乳腺浸润性微乳头状癌临床病理特征及其预后分析

Analysis of clinicopathological characteristics and prognosis of invasive micropapillary carcinoma of the breast

目的：探讨乳腺浸润性微乳头状癌（invasive micropapillary carcinoma,IMPC）的临床病理特征及预后分析.方法：回顾性分析河北医科大学第四医院2009年1月至2011年12月确诊的65例乳腺IMPC患者,采用免疫组织化学法检测上皮膜抗原（ep？ithelial membrane antigen,EMA）表达以确定微乳头成分在肿瘤中所占比例.按微乳头比例≤10%、11%-30%、31%-50%、〉50%将患者分为4组,并同时检测ER、PR、HER-2的表达.Kaplan-Meier单因素生存分析中行Log rank检验,采用多因素Cox风险回归模型行生存时间的影响因素分析.结果：65例乳腺IMPC患者中单纯IMPC 12例,IMPC伴浸润性导管癌46例,IMPC伴其他浸润性癌7例.乳腺IMPC中微乳头比例≤10%组为7.69%（5/65）、11%-30%组为44.62%（29/65）、31%-50%组为26.15%（17/65）、〉50%组为21.54%（14/65）,4组乳腺IMPC患者中淋巴结转移阳性率差异具有统计学意义（P〈0.01）.免疫组织化学法结果显示, ER、PR和HER-2在乳腺IMPC组织中的阳性率分别为76.92%（50/65）、67.69%（44/65）和24.62%（16/65）,差异具有统计学意义（P〈0.05）.Kaplan-Meier单因素分析显示患者生存时间与淋巴结转移数,微乳头比例,脉管瘤栓,ER、PR、HER-2的表达相关（P〈0.05）.结论：淋巴结转移数,微乳头比例,脉管瘤栓,ER、PR及HER-2的表达均与乳腺IMPC的预后相关。

Objective：To investigate the clinicopathological characteristics and prognosis of invasive micropapillary carcinoma （IMPC） of the breast. Methods：Data of 65 IMPC cases obtained from the Fourth Hospital of Hebei Medical University between Janu-ary 2009 and December 2011 were retrospectively analyzed. The expression of epithelial membrane antigen （EMA） was evaluated us-ing immunohistochemistry （IHC） to detect the micropapillary component in the tumor. The patients were divided into 4 groups based on the percentage of micropapillary component：≤10%, 11%-30%, 31%-50%, and〉50%. Expressions of estrogen receptor （ER）, pro-gesterone receptor （PR）, and HER-2 were analyzed by IHC. Kaplan-Meier method, Log rank test, and multivariate Cox proportional hazard model were used to determine the factors affecting post-treatment survival. Results：Of the 65 cases, 12 were simple IMPC, 46 were IMPC with invasive ductal carcinoma, and 7 were other invasive carcinoma cases. The≤10%, 11%-30%, 31%-50%, and〉50%micropapillary component groups comprised 7.69%（5/65）, 44.62%（29/65）, 26.15%（17/65）, and 21.54%（14/65） of the total cases, re-spectively. Statistically significant differences were found in the four groups （P〈0.01）. IHC results showed that the positive rates of ER, PR, and HER-2 in the IMPC tissues were 76.92%（50/65）, 67.69%（44/65）, and 24.62%（16/65）, respectively. Statistical differences ex-isted among the groups （P〈0.05）. Kaplan-Meier method indicated that positive rate of lymph node metastasis, the proportion of IMPC, vascular invasion, and the expression of ER, PR, and HER-2 significantly affect survival time of IMPC cases （P〈0.05）. Conclusion：Positive rate of nodal metastasis, the proportion of IMPC, vascular invasion, and the expression of ER, PR, and HER-2 are correlated with the prognosis of IMPC.