化生性乳腺癌的临床病理特征及预后分析

Clinic pathological features and prognosis of metaplastic breast carcinoma

目的:探讨化生性乳腺癌的临床病理特征及预后,为治疗提供参考。方法:收集2008~2013年浙江大学附属第一医院和浙江中医药大学附属广兴医院收治的73例化生性乳腺癌患者的临床资料,分析其预后及预后因素。结果:73例患者,纯上皮型41例,上皮-间质混合型32例,中位肿瘤大小为4.6 cm,58.8%患者发生淋巴结转移,84.9%TNM分期Ⅱ期以上,Ki-67过表达占60.2%。中位随访时间59个月,76.7%患者发生复发或转移,中位总生存期(OS)和无病生存期(DFS)分别为59.7个月和43.9个月,5年总生存率和无病生存率分别为45.2%和30.1%。单因素分析显示肿瘤大小、淋巴结和放疗影响总生存期和无病生存期(P<0.05),Ki-67影响总生存期(P<0.05)。多因素分析表明肿瘤大小、淋巴结和放疗影响预后(P<0.05),而病理学分型不是独立的预后因素(P>0.05)。结论:化生性乳腺癌是少见的恶性肿瘤,其肿瘤较大、淋巴结转移率较高、分期晚、局部复发和远处转移率高;治疗遵循以手术为主的综合治疗原则,但预后差;肿瘤大小、淋巴结和放疗影响预后;Ki-67的过表达可作为化生性乳腺癌的潜在的诊断、指导治疗、预后监测的指标。

Objective: To investigate clinic pathological peculiarities and evaluate prognosis of metaplastic breast carcinoma(MBC), then provide reference for effective treatment. Methods: MBC patients at the First Affiliated Hospital of Zhejiang University and Guangxing Hospital Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine from 2008 to 2013 were retrospectively selected. Results: A total of 73 patients were reviewed, including 41 cases of purely epithelial type and 32 cases of mixed epithelial and mesenchymal type. Median tumor size was 4.6 cm. Forty-three patients(58.8%) presented with lymph node(LN) metastasis, 84.9% of cases were in advanced TNM stage, and 60.2% of cases were overexpressed by Ki-67. At a median follow-up of 59 moths, Median OS and DFS were 59.7 and 43.9 months. Five-year overall survival(OS) rate was 45.2% and disease-free survival(DFS) rate was 30.1%, 76.7% of patients had recurrence or metastasis. Using univariate analysis showed that tumor size, LN, and radiotherapy were associated with overall survival and disease-free survival(P<0.05), while Ki-67 over-expression was correlated with overall survival(P<0.05). With multivariate analysis, tumor size, LN, and radiotherapy affected prognosis(P<0.05);however, pathological typing was not an independent prognostic factor(P>0.05). Conclusion: MBC is a rare malignant tumor with large tumor, high lymph node metastasis rate, staging relatively late, high local recurrence and distant metastasis rate. The treatment follows the principle of comprehensive treatment based on surgery, but the prognosis is poor. Tumor size, LN, and radiotherapy treatment affected the prognosis. Overexpression of Ki-67 can be used as a potential diagnostic, therapeutic and prognostic indicator for metaplastic breast cancer.