晚期乳腺浸润性小叶癌与浸润性导管癌临床病理特征及预后比较

Comparison of clinicopathological features and prognostic factors between advanced invasive lobular cancer and invasive ductal breast cancer

目的 :比较晚期乳腺浸润性小叶癌(invasive lobular carcinoma,ILC)与乳腺浸润性导管癌(invasive ductal carcinoma,IDC)患者的临床病理特征及预后因素。方法:采用回顾性病例对照研究方法,选择2008年1月—2016年12月天津医科大学肿瘤医院收治的59例女性晚期乳腺ILC病例,另按照匹配条件确诊年龄和手术时间(±2年),按1∶4的比例选取同期住院的236例女性晚期乳腺IDC病例。比较2组临床病理特征和预后的差异以及预后相关因素。结果:晚期乳腺ILC患者与IDC患者初诊时的肿瘤临床分期、T分期、M分期、组织学分级、雌激素受体状态、孕激素受体状态、人表皮生长因子受体2状态和分子分型的差异均有统计学意义(P值均<0.05)。对晚期乳腺ILC患者与IDC患者的复发/转移特征进行比较,结果显示ILC患者的中位复发年龄为50岁(范围:28~73岁),IDC患者的中位复发年龄为51岁(范围:27~69岁);2组首次转移部位数目、淋巴结转移、内脏转移、肺转移和骨转移的差异均有统计学意义(P值均<0.05)。ILC患者的中位无进展生存时间为14个月(范围:2~62个月),IDC患者的中位无进展生存时间为11个月(范围:1~89个月),2组的差异无统计学意义(P=0.121)。ILC患者的转移后中位生存时间为42个月(范围:5~78个月),IDC患者的转移后中位生存时间为44个月(范围:1~110个月),2组的差异无统计学意义(P=0.392)。多因素分析结果显示,孕激素受体状态、复发/转移年龄和骨转移治疗是晚期乳腺ILC患者预后的独立影响因素(P值均<0.05);分子分型、首次转移部位数目和胸腔积液是晚期乳腺IDC患者预后的独立影响因素(P值均<0.05)。结论:女性晚期乳腺ILC与IDC相比,前者显示出独特的临床病理、复发/转移和预后特征,应指导临床开展个体化的精准诊疗。

Objective： To analyze and compare the clinicopathological features and prognostic factors between patients with advanced breast invasive Iobular carcinoma （ILC） and invasive ductal carcinoma （IDC）. Methods： Fifty-nine female patients with advanced breast ILC from Tianjin Medical University Cancer Institute and Hospital were included in this retrospective case-controlled study. Matched two hundred and thirty-six female patients with advanced breast IDC were selected according to age at diagnosis and the time of surgery （＋2 years） in Tianjin Medical University Cancer Institute and Hospital between January 2008 and December 2016. Clinical and pathological features and prognostic factors were analyzed by using univariate and multivariate analyses. Results： The clinical pathological features of clinical stage at initial diagnosis, T stage, M stage, histological degree, estrogen receptor （ER） status, progesterone receptor （PR） status, human epidermal growth factor receptor-2 （HER-2） status and molecular subtype were significantly different between two groups （all P 〈 0.05）. The median ages at recurrence/metastasis of patients with breast ILC and IDC were 50 years （range： 28-73） and 51 years （range： 27-69）, respectively. The differences in the number of first metastatic sites, lymph node metastasis, visceral metastasis, lung metastasis and bone metastasis were statistically significant between two groups （all P 〈 0.05）. The median progression-free survivals of patients with breast ILC and IDC were 14 months （range： 2-62） and 11 months （range： 1-89）, respectively （P = 0.121）. The median metastases- overall survivals （M-OS） of patients with ILC and IDC were 42 months （range： 5-78） and 44 months （（range： 1-110）, respectively （P = 0.392）. Multivariate analysis revealed that PR status, age at recurrence or metastasis and treatment of bone metastases were the independent predictors of survival in patients with advanced breast ILC （all P 〈 0.05）. The molecular subtype, the number of first metastatic sites and pleural effusion were the independent prognostic factors in patients with breast IDC （all P 〈 0.05）. Conclusion： Patients with advanced breast ILC have unique clinicopathological, recurrent/ metastatic and prognostic features. It is necessary to reveal the definitive features of ILC and develop new personalized precision therapies.