乳腺黏液腺癌的临床病理特征及其预后分析

Clinicopathological characteristics and prognosis of mucinous breast carcinoma

目的对比分析乳腺黏液腺癌(MBC)与浸润性导管癌(BIDC)的临床特点、治疗方法及影响预后的因素.方法回顾性分析2010年1月至2014年12月中国医学科学院肿瘤医院乳腺外科收治的乳腺黏液腺癌与浸润性导管癌各100例的临床资料,采用t检验、秩和检验、X^(2)检验或Fisher确切概率法比较2组患者的临床病理特征.采用Kaplan Meier法绘制生存曲线,并用Log-rank法比较2组患者的DFS及OS.采用单因素及多因素Cox比例风险模型分析DFS及OS的影响因素.结果MBC组与BIDC组患者的年龄、TNM分期、组织学分级、分子分型及手术方式比较,差异均有统计学意义(t=1.297,Z=3.567、-8.627,X^(2)=10.086、17.737;P均<0.050).共14例失访,其中MBC组3例,BIDC组11例,随访率为93%(186/200).12例死亡,其中MBC组2例,BIDC组10例.MBC组5年DFS率为91%,BIDC组为78%,差异有统计学意义(X^(2)=7.585,P=0.006).MBC组5年OS率为97%,BIDC组为88%,差异有统计学意义(X^(2)=7.752,P=0.005).MBC组的DFS优于BIDC组(HR=0.30,95%CI:0.13~0.69,P=0.004);luminal B型(HER-2阳性)DFS的风险是luminal A型的4.97倍(95%CI:1.71~14.42,P=0.003),HER-2过表达型是luminal A型的6.08倍(95%CI:2.22~16.13,P<0.001);接受改良根治术的患者DFS风险是接受保留乳房手术+前哨淋巴结活组织检查(SLNB)患者的0.36倍(95%CI:0.13~0.99,P=0.047).MBC组的OS优于BIDC组(HR=0.26,95%CI:0.10~0.63,P=0.003);luminal B型(HER-2阳性)患者的OS风险是luminal A型的6.90倍(95%CI:1.72~27.67,P=0.006),HER-2过表达型患者的OS风险是luminal A型的11.44倍(95%CI:3.13~41.89,P<0.001),三阴性患者的OS风险是luminal A型的6.46倍(95%CI:1.57~26.51,P=0.010);接受改良根治术的患者OS风险是接受保留乳房手术+SLNB患者的0.21倍(95%CI:0.06~0.74,P=0.015).结论MBC患者的预后明显好于BIDC,且生存期较长,与其分子分型有相关性.

Objective To compare the clinical characteristics and treatment methods of mucinous breast carcinoma(MBC)and breast invasive ductal carcinoma(BIDC),and analyze prognostic factors.Methods The clinical data of 100 patients with MBC and 100 patients with BIDC in the Department of Breast Surgery,Cancer Hospital,Chinese Academy of Medical Sciences from January 2010 to December 2014 were retrospectively analyzed.The clinicopathological characteristics were compared between two groups using t test,rank sum test,χ^(2)test or Fisher’s exact test.Survival curves were drawn by Kaplan-Meier method,and DFS and OS were compared between two groups by log-rank test.Univariate and multivariate Cox proportional hazards models were used to analyze related factors affecting DFS and OS.Results There were significant differences in age,TNM stage,histological grade,molecular typing and surgical methods between MBC group and BIDC group(t=1.297,Z=3.567,-8.627,χ^(2)=10.086,17.737;all P<0.050).A total of 14 cases were lost to follow-up,including 3 cases in MBC group and 11 cases in BIDC group,with the follow-up rate of 93%(186/200).There were 12 deaths,including 2 in MBC group and 10 in BIDC group.The 5-year DFS was 91%in MBC group and 78%in BIDC group,indicating a significant difference(χ^(2)=7.585,P=0.006).The 5-year OS was 97%in MBC group and 88%in BIDC group,indicating a significant difference(χ^(2)=7.752,P=0.005).The DFS in MBC group was significantly better than that in BIDC group(HR=0.30,95%CI:0.13-0.69,P=0.004);the risk of DFS in luminal B subtype(HER-2 positive)was 4.97 times as high as that of luminal A subtype(95%CI:1.71-14.42,P=0.003),HER-2 overexpression subtype 6.08 times(95%CI:2.22-16.13,P<0.001);the risk of DFS in patients receiving modified radical mastectomy was 0.36 times as high as that in patients who received breast-conserving surgery+sentinel lymph node biopsy(95%CI:0.13-0.99,P=0.047).The OS in MBC group was significantly better than that in BIDC group(HR=0.26,95%CI:0.10-0.63,P=0.003);the risk of OS in patients with luminal B subtype(HER-2 positive)was 6.90 times as high as that of luminal A subtype(95%CI:1.72-27.67,P=0.006),HER-2 overexpression subtype 11.44 times(95%CI:3.13-41.89,P<0.001),triple-negative subtype 6.46 times(95%CI:1.57-26.51,P=0.010);the risk of OS in patients receiving modified radical mastectomy was 0.21 time as high as that in patients who received breast-conserving surgery+sentinel lymph node biopsy(95%CI:0.06-0.74,P=0.015).Conclusion The patients with MBC have a better prognosis and longer survival compared with patients with BIDC,which is related to the molecular subtype.