乳腺黏液癌前体病变及预后相关临床病理特征分析  

Precursor lesions and prognosis-related clinicopathological characteristics of breast mucinous carcinoma

作　　者：冯孟钠 张渝 高乐怡 申梦佳 李凤玲 魏兵[1] 步宏[1,2] 张璋[1,2] 杨李波[1] FENG Mengna;ZHANG Yu;GAO Leyi;SHEN Mengjia;LI Fengling;WEI Bing;BU Hong;ZHANG Zhang;YANG Libo(Department of Pathology,West China Hospital,Sichuan University,Chengdu 610041,China;Institute of Clinical Pathology,West China Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院病理科,成都610041 [2]四川大学华西医院临床病理研究所,成都610041

出　　处：《临床与实验病理学杂志》2024年第11期1142-1147,1153,共7页Chinese Journal of Clinical and Experimental Pathology

基　　金：国家自然科学基金(82401894);四川省科技厅重点研发项目(2024YFFK0394);成都市科学技术局重点研发支撑计划(2022-YF05-01429-SN)。

摘　　要：目的探讨乳腺黏液癌(mucinous carcinoma,MC)的前体病变、临床病理特征及预后,为MC的诊断和治疗提供理论依据。方法收集乳腺MC手术切除标本303例,包括单纯型黏液癌(pure mucinous carcinoma,PMC)193例和混合型黏液癌(mixed mucinous carcinoma,MMC)110例,其中PMC包括A型(少细胞型)163例和B型(富于细胞型)30例。采用HE、免疫组化染色观察MC与癌旁乳腺的组织学特征,分析MC前体病变及与预后相关的临床病理特征。结果MC中位年龄50岁,中位肿瘤最大径2.5 cm。与PMC相比,MMC中淋巴结累及、Ⅲ~Ⅳ期和Ki67>20%的肿瘤更多(P<0.05)。A、B型PMC的肿瘤大小、淋巴结累及和临床分期差异无统计学意义。前体病变为黏液囊肿样病变(mucocoele-like lesions,MLL)的55例MC(A型PMC 49例,MMC 6例)均为组织学1~2级,其中大多数病例(54/55,98.2%)为T1~T2,在6例MMC中MC成分占比均≥50%。前体病变为导管原位癌(ductal carcinoma in situ,DCIS)的MC有119例,其中28.6%(34/119)有淋巴结累及,16.8%(20/119)为高增殖活性(Ki67>20%)。16例MC的前体病变为原位实性乳头状癌(solid papillary carcinoma,SPC),其中B型PMC 7例,MMC 9例,中位年龄67岁,随访期间患者均无复发或转移。303例MC的无瘤生存率(disease-free survival,DFS)为93.5%,总生存率(overall survival,OS)为98.6%。PMC预后优于MMC(DFS:95.2%vs 90.6%;OS:99.5%vs 97.2%),A、B型PMC之间的DFS差异无统计学意义。发生淋巴结累及和临床分期为Ⅲ~Ⅳ期的患者预后较差(P<0.05)。结论乳腺MC是一类异质性恶性肿瘤,具有特定前体病变的MC有不同的演进途径。前体病变为MLL和SPC的MC患者预后较好,与高级别DCIS相关的MC更具侵袭性,淋巴结累及、临床分期高和患病年龄小与预后不良相关,关注前体病变和高危临床病理特征有助于为这类患者提供更有效的治疗。Purpose To analyze the precursor lesions,clinicopathological features and prognosis of mucinous carcinoma(MC).Methods A total of 303 MC cases diagnosed by surgical specimens were included,including 193 pure mucinous carcinomas(PMC)and 110 mixed mucinous carcinomas(MMC).PMC included 163 cases of type A(hypocellular type)and 30 cases of type B(hypercellular type).The histomorphological characteristics,surrounding breast tissue morphology,and immune markers were evaluated to analyze the clinicopathological features related to MC precursor lesions and prognosis.Results The median age at diagnosis of MC was 50 years,and the median tumor size was 2.5 cm.Compared to PMC,MMC had more lymph node(LN)involvement,more grade Ⅲ-Ⅳ and Ki67>20%tumors(P<0.05).There were no significant differences in tumor size,LN involvement and clinical stage between type A and type B PMC.55 cases of MC(49 PMC and 6 MMC)with precursor lesions of mucocoele-like lesions(MLL)were all grade 1 to 2,most of them(54/55,98.2%)were T1-T2,and the proportions of MC component in all 6 MMCs were all≥50%.There were 119 cases of MC whose precursor lesions were ductal carcinoma in situ(DCIS),of which 28.6%of cases(34/119)had LN involvement,and 16.8%(20/119)of cases showed high proliferative activity(Ki67>20%).The precursor lesions of MC in 16 cases were solid papillary carcinoma(SPC)in situ,including 7 cases of type BPMC and 9 cases of MMC.The median age of these patients was 67 years and no recurrence or metastasis was observed during follow-up.The disease-free survival(DFS)and overall survival(OS)of the 303 cases of MC was 93.5%and 98.6%,respectively.PMC had a better prognosis than MMC(DFS:95.2%vs.90.6%;OS:99.5%vs.97.2%),but there was no significant difference between type A and type B PMC.The prognosis of patients with LN involvement and clinical stage Ⅲ-Ⅳ was worse(P<0.05).Conclusion MC of the breast is a kind of heterogeneous malignant tumors.Our findings support that MC with specific precursor lesions have different evolutionary pathways,that MC

关 键 词：乳腺肿瘤 黏液癌 前体病变 预后 

分 类 号：R737.9[医药卫生—肿瘤]