含微乳头成分的乳腺浸润性黏液癌的分析

Analysis of invasive micropapillary mucinous carcinoma of breast

目的:探讨含微乳头成分的乳腺浸润性黏液癌(invasive micropapillary mucinous carcinoma, IMpMC)与纯黏液癌(pure mucinous carcinoma, PMC)临床病理特征以及预后的差异。方法:回顾性分析2008年9月至2017年12月上海交通大学乳腺癌数据库中有完整临床病理与随访资料的IMpMC与PMC病人。比较这两类乳腺癌临床病理特征以及预后的差异,分析微乳头成分对黏液癌病人预后的影响。结果:共239例乳腺癌病人入组,其中IMpMC病人27例(11.3%),PMC病人212例(88.7%)。临床病理特征的多因素分析显示,与PMC相比,IMpMC有较高的淋巴结阳性率(OR=4.84,P=0.014)、较多的脉管浸润(OR=13.38,P=0.001)以及较多的Ki67高表达(OR=4.07,P=0.044)。治疗方面的多因素分析显示,IMpMC比PMC病人较多行乳腺癌根治术(OR=10.00,P=0.003)、辅助化疗(OR=7.11,P<0.001)与放疗(OR=5.33,P=0.006)。PMC病人的5年无病生存率(disease free survival, DFS)和总生存率分别为92.5%和98.6%,高于IMpMC病人的79.2%(P=0.011)和93.8%(P=0.022)。多因素生存分析显示,病理类型和肿瘤直径是影响病人DFS的独立因素。IMpMC较PMC病人有较差的DFS(HR=10.39,P=0.014)。结论:与PMC相比,IMpMC的肿瘤侵袭性较高。IMpMC病人的预后较PMC差。

Objective To investigate differences in clinicopathological features and prognosis between invasive micropapillary mucinous carcinoma(IMpMC) and pure mucinous carcinoma(PMC) of breast. Methods The patients of IMpMC and those of PMC were enrolled in this study retrospectively with clinicopathological and follow-up data from Shanghai Jiao Tong University Breast Cancer Database(SJTU-BCDB) between September 2008 and December 2017. Differences in clinicopathology and prognosis between IMpMC and PMC were analyzed. Results A total of 239 patients were enrolled including 27(11.3%) cases with IMpMC and 212(88.7%) cases with PMC. Multivariate analysis on clinicopatho-logical feature showed that there were more cases with IMpMC with lymph node metastasis(OR=4.84, P=0.014), lymphovascular invasion(OR=13.38, P=0.001) and higher expression of Ki67(OR=4.07, P=0.044) when compared the patients with PMC. Multivariate analysis on treatment showed that radical mastectomy for breast cancer(OR=10.00, P=0.003), adjuvant chemotherapy(OR =7.11, P <0.001) and radiotherapy(OR =5.33, P =0.006) were performed for more cases with IMpMC than for cases with PMC. PMC patients had higher disease free survival(DFS) 92.5% and overall survival(OS)98.6%, compared to IMpMC patients(DFS 79.2%, P=0.011, OS 93.8%, P=0.022). Pathological type and tumor size were independent factors associated with DFS shown in multivariate analysis. IMpMC patients had lower DFS than PMC patients(HR=10.39, P=0.014). Conclusions IMpMC was associated with aggressive behavior and worse prognosis when compare to PMC.