乳腺分泌性癌的临床病理特征及预后因素分析

tures and prognostic factors of breast secretory carcinoma

目的探讨乳腺分泌性癌(SBC)的临床病例特征及预后的影响因素。方法利用美国国立癌症研究监测、流行病学和最终结局数据库(SEER), 筛选2004年1月至2020年12月经病理诊断为SBC(79例)和浸润性导管癌(IDC)(461 750例)的病例资料, 分析两组的临床病理特征及生存情况, 使用COX分析总生存期(OS)和乳腺癌特异性生存期(BCSS)的影响因素。采用倾向性得分匹配法(PSM)按1∶1比例匹配平衡混杂因素, 利用Kaplan-Meier法分析匹配后两组生存差异。结果乳腺分泌性癌患者与浸润性导管癌患者在年龄(Z=27.887, P<0.01)、婚姻状况(χ^(2)=9.639, P<0.01)、雌激素受体(χ^(2)=4.873, P<0.05)、孕激素受体(χ^(2)=42.917, P<0.01)、组织学分级(Z=5.442, P<0.01)及N分期(Z=2.616, P<0.01)方面差异有统计学意义;而在性别、种族、肿瘤位置、T分期、M分期、手术、放疗和化疗无统计学意义(P>0.05)。COX回归提示乳腺分泌性癌患者预后更好[风险比(HR)=1.616, 95%可信区间(CI):1.589~0.871, P<0.05];组织学分级越高, 其预后越差(组织学为Ⅱ级HR=1.159, 95%CI:1.133~1.186, P<0.01;组织学为Ⅲ级HR=1.440, 95%CI:1.406~1.476, P<0.01);肿瘤体积越大, 其预后更差(T2分期HR=1.616, 95%CI:1.589~1.643, P<0.01;T3分期HR=2.188, 95%CI:2.130~2.249, P<0.01;T4分期HR=2.484, 95%CI:2.416~2.554, P<0.01);淋巴结转移越多的患者预后差(N1分期HR=1.426, 95%CI:1.402~1.451, P<0.01;N2分期HR=2.079, 95%CI:2.028~2.131, P<0.01;N3分期HR=2.576, 95%CI:2.054~2.649, P<0.01)。按1∶1比例将两组进行倾向性得分匹配, 两组患者的总生存期和乳腺癌特异性生存期均无统计学意义(HR=1.816, 95%CI:0.785~4.205、HR=0.928, 95%CI:0.232~3.721, P>0.05)。结论乳腺分泌性癌是临床罕见的恶性肿瘤, 具有生长缓慢、组织学分级低、较少发生转移等临床病理特征。组织学分级、肿瘤体积、淋巴结转移情况是影响预后的因素。

Objective To investigate the clinical features and prognostic factors of secretory breast carcinoma(SBC),and to provide reference for the clinical treatment of SBC.Methods Using the Nation-al Cancer Institute Surveillance,Epidemiology,and End Outcomes(SEER)database,the clinical data of 79 patients with SBC and 461750 patients with invasive ductal carcinoma were selected from January 2004 to December 2020.The clinicopathologic features and survival of the two groups were analyzed retrospec-tively.The COX analysis was done to determine the influencing factors of overall survival(OS)and breast cancer specific survival(BCSS).The propensity score matching method(PSM)was used to balance con-founding factors in a l:1 ratio,and Kaplan-Meier method was used to analyze the survival difference be-tween the two matched groups.Results There were differences between patients with SBC and those with invasive ductal carcinoma in terms of age(Z=27.87,P<0.01),marital status(χ^(2)=9.639,P<0.01),estrogen receptor(χ^(2)=4.873,P<0.05),progesterone receptor(χ^(2)=42.917,P<0.01),histological grade(Z=5.442,P<0.01),and N staging(Z=2.616,P<0.01).There was no statistically significant dfference in terms of gender,race,tumor location,T staging,M staging,surgery,radiotherapy,and chemotherapy(P>0.05).COX regression indicated that patients with SBC had a better prognosis[hazard ratio(HR)=1.616,95%confidence interval(CD):1.589-0.871,P<0.05].The higher the histological grade,the worse the prognosis(HR for histological grade I=1.159,95%Cl:1.133-1.186,P<0.01;HR for histological grade II=1.440,95%CI:1.406-1.476,P<0.01).The larger the tumor size,the worse the prognosis(HR for T2 staging=1.616,95%CI:1.589-1.643,P<0.01;HR for T3 staging=2.188,95%CI:2.130-2.249,P<0.01;HR for T4 staging=2.484,95%CI:2.416-2.554,P<0.01).Patients with more lymph node metastasis had a poor prognosis(HR for N1 staging=1.426,95%CI:1.402-1.451,P<0.01;HR for N2 staging=2.079,95%CI:2.028-2.131,P<0.01;HR for N3 staging=2.576,95%CI:2.054-2.649,P<0.01).When SBC and IDC were matched in the ratio of 1:1,there was no statistically significant difference in OS and BCSS in both groups(HR=1.816,95%CI:0.785-4.205;HR=0.928,95%CI:0.232-3.721,P>0.05).Conclusion SBC is a rare clinical malignant tumor with slow growth,low histological grade and less metastasis.Histological grade,tumor volume and lymph node metastasis were the prognostic factors.