乳腺浸润性小叶癌患者阳性手术切缘的预测因素分析

Predictive factors of positive surgical margins in patients with breast invasive lobular carcinoma

目的分析乳腺浸润性小叶癌(invasive lobular carcinoma,ILC)患者手术切缘阳性与临床病理因素的关系。方法回顾分析2010年1月—2016年12月在泰州市人民医院行保乳手术的192例ILC患者的临床资料,采用单因素和多因素分析法分析手术切缘阳性与临床病理的关系。结果 192例ILC患者中首次手术后47例为切缘阳性(24.48%),进行再次局部扩大切除术后仍有14例为切缘阳性,约占首次阳性的29.79%。单因素分析显示,ILC患者首次手术切缘阳性与ILC组织分型、钼靶及超声提示有多中心/多灶性或结构紊乱明显相关(P<0.05),而与年龄、绝经状态、肿瘤大小、组织学分级、TNM分期、腋下淋巴转移、手术切除范围、ER、PR及HER-2表达水平无明显相关性(均P>0.05);ILC患者二次手术切缘阳性与钼靶及超声提示有多中心/多灶性或结构紊乱存在明显相关性(均P<0.05),而与年龄、绝经状态、肿瘤大小、组织学分级、组织分型、TNM分期、腋下淋巴转移、手术切除范围、ER、PR及HER-2表达水平无明显相关性(均P>0.05)。多因素Logistic回归分析结果显示钼靶及超声提示有多中心/多灶性或结构紊乱均是影响ILC患者首次手术和二次手术切缘阳性的独立危险因素。结论 ILC患者保乳术后手术切缘阳性率相对较高,且与钼靶或超声提示存在结构紊乱、多中心或多灶性密切相关,临床应予以重视。

Objective To analyze the relationship of positive surgical margin and clinical pathological factors in patients with breast invasive lobular carcinoma （ ILC ）. Methods Clinical data of 192 cases of patients with ILC undergoing breast conserving surgery in our hospital from January, 2010 to December, 2016 were selected, and the relationship of positive surgical margin and clinical pathological factors was analyzed by using single factor and multiple factor analysis method. Results Of the 192 patients with ILC, 47 patients had positive margins （24.48%） after the first operation, and 14 cases still had positive margins after the resection, accounted for 29.79%. Univariate analysis showed that the positive margins of ILC patients at the first operation were significantly correlated with ILC tissue type, mammography and ultrasound prompted multi center/muhifocal or structural disorder were closely related with the first positive margin （ P 〈 0.05 ） , but there was no significant correlation among age, menopause, tumor size, histological grade, TNM stage, axil- lary lymphatic metastasis, surgical resection range, ER, PR and HER-2 expression （ all P 〉 0.05 ）. The positive margins of ILC patients after two resections were significantly correlated with mammography and ultrasound prompted multi center/ multifocal or structural disorder were closely related with the first positive margin （ all P 〈 O. 05 ）, but there was no signif- icant correlation between age, menopause, tumor size, histological grade, TNM stage, tissue type axillary lymphatic me- tastasis, surgical resection range, ER, PR and HER-2 expression （ all P 〉 0.05 ）. Multivariate Logistic regression analy- sis showed that mammography and ultrasound indicated multifocal/multifocal or structural disturbances were independent risk factors for positive resection margins of patients with ILC. Conclusion The positive rate of margin resection after breast-conserving surgery in ILC patients is relatively high, and closely related to the presence of structural disorder, mul- tifocal or muhifocal presence of mammography or ultrasound. More attentions should be paid to that in clinical.