乳腺非特殊型浸润性癌淋巴管瘤栓分级与预后的关系

Prognostic values of grading system for lymph vessel tumor emboli in patients with invasive breast carcinomas of no special type

目的探讨乳腺非特殊型浸润性癌（ICNST）患者的淋巴管瘤栓分级与预后的关系。方法回顾性分析河北医科大学第四医院2006年1月至2008年12月确诊的466例ICNST患者的临床病理资料。采用免疫组化法检测D2-40、雌激素受体（ER）、孕激素受体（PR）和人表皮生长因子受体2（HER．2）的表达，按照每高倍视野瘤栓核分裂及凋亡细胞数进行分级，分析淋巴管瘤栓分级与患者预后的关系。采用Kaplan-Meier法和Logrank检验进行单因素生存分析，采用Cox比例风险模型进行多因素生存分析。结果466例ICNST患者中，淋巴管瘤栓0级280例（60．1％），1级112例（24．0％），2级58例（12．5％），3级16例（3，4％）。淋巴管瘤栓分级与淋巴结转移数目呈正相关（r=0．365，P〈0．001）。单因素分析显示，组织学分级、淋巴管瘤栓分级、淋巴结转移数目、ER、PR表达、HER-2扩增和分子分型与ICNST患者的预后均有关（均P〈0．05）。cox多因素分析显示，淋巴管瘤栓分级和淋巴结转移数目与ICNST患者的预后均有关（均P〈0．05）。结论ICNST患者淋巴管瘤栓分级可预测ICNST患者的预后．

Objective To investigate the grading system for lymph vessel tumor emboli and its prognostic value in patients with invasive carcinomas of no special type （ICNST） of the breast. Methods Clinical data of 466patients with ICNST were collected from January 2006 to December 2008 in the Fourth Hospital of Hebei Medical University. The expression levels of D2-40, estrogen receptor（ER） , progesterone receptor （PR） and human epidermal growth factor receptor 2 （HER-2） were analyzed using immunohistochemical staining. Grades for lymph vessel tumoremboli were classified based on the number of mitotic and apoptotic figures in tumor cells under a high-power field. Correlation analysis was performed using Spearman rank correlation test. Kaplan-meier curves and Log-rank tests were used to analyze the survival rate. Multivariate Cox proportional hazard model was used to analyze the prognostic factors. Results Among the 466 patients, grades for lymph vessel tumor emboli were categorized as follows：280 cases were grade 0 （60.1%）; 112 cases were grade 1 （24.0%） ; 58 cases were grade 2 （12.5%） ; 16 cases were grade 3 （3.4%）. Correlation analyses showed that lymph vessel tumor emboli grading system was positively correlated with lymph node metastasis （r= 0.365, P〈O.001）. Kaplan-Meier univariant analysis showed that histological grading, lymph vessel tumor emboli grading system, lymph node metastasis, the expression levels of ER, PR and HER-2 and molecular typing were associated with prognosis of patients （P 〈 0.05 for all ）. Multivariate analysis of Cox proportional hazard model showed that lymph vessel tumor emboli grading system and lymph node metastasis were independent prognostic factors in patients with ICNST（P〈0.05 for all）. Conclusion Grading system for lymph vessel tumor emboli canpredict the clinical outcome of patients with ICNST.