乳腺化生性癌的临床病理特征及预后影响因素

Clinicopathologic characteristics and prognosis of metaplastic breast carcinoma

目的:分析乳腺化生性癌(metaplastic breast carcinoma,MBC)患者的临床病理特征及其影响预后的因素。方法:收集2005年1月至2015年1月55例天津医科大学肿瘤医院诊治MBC患者完整的临床病理资料。回顾性分析MBC患者的临床病理特征、复发及生存情况。MBC患者根据淋巴结是否转移分为淋巴结阳性组(13例)及淋巴结阴性组(39例);根据术后是否接受化疗、放疗及内分泌治疗,将其分为化疗组(40例)和非化疗组(15例)、放疗组(12例)及非放疗组(43例)和内分泌治疗组(5例)及非内分泌治疗组(50例)。并且每例MBC患者与3例同期年龄及临床TNM分期情况基本类似,均接受手术治疗的三阴性乳腺癌(TNBC)患者170例匹配。结果:MBC患者5年无疾病生存率(disease-free survival,DFS)和总生存率(overall survival,OS)分别为45.0%及48.2%,显著低于TNBC患者5年DFS 74.7%及OS 83.5%,且两者之间比较5年OS和DFS差异具有统计学意义(均P<0.001)。肿瘤大小、淋巴结是否转移及接受化疗与否是影响患者生存预后的重要因素。化疗组5年OS和DFS明显高于非化疗组的OS(P=0.008)和DFS(P=0.033)。淋巴结阳性组的MBC患者接受放疗可明显提高其5年OS(P=0.030)。结论:MBC是一种侵袭性强的罕见的乳腺癌特殊类型,预后较TNBC差,化疗使其5年OS及DFS获益,且以铂类为基础的化疗方案可使患者获益更大,对淋巴结阳性患者应行术后放疗。

Objective： To investigate the clinicopathologic characteristics and prognostic factors of metaplastic breast cancer （MBC）. MBC prognosis was compared with that of triple negative breast cancer （TNBC）. Methods：This retrospective study reviewed the medical records of 55 MBC patients who underwent surgery in Tianjin Medical University Cancer Institute and Hospital between January 2005 and January 2015. Clinicopathological features and different therapeutic strategies were analyzed. Univariate and multi-variate analyses were conducted to identify prognostic factors. Based on nodal status, the MBC patients were divided into node positive （N＋） and node negative （N0） groups. According to specific treatment conditions, such as chemotherapy, radiation therapy （RT）, and en-docrine therapy, MBC patients were divided into adjuvant chemotherapy and non-adjuvant chemotherapy groups, RT and non-RT groups, and endocrine therapy and non-endocrine therapy groups. Each MBC case, which had complete follow-up data, was compared with three TNBC cases that were used as controls in the same database and matched with age, year of diagnosis, and tumor-node-metas-tasis staging. Results： Five-year disease-free survival （DFS） rate of MBC cases was 45.0%. Overall survival （OS） rate was 48.2%. These results were worse than those of TNBC cases, in which the five-year DFS and OS rates were 74.7%and 83.5%, respectively. MBC and TNBC cases exhibited significant differences in both rates. Survival analysis showed that large tumor size, lymph node metas-tasis, and adjuvant chemotherapy were correlated with worse prognosis. Adjuvant chemotherapy significantly improved OS （P=0.008） and DFS rates （P=0.033） of patients. RT significantly improved the five-year OS （P=0.030） in MBC patients with node metastasis. Con-clusion：MBC is a clinically aggressive subtype of breast cancers, and its prognosis was worse compared with TNBC. Adjuvant chemo-therapy may be recommended, and cisplatin-based chemotherapy regimen may be an effective therapeutic regimen for several MBC subtypes. For MBC patients with N＋, RT should be a multimodality therapy component.