乳腺浸润性导管/小叶混合癌与浸润性小叶癌、导管癌的临床病理特征及预后差异

Clinicopathological characteristics and prognosis of invasive ductal/lobular mixed carcinoma,invasive lobular carcinoma and invasive ductal carcinoma of breast

目的研究乳腺浸润性导管/小叶混合癌(infiltrative ductal/lobular mixed carcinoma,IDC-L)与浸润性小叶癌(infiltrative lobular carcinoma,ILC)及浸润性导管癌(infiltrative ductal carcinoma,IDC)病理特征及预后差异。方法选择深圳市龙华区中心医院2011年9月至2020年9月收入的254例乳腺癌患者,其中IDC-L 18例,ILC 20例,IDC 216例,观察患者临床病理特征预后情况。结果IDC-L、ILC及IDC患者在年龄、肿瘤大小、多中心病灶、脉管浸润、HER2状态、Ki-67表达方面具有明显差异,IDC-L患者发病年龄较小、肿瘤直径>2.0cm较多,而IDC患者多中心病灶及脉管浸润较少,IDC-L与ILC患者的HER2阳性及Ki-67高表达比例均低于IDC,差异有显著性(P<0.05)。年龄、更年期状态、肿瘤大小、淋巴结状态、多中心病变、淋巴血管侵犯、HER2状态、Ki-67表达均是临床病理特征差异的影响因素。无乳腺癌间期(breast cancer-free interval,BCFi)、总生存期(overall survival,OS)与患者肿瘤大小、淋巴结状态、淋巴血管侵犯、Ki-67表达之间是存在一定关系(P<0.05)。结论在乳腺癌患者中,ILC与IDC-L之间临床病理特征存在一定相似,但三者有明显差异,临床可加以区分,以便对患者更好地进行治疗。

Objective To study the pathological characteristics of breast infiltrative ductal/lobular mixed carcinoma(IDC-L),infiltrative lobular carcinoma(ILC)and infiltrative ductal carcinoma(IDC).Methods From September 2011 to September 2020,254 breast cancer patients were selected,Among them,there were 18 cases of IDC-L,20 cases of ILC and 216 cases of IDC.The prognosis of the three groups of patients was observed.Results IDC-L,ILC and IDC patients had significant differences in age,tumor size,multicentric lesions,vascular invasion,HER2 status,Ki-67 expression.IDC-L patients had younger onset age,more tumor diameter>2.0 cm,while IDC patients had less multicentric lesions and vascular invasion,while HER2 positive rate and Ki-67 high expression ratio in IDC-L and ILC patients were lower than IDC,the difference was statistically significant(P<0.05).Age,climacteric state,tumor size,lymph node state,multicentric lesions,lymphatic vessel invasion,HER2 state and Ki-67 expression were all the influencing factors of clinic pathological differences.Breast cancer-free interval and overall survival were related to tumor size,lymph node status,lymphatic vessel invasion and Ki-67 expression(P<0.05).Conclusion In breast cancer patients,the clinicopathological characteristics of ILC and IDC-L are similar to each other,but there are obvious differences among ILC,IDC-L and IDC.The breast cancer patients can be differentiated clinically and treated better.