∶1进行匹配,共匹配到414例IDC患者。使用Cox比例风险模型分析生存影响因素,Kaplan-Meier方法分析PSM后两组生存率。结果与IDC患者比较,ILC患者年龄大,淋巴结阴性比例高(P<0.05),HER2阳性比例低(P<0.05)。ILC患者的肺转移率低于IDC患者,单独骨转移率高于IDC患者(P<0.05)。ILC患者和IDC患者的无病生存率(DFS)和总生存率(OS)比较,差异无统计学意义(P>0.05),ER阳性PR阳性ILC患者的DFS患者高于ER阳性PR阴性患者(P<0.05)。HER2阳性ILC患者的DFS和OS均显著高于IDC患者(P<0.05)。多因素分析结果显示,淋巴结分期是ILC和IDC患者DFS的预后因素(P<0.05),而年龄对IDC患者的影响更显著(P<0.05)。结论ER阳性PR阳性ILC患者的DFS优于ER阳性PR阴性患者。HER2阳性ILC患者的DFS和OS优于IDC患者。淋巴结分期是ILC和IDC患者DFS的独立预后因素,而年龄是IDC患者预后的独立因素。Objective To investigate the clinicopathologic features and survival factors of breast invasive lobular carcinoma(ILC)and invasive ductal carcinoma(IDC).Methods This study retrospectively selected 421 patients with ILC of breast and 3000 patients with IDC of breast in Department of Breast,Shanxi Provincial People’s Hospital from January 2003 to December 2016.Propensity score matching(PSM)analysis was performed using R software to balance confounding bias caused by differences in baseline characteristics between the two groups.Matching was performed 1∶1 according to age,tumor size,lymph node status,estrogen receptor(ER),progesterone receptor(PR),and human epidermal growth factor receptor 2(HER-2)status.A total of 414 patients with IDC were matched.Cox proportional risk model was used to analyze the influencing factors for survival,and Kaplan-Meier method was used to analyze the survival rate of the two groups after PSM.Results Compared with IDC patients,the average age of ILC patients was older,the proportion of lymph node negative was higher(P<0.05),and the proportion of HER2 positive was lower(P<0.05).The lung metastasis rate of ILC patients was lower than IDC patients,and the bone metastasis rate of ILC patients was higher than IDC patients(P<0.05).There were no significant differences in disease-free survival(DFS)and overall survival(OS)between ILC and IDC patients(P>0.05).The DFS of ER positive and PR positive ILC patients were significantly higher than those of ER positive and PR negative ILC patients(P<0.05).Both DFS and OS of HER2-positive ILC patients were significantly higher than IDC patients(P<0.05).Multivariate analysis showed that lymph node stage was a prognostic factor for DFS in ILC and IDC patients(P<0.05),while age had a more significant effect on IDC patients(P<0.05).Conclusion The DFS of ER-positive and PR-positive ILC patients warebetter than those of ER-positive and PR-negative ILC patients.The DFS and OS of HER2-positive ILC patients are superior to IDC patients.Lymph node stage is an i

关 键 词：乳腺浸润性小叶癌 乳腺浸润性导管癌 生存 临床病理特征 

分 类 号：R737.9[医药卫生—肿瘤]