基于SEER数据库的乳腺黏液腺癌临床病理学特征及生存分析

Clinicopathological characteristics and survival analysis of patients with mucinous breast carcinoma based on SEER database

背景与目的:乳腺黏液腺癌(mucinous carcinoma,MC)恶性程度较低,预后较好。目前美国国立综合癌症网络(National Comprehensive Cancer Network,NCCN)指南推荐对雌激素受体(estrogen receptor,ER)和孕激素受体(progesterone receptor,PR)阴性MC的辅助化疗按照非特殊类型的浸润性导管癌(invasive ductal carcinoma,IDC)处理,即激素受体阴性、淋巴结阴性的pT≥0.6 cm的MC考虑及需要辅助化疗。探讨IDC和MC的临床、病理学等因素与乳腺癌特异生存率(breast cancer-specific survival,BCSS)的关系,为MC的辅助治疗策略提供依据。方法:回顾性分析2000—2009年美国流行病监测与最终治疗结果(Surveillance,Epidemiology,and End Results,SEER)数据库中可手术的245235例IDC及6705例MC的病例资料,比较两种不同组织学类型乳腺癌的临床病理学特征及BCSS率的差异。结果:MC患者ER阳性率高达97.3%,而IDC为76.0%(P<0.01);中位随访104个月,整体上MC的预后优于IDC,MC的10年BCSS率为92.0%,而IDC为84.0%(P<0.001);ER和PR均阳性的MC和IDC的10年BCSS率分别为93.0%和87.0%(P<0.001),ER和PR均阴性则分别为81.0%和76.0%(P=0.022);激素受体阴性的MC患者中,pT2N0M0和pT3-4N0M0的BCSS率均较低,分别为85.2%和80.0%,而pT1N0M0预后较好,10年BCSS率为94.5%,其中接受化疗和未经过化疗的10年BCSS率分别为94.1%和94.6%(P=0.87)。结论:MC生物学行为较好,与IDC相比,MC具有更好的长期生存;激素受体阴性、pT1N0M0的MC预后好,辅助化疗并没有进一步改善生存,提示对这部分高选择的患者有可能豁免辅助化疗,减少不必要的毒性。

Background and purpose:Breast cancer is a common and heterogeneous disease.Mucinous carcinoma(MC)of the breast is often considered to has a better prognosis than invasive ductal carcinoma(IDC).National Comprehensive Cancer Network(NCCN)guidelines for optimal systemic control of MC are mostly extrapolated from data on the basis of IDC.In this study,we investigated the relationship between the breast cancer-specific survival(BCSS)and the significance of the available clinical and pathologic prognostic factors for patients with MC and IDC.Methods:Using the Surveillance,Epidemiology,and End Results(SEER)Program in the United States(2000-2009),we retrospectively analyzed the relative hazard ratio(HR)and absolute HR of the cumulative 10-year BCSS in 251940 female operable breast cancer patients with IDC or MC,stratified by age,estrogen receptor(ER),progesterone receptor(PR)and lymph node(LN),treated with or without adjuvant chemotherapy or radiotherapy and adjusted for other prognostic factors.Results:The incidence of ER-positive breast cancer was 97.3%in MC and 76.0%in IDC(P<0.01).MC showed less aggressive behavior and had a better prognosis compared with IDC,and this favorable outcome was maintained after 10 years of follow up.The 10-year BCSS was 92.0%for MC and 84.0%for IDC,respectively(P<0.001).The 10-year BCSS was 93.0%and 87.0%for MC and IDC with ER-and PR-positive cancer,while the 10-year BCSS was 81.0%and 76.0%in ER-and PRnegative MC and IDC,respectively(P=0.022).Among MC patients with ER-negative and PR-negative cancer,the 10-year BCSS was 85.2%and 80.0%in pT2N0M0 and pT3-4N0M0 respectively,and 94.5%in pT1N0M0.Furthermore,the 10-year BCSS was 94.1%and 94.6%(P=0.87)in ER-and PR-negative MC pT1N0M0 with or without chemotherapy,respectively.Conclusion:Mucinous cancer of the breast has better prognosis.Systemic adjuvant chemotherapy may be avoided in the patients with pT1N0M0,ER-and PRnegative mucinous breast cancer.