乳腺浸润性导管癌伴广泛导管内癌保乳术后局部复发的影响因素分析

Influencing factor analysis of local recurrence of breast invasive ductal carcinoma with extensive intraductal carcinoma after breast conserving surgery

目的探讨乳腺浸润性导管癌(invasive ductal carcinoma,IDC)伴广泛导管内癌(extensive intraductal carcinoma,EIC)组织血管细胞黏附因子-1(vascular cell adhesion molecule-1,VCAM-1)与生存素(survivin)对保乳术后局部复发的影响。方法选择2014年2月至2016年3月徐州医科大学附属沭阳医院收治的拟行保乳术治疗的乳腺IDC伴EIC患者179例,所有患者采用保乳术治疗,术中采集癌组织与癌旁组织。采用免疫组化法检测癌组织与癌旁组织VCAM-1与survivin表达水平。随访5年,根据是否局部复发分为复发组与未复发组。采用多因素logistic回归分析对乳腺IDC伴EIC患者术后局部复发的影响因素进行分析。结果179例患者中,171例完成5年随访,随访率95.5%,其中复发组38例,未复发组133例。乳腺IDC伴EIC患者癌组织中VCAM-1与survivin表达阳性率高于癌旁组织(74.9%比13.4%,60.9%比10.1%),差异有统计学意义(P<0.001)。复发组淋巴结转移占比、免疫分型为基底细胞样型占比、癌组织中VCAM-1阳性占比、survivin阳性占比、CK5/CK6阳性占比显著高于未复发组(68.4%比24.1%,68.4%比26.3%,92.1%比69.9%,89.5%比54.1%,84.2%比18.8%),差异均有统计学意义(P<0.05);复发组癌组织中ER和PR阴性占比显著高于未复发组(57.9%比31.6%,68.4%比36.1%),差异有统计学意义(P<0.05);多因素logistic回归分析显示,免疫分型为基底细胞样型(OR=2.759,95%CI:1.135~6.706)、癌组织中VCAM-1阳性(OR=2.790,95%CI:1.148~6.780)和survivin阳性(OR=2.878,95%CI:1.184~6.994)为乳腺IDC伴EIC患者术后局部复发的危险因素(P<0.001)。结论免疫分型为基底细胞样型、癌组织中VCAM-1阳性、survivin阳性为乳腺IDC伴EIC患者保乳术后局部复发的危险因素。

Objective To investigate the effect of vascular cell adhesion molecule-1(VCAM-1)and survivin on local recurrence of breast invasive ductal carcinoma(IDC)with extensive intraductal carcinoma(EIC)after breast conserving surgery.Methods From February 2014 to March 2016,179 patients with breast IDC and EIC underwent breast conserving surgery were selected as the research objects.During the operation,carcinoma tissue and para-carcinoma tissue of all patients were collected,immunohistochemistry was used to detect the levels of VCAM-1and survivin.Followed up for five years,the patients were divided into recurrence group and non-recurrence group.General information of the patients were collected.Logistic regression analysis was used to analyze the influencing factors of postoperative local recurrence in the patients with breast IDC and EIC.Results Among 179 patients with breast IDC and EIC,eight patients were lost during follow-up,the follow up rate was 95.5%.The positive rates of VCAM-1 and survivin were higher in carcinoma tissue than those in para-carcinoma tissue(74.9%vs.13.4%,P<0.001;60.9%vs.10.1%,P<0.001).Compared with the non-recurrence group,the proportion of lymphatic metastasis(68.4%vs.24.1%),basaloid-like type(68.4%vs.26.3%),VCAM-1 positive(92.1%vs.69.9%),survivin positive(89.5%vs.54.1%),CK5/CK6 positive(84.2%vs.18.8%)in the recurrence group were significantly higher(P<0.05).The proportion of ER-negative cases(57.9%vs.31.6%)and PR-negative cases(68.4%vs.36.1%)in the recurrence group was higher than that in the non-recurrence group(P<0.05).Logistic regression analysis showed that basaloid-like type(OR=2.759,95%CI:1.135-6.706,P<0.001),positive VCAM-1(OR=2.790,95%CI:1.148-6.780,P<0.001)and positive survivin(OR=2.878,95%CI:1.184-6.994,P<0.001)in carcinoma tissue were risk factors for postoperative local recurrence in the patients with breast IDC and EIC.Conclusions Basaloid-like type,VCAM-1positive and survivin positive in carcinoma tissue were risk factors for local recurrence after breast conserving surgery in breast IDC patients with EIC.