乳腺神经内分泌癌的临床分析

Clinical analysis of neuroendocrine carcinoma of the breast

目的探讨乳腺神经内分泌癌的临床特点、病理特征、治疗及预后。方法收集2013年7月至2021年3月江苏省苏北人民医院确诊的26例乳腺神经内分泌癌患者的临床资料,分析其临床病理特征及预后。结果26例患者均为女性,平均年龄(62.81±11.95)岁,首发症状均为无痛性乳房肿物,肿瘤平均大小(23.34±9.47)mm。确诊时4例伴区域淋巴结转移,1例伴远处转移。TNM分期多为Ⅱ期,分子分型多为Luminal A型,以伴神经内分泌分化的浸润性乳腺癌最多见,ER和PR阳性率均为96%,CgA和Syn阳性率分别为69%和100%,HER2无阳性表达。全部患者均接受手术治疗,25例接受术后辅助治疗。25例患者获得随访,随访率96%,中位随访时间39.50个月,3例出现远处转移,1例死亡,平均生存期(40.81±26.90)个月,与浸润性乳腺癌相比差异无统计学意义(t=1.291,P=0.209)。平均无病生存期(39.96±27.58)个月,1、2、5年总生存率和无病生存率分别均为100%、100%、87%。结论乳腺神经内分泌癌好发于老年女性(>60岁),临床表现无特征性,肿瘤体积较大(直径>20 mm),分子分型多为Luminal A型,组织学分级中等,区域淋巴结和远处转移率低,临床分期较早,治疗效果及预后较好。

Objective To investigate the clinicopathological features,treatment and prognosis of neuroendocrine carcinoma of the breast.Methods Clinical data of 26 patients with neuroendocrine carcinoma of the breast admitted to the Northern Jiangsu People's Hospital from July 2013 to Mar 2021 were analyzed.Results All 26 cases were female,the average aged of(62.81±11.95)years,the first clinical manifestations were painless breast masses,the average size being of(23.34±9.47)mm.At the time of diagnosis,regional lymph node metastasis was found in 4 cases,1 case developed distant metastasis.Most patients'were on stageⅡby TNM staging,molecular typing was Luminal A,and invasive mammary carcinoma with neuroendocrine differentiation was most common,with positive rates of ER and PR of 96%,the positive rate of CgA and Syn were 69%and 100%,and there was not positive expression of HER2.All patients received surgical treatment,25 patients underwent postoperative adjuvant therapy.Twenty-five patients were followed up for a median follow-up time of 39.50 months.During the follow-up,3 cases developed distant metastasis,1 case died,the mean survival time was(40.81±26.90)months,there was ao satistically significant difference compared with invasive mammary carcinoma(t=1.291,P=0.209).The mean disease free interval is(39.96±27.58)months.The overall survival and disease free survival at 1,2 and 5 years are 100%,100%and 87%,respectively.Conclusions Neuroendocrine carcinoma of the breast occurs more frequently in elderly women,often with large tumor size,low rate of regional lymph node and distant metastasis,moderate histological grade,early clinical stage,and the molecular typing is mostly Luminal A.The overall prognosis is fair.