年轻乳腺佩吉特病伴浸润性导管癌患者的临床病理特征及预后分析

Young mammary Paget's disease patients with underlying breast invasive ductal carcinoma:clinicopathological features and prognosis

目的探讨年轻乳腺佩吉特病(MPD)伴乳腺浸润性导管癌(IDC)患者的临床病理特征及预后状况。方法纳入2002年6月至2019年2月于中国医学科学院肿瘤医院乳腺外科就诊的MPD伴IDC患者123例,按照发病年龄将患者分为年轻组(≤40岁,15例)和年长组(>40岁,108例),比较两组患者的临床病理特征和预后,采用Cox回归模型分析进行预后影响因素分析。结果年轻组患者中未绝经、腋窝淋巴结转移、Ki-67指数≥15%的患者所占比例分别为93.3%(14/15)、73.3%(11/15)和86.7%(13/15),高于年长组[分别为45.4%(49/108)、39.8%(43/108)和60.2%(65/108)],差异均有统计学意义(均P<0.05)。平均随访63.2个月,年轻组与年长组比较,患者的无病生存时间(DFS)明显缩短(P=0.012),而两组患者的总生存时间(OS)差异无统计学意义(P=0.161)。多因素Cox回归分析显示,腋窝淋巴结状态是MPD伴IDC患者OS(HR=3.339,95%CI为1.121~9.943)的独立影响因素,而年龄并非DFS和OS的独立影响因素。结论与年长组相比,年轻MPD伴IDC患者腋窝淋巴结转移率高,Ki-67更易高表达,DFS更短,但年龄并非MPD伴IDC患者DFS或OS的独立影响因素。

Objective To investigate the clinicopathological factors and prognostic status of young Mammary Paget′s disease(MPD)patients with invasive ductal carcinoma(IDC).Methods In this study,we defined the age at diagnosis below 40 years old as young patients,and retrospectively analyzed data from 123 MPD-IDC patients who were admitted at the Cancer Hospital Chinese Academy of Medical Sciences from June 2002 to February 2019.Patients were divided into the young group(≤40 years old,15 cases)and the old group(>40 years old,108 cases)according to the age of onset,and the clinicopathological characteristics and prognosis of the two groups were compared.Cox regression model analysis was used to analyze the prognosis influencing factors.Results The proportions of patients in the young group with non-menopausal,axillary lymph node metastasis,and Ki-67 index≥15% were 93.3%(14/15),73.3%(11/15),and 86.7%(13/15),respectively,which were higher than those in the old group[45.4%(49/108),39.8%(43/108),and 60.2%(65/108),respectively],with statistically significant differences(P<0.05).At an average follow-up of 63.2 months,patients in the young group had a significantly shorter disease-free survival(DFS)compared with that of the old group(P=0.012),while the difference in overall survival(OS)between the two groups was not statistically significant(P=0.161).Multifactorial Cox regression analysis showed that axillary lymph node status was an independent influencing factor on OS(HR=3.339,95%CI:1.121-9.943)in patients with MPD-IDC,while age was not.Conclusion Compared with the old group,young patients with MPD-IDC have a higher incidence of axillary lymph node metastasis,high Ki-67 expression,and a shorter DFS,but age is not an independent influencing factor on DFS or OS in patients with MPD-IDC.