乳腺叶状肿瘤的诊断和治疗(英文)

Diagnosis and Treatment of Phyllode Tumor of Breast

目的研究乳腺叶状肿瘤的基本的组织特征、病理诊断、鉴别诊断和分类标准,筛选各型肿瘤外科治疗的适宜术式,寻找临床和病理预后因素。方法对203例乳腺叶状瘤的病理形态学特征、临床因素和不同术式的疗效,按统计学软件SPSS(10.0)要求,建立数据库作Cluster、Focater、Logistic及Coxregression分析。结果203例叶状肿瘤可分为良性、交界和恶性三型,分别为133、42和28例;局部复发分别为28、19和18例;因瘤死亡分别为0、2和16例;在131例随访5年以上的病例中,5年生存率分别为100%、92%和33.3%。结论肿瘤性坏死具有重要的诊断价值。肿瘤性坏死、生长方式、异型性和核分裂数是在无错判条件下的肿瘤病理诊断参数集,亦是目前文献中最简化的诊断方案。良性、交界性和恶性叶状肿瘤应废止以往常用的肿物单纯切除术式;对于良性和交界性肿瘤至少应选择肿物连同周围2cm正常乳腺组织一并切除的扩大切除术;复发的交界性和恶性肿瘤要选择乳房单纯切除术式。叶状肿瘤的病理组织学等级(类型)与肿瘤的局部复发和因瘤死亡有统计学线性关系(P<0.01);肿瘤的浸润性生长方式与肿瘤的复发有线性关系(P<0.01);肿瘤性坏死和核分裂数值是独立的预后因素;术式等11个临床病理因素为单风险预后因素。

Objective To study the histopathological features, diagnosis criteria, the relationship of surgery pattern and prognosis of phyllode tumor of breast. Methods To analyze the histopathological features and clinical outcome of different surgery patterns in 203 patients with phyllode tumor of breast by Chi-square test, Cluster, Focater, Logistic and Cox multivariate regression according to the request of SPSS 10. 0. Results 203 patients with phyllode tumor of breast were divided into three groups, L e. benign 133 cases, borderline 42 cascs and malignant 28 cascs,Local recurrences in three groups were 28, 19 and 18, respectively. The patients died from tumor were 0, 2 and 16, and circulatory metastases were 0, 1 and 10, respectively. Five-year survival were 100%, 92. 0% and 33. 3% in the three groups of 131 patients by a 5 years＇ follow-up survey. Conclusions Tumor necrosis has important value in the diagnosis of phyllode tumor. Nature of tumor margin, cellular pleomorphism, frequency of mitoses and tumor necrosis were statistically appropriate composition in histological diagnosis of phyllode tumor. Wide local excision is preferred for the benign and borderline phyllode tumor, while simple mastectomy is indicated for recurred borderline and malignant, but tylectomy should be abolished in the treatment of phyllode tumor. Correlation of histotypes of phyllode tumor with local recurrence and tumor death was statistically significant at a level of P〈0. 001 ; correlation of infiltrative growth of the tumor with local recurrence was statistically significant at a Level. of P〈0. 001. Tumor necrosis and mitotic activity were independent prognostic factors.