乳腺黏液癌与浸润性导管癌的临床病理特征及预后分析

Clinical pathological features and prognosis of mucinous breast carcinoma and invasive ductal carcinoma

目的探讨乳腺黏液癌(mucinous breast carcinoma, MBC)的临床病理学特点及其预后情况,并进一步将其与浸润性导管癌非特殊型(invasive ductal carcinoma - not otherwise specified,IDC - NOS)比较。方法收集徐州医科大学附属医院于2008年1月-2017年12月诊断的88例MBC及210例IDC - NOS的临床资料,分析2组患者年龄、临床分期、肿瘤大小、淋巴结转移率及雌激素受体(estrogen receptor,ER)、孕激素受体(progesterone receptor,PR)、人表皮生长因子受体(human epidermal growth factor,Her -2)的表达情况,并进一步分析两者的预后情况。结果88例MBC中单纯型乳腺黏液癌(pure mucinous breast carcinoma,PMBC)64例,混合型乳腺黏液癌(mixed mucinous breast carcinoma, MMBC ) 24 例,患者年龄 29 - 83 岁,平均年龄 56 岁,中位年龄 57 岁。88 例 MBC的ER、PR、Her-2的阳性率分别为94. 3%,85. 2%.27.2%,淋巴结转移率为31.8%.与MMBC组相比,PMBC组的淋巴结转移率以及临床分期较低,差异具有统计学意义(P<0.01).与IDC-NOS组相比,MBC组患者发病年龄较大,淋巴结转移率较低;2组的免疫组化结果显示MBC组的ER和PR的阳性率较高,Her-2的阳性率较低,差异均具有统计学意义(P <0.05). MBC组患者5年DFS( disease free survival,无病生存时间)率和OS( cwerallsurvival,总生存时间)率分别为88. 8%和98. 6%,而IDC - NOS组患者5年DFS率和OS率分别为85. 4%和95.5%,虽然MBC组患者的5年DFS率和OS率均较高,但两者之间无显著差异(P>0.05).结论 MBC是一种生长缓慢且低度恶性的肿瘤。和IDC-NOS相比,它的激素受体表达率高,淋巴结转移率较低,预后较好。

Objective To investigate the clinicopathological features and prognosis of mucinous breast carcinoma (MBC), and then compare it with invasive ductal carcinoma non - specific type (IDC - NOS). Methods we collected clinical data from 88 MBC patients and 210 IDC - NOS patients who were diagnosed in the Affiliated Hospital of Xuzhou Medical University from January 2008 to December 2017. Both groups were compared for patient age, tumor size, clinical stage, lymph node metastasis rate and immunohistochemical expression of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor-2 (Her -2) and prognosis. Results Among 88 MBC patients, there were 64 patients with pure mucinous breast carcinoma (PMBC) and 24 ones with mixed mucinous breast carcinoma ( MMBC). The patients were 29 - 83 years old, with an average age of 56 years and a median age of 57 years. The total positive rates of ER, PR and Her -2 in 88 MBC cases were 94. 3%, 85. 2% and 27.2% respectively, with the lymph node metastasis rate was 31. 8%. Compared with the MMBC group, the MMBC group presented remarkable decreases in the lymph node metastasis rate and clinical stage (P <0. 01). Compared with the IDC - NOS group, the MBC group had a higher age and a lower lymph node metastasis rate. Based on immunohistochemical staining, the MBC groups showed that increased positive rate of ER and PR and decreased positive rate of Her -2, compared with the IDC - NOS group (P < 0.05). The 5 - year disease free survival ( DFS) rate and overall survival ( OS) rate in the MBC group were 88. 8% and 9& 6%, which however were not statistically different from those in the IDC - NOS group (85.4% and 95. 5%, respectively, P >0.05). Conclusions MBC is a slow growing tumor with a low - grade malignancy. Compared with IDC - NOS, MBC has higher hormone expression, lower lymph node metastasis rate and better prognosis.