104例乳腺癌的临床病理分析

Pathological analysis of surgical specimens from 104 breast cancer cases

目的探讨乳腺癌腋窝淋巴结转移的相关因素,为临床诊治及预后评估提供参考依据。方法选取1993年1月至2013年12月间收治经临床病理确诊乳腺癌患者104例,其中腋窝淋巴结转移48例,分析肿瘤大小、粉刺样坏死、核分裂数与腋窝淋巴结转移和分级的关系。结果乳腺癌发病的高峰年龄在40~50岁之间。腋窝淋巴结转移率随肿瘤增大而增高,肿瘤≤2 cm的腋窝淋巴结转移率为25.7%,2.1~5 cm者为50.0%,〉5 cm者为84.6%,差异有统计学意义（P〈0.05）。随肿瘤组织学分级的增高,出现粉刺样坏死的肿瘤也逐渐增加,但差异无统计学意义（P〉0.05）。腋窝淋巴结转移患者的粉刺样坏死发生率（52.1%）高于未转移患者（51.8%）,但差异无统计学意义（P=0.951）。细胞核分裂像≥10个组比0~9个组的患者发生腋窝淋巴结转移的数量明显增加,差异有统计学意义（P=0.010）。结论乳腺癌的肿瘤大小、核分裂数与腋窝淋巴结转移的密切相关,可以作为预测乳腺癌患者发生腋窝淋巴结转移的高危险因素。

Objective To investigate the related factors of axillary lymph node metastasis in breast cancer patients,in order to provide a reference guideline for diagnosis,treatment options and prognosis.Methods From January 1993 to December 2013 in Pudong Hospital,104 breast cancer specimens were collected. 48 patients were diagnosed with axillary lymph node metastasis. The correlations between axillary lymph node involvement and gross tumor size,comedo necrosis and the number of mitotic figures were investigated. Results The age of onset of breast cancer was between 40 ~ 50 years. The greater the gross tumor size,the higher the rate of axillary lymph node metastasis. The gross tumor size（ 5. 0 cm） and the gross tumor size（ 2 T_2 ≤5 cm） in breast cancer patients with axillary lymph node metastasis（ 84. 6%） were significantly higher than those with the gross tumor size（ ≤2 cm,25. 7%,P〈0. 05）. The number of mitotic figures（ ≥10） were also significantly associated with axillary lymph node metastasis（ P = 0. 010） in breast cancer patients. Nevertheless,no significant association was found between comedo necrosis lesions and axillary lymph node metastasis,although the frequency of necrosis lesions in axillary lymph node metastasis patients（ 52. 1%） was higher than those of non-metastatic patients（ 51. 8%）. Conclusion The presence of mitotic figures（ ≥10） and gross tumor size（ 〉2. 0 cm） are the risk factors for axillary lymph node involvement in breast cancer patients.