乳腺化生性癌的临床病理特征及预后因素分析

Clinicopathological features and prognostic factors associated with metaplastic carcinoma of the breast

目的探讨乳腺化生性癌(MBC)的临床病理特征,分析其预后影响因素。方法收集北京大学人民医院病理科18年间诊断的MBC 49例,同期乳腺浸润性导管癌(IDC)30例。应用免疫组织化学方法进行CK5/6、CK、P63、ER、HER2、Ki67等染色观察其在不同类型MBC中的表达。结果MBC组患者的中位年龄55岁,肿物最大径0.6~19 cm,中位数为2.5 cm。MBC伴异源性间叶成分15例(产生基质的癌8例),梭形细胞癌12例,鳞状细胞癌7例,混合性化生性癌11例,其他类型4例。MBC组的5年和10年累积生存率分别为50%、41%,低于IDC组的76%、63%,差异均有统计学意义(均P<0.05)。MBC组患者的腋窝淋巴结转移率、ER、PR、HER2表达率均低于IDC组,差异均有统计学意义(均P<0.05)。MBC组的三阴性病例(82%)多于IDC组,差异有统计学意义(χ^(2)=26.244,P=0.000)。两组的Ki67增生指数差异有统计学意义(t=2.624,P=0.011)。结论MBC在临床少见,通常体积较大、淋巴结转移较少、Ki67增生指数较高、多为三阴性。淋巴结转移、Ki67增生指数高、三阴性是MBC预后不良的指标。

Objective To study the clinicopathological features of metaplastic breast cancer(MBC),and its prognostic factors.Methods Data of 49 MBC cases and 30 cases of invasive ductal carcinoma(IDC)during the same period as matched control were collected.The immunohistochemistry staining of CK5/6,CK,P63,ER,HER2,Ki67 was performed in all MBC samples.Results In MBC cases,the median age was 55 years.Median tumor size was 2.5 cm(range,0.6-19 cm).Fifteen cases were classified as metaplastic carcinoma with heterologous mesenchymal differentiation(8 as matrix-producing carcinoma),12 as spindle cell carcinoma,7 as squamous cell carcinoma,2 as low-grade adenosquamous carcinoma,2 as fibromatosis-like metaplastic carcinoma,and 11 as mixed metaplastic carcinoma.The 5-,10-year overall survival rate was 50%,41%,respectively,lower than those of IDC(76%,63%)(all P<0.05).Lymph node metastasis rate,and expression of ER,PR,HER2 in MBC were lower than those in IDC(all P<0.05).Triple-negative cases in MBC were more than those of IDC(χ^(2)=26.244,P=0.000).The proliferative index of Ki67 was statistically different between the two groups(t=2.624,P=0.011).Conclusions MBC is a rare and heterogenous breast cancer.Compared to IDC,MBCs are usually larger,lower in lymph nodes metastasis,higher in proliferative index of Ki67,more triple-negative,hence with a poorer prognosis.