Paget’s病伴浸润性导管癌的临床病理特征及预后因素分析:基于SEER的回顾性研究

Clinicopathological features and prognostic factors of Paget’s disease with invasive ductal carcinoma:A retrospective study based on SEER

目的:分析佩吉特氏病伴浸润性导管癌(Paget’s disease with invasive ductal carcinoma,PD-IDC)患者的临床病理特征、治疗和预后情况。方法:通过美国SEER*Stat软件搜集2010至2014年病理明确诊断为PD-IDC及浸润性乳腺癌(invasive ductal carcinoma,IDC)并接受手术治疗的患者分别550例和207 221例。用SPSS 21.0进行统计学分析和绘制生存曲线。结果:与IDC相比,PD-IDC患者男性乳腺癌比例更大,可能有更大的体积、更多的淋巴结受累、更高级别以及更晚期的肿瘤(P均<0.05);且更可能是激素受体(HR)阴性[ER阴性(37.3%vs 18.5%)、PR阴性(52.0%vs 28.5%)]和Her-2阳性(53.3%vs 15.4%);在治疗方案中更有可能接受乳房切除术(85.8%vs 43.9%)和腋窝淋巴结清扫术(45.1%vs 29.5%)(P均<0.05);但预后更差,死亡率更高,且乳腺癌相关死亡率(BCSM)更高。此外,Cox回归分析显示肿瘤分级和Her-2状态与PD-IDC患者的总生存时间(OS)显著相关(P<0.05),而患者性别和肿瘤分级与PD-IDC患者的BCSM相关(P<0.05),且Her-2阳性者相较于阴性者(OS:HR=0.019,P=0.009;BCSM:HR=0.000,P=0.623)与PD-IDC患者的OS显著相关,淋巴结手术方式也与PD-IDC患者的OS有一定的相关性。结论:与IDC相比,PD-IDC患者更可能是HR阴性和Her-2阳性且预后较差。同时,淋巴结的处理在PD-IDC的治疗中有一定的必要性。

Objective:To analyze the clinicopathological features,treatment and prognosis of patients suffered from Paget's disease with invasive ductal carcinoma(PD-IDC). Methods:Using data obtained by the Surveillance,Epidemiology,and End Results(SEER) program from2010 to2014,550 patients with pathologically diagnosed Paget's disease with invasive ductal carcinoma(PD-IDC) and207221 cases with invasive ductal carcinoma(IDC) who underwent surgery were collected.Statistical analysis was performed with SPSS 21.0 and survival curves were plotted. Results:Compared with IDC,PD-IDC patients have a higher proportion of male breast cancer,and are more likely to have larger volume,more lymph node involvement,higher grade and more advanced tumors(all above P <0.05).More likely HR negative(ER negative 37.3% vs18.5%),PR negative(52.0% vs28.5%) and Her-2 positive(53.3% vs15.4%).More likely to undergo mastectomy in the treatment regimen(85.8% vs 43.9%) and axillary lymph node dissection(45.1% vs29.5%)(all P <0.05).However,the prognosis was worse,mortality was higher,and breast cancer-related mortality was higher.In addition,Cox regression analysis showed that tumor grade and Her-2 status were significantly associated with OS in PD-IDC patients( P <0.05),while patient's gender and tumor grade were associated with BCSM in PD-IDC patients( P <0.05),and Her-2 positive patients were significantly associated with OS in patients with PD-IDC compared with those negative(OS:HR=0.019, P =0.009,BCSM:HR=0.000, P =0.623),lymph node surgery was also associated with OS in PD-IDC patients.OS has a certain correlation as well. Conclusion:Compared with IDC,PD-IDC patients are more likely to be HR negative and Her-2 positive with a poor prognosis.At the same time,the treatment of lymph nodes is necessary in the treatment of PD-IDC.