乳腺导管内乳头状瘤的临床病理及预后分析

Clinicopathological and prognosis analysis of intraductal papilloma the breast cancer

目的乳腺导管内乳头状瘤是发生在乳头乳晕区的乳腺良性肿瘤，临床上较为常见。本研究探讨乳腺导管内乳头状瘤临床病理特征与复发的关系。方法回顾性分析2010-01-01-2015-07-01中国医学科学院肿瘤医院547例乳腺导管内乳头状瘤患者的临床病理资料。结果547例患者中，348例不伴有非典型增生（63．6％），199例（36．4％）伴有非典型增生。中位随访37个月，导管内乳头状瘤组和导管内乳头状瘤伴非典型增生组3年无复发生存率分别为98．2％和95．0％；3年无肿瘤生存率分别为99．1％和98．5％。2组无复发生存曲线比较差异有统计学意义，P=0．009。Cox分析结果显示，非典型增生是影响术后复发的主要因素，RR=0．183，95％CI=0．045-0．675，P=0．011；Logistic回归分析结果显示，伴有乳房肿物（OR=0．448，95％CI=0．29-0．68，P〈0．001）、外周型导管内乳头状瘤（OR=0．444，95％CI=0．45-0．72，P=0．001）术后病理更易出现非典型增生。结论非典型增生情况是乳腺导管内乳头状瘤术后复发重要预测指标。

OBJECTIVE Intraductal papilloma is a common breast tumor. The aim of the study was to analysis the rele vance between clinicopathological characteristics and recurrence in breast intraductal papilloma patients. METHODS The clini- calpathological data of 547 patients with breast intraductal papilloma, who underwent surgery in Cancer Hospital, Chi- nese academy of medical sciences from January 2010 to July 2015, were retrospectively analyzed. RESULTS The median follow up time was 37 months. The 547 patients were classified into intraductal papilloma without atypical （348 cases） and intraductal papilloma with atypical hyperplasia （199 cases）. The 3 year recurrence free survival rates in the two groups were 98.2% and 95.0% respectively. The 3-year tumor free survival rates in the two groups were 99. 1% and 98.5 %. The log rank test showed a significant difference （P = 0. 009）. Multivariate analysis indicated that the atypical ductal hyperplasia was a major prognostic factor affecting the recurrence free survival （RR = 0. 183,95 % CI=0. 045- 0. 675,P= 0. 011）. Logistic analysis results showed that patient with breast mass and peripheral intraductal papilloma were the factors affecting ADH（OR=0.448,95%CI=0.29-0.68, P〈0.001;OR=0.444,95%CI =0.45-0.72, P=0. 001）. CONCLUSION The atypical ductal hyperplasia status is an effective indicator for predicting recurrence in breast intraductal papilloma patients.