乳腺癌微钙化超声征象及预后因素分析

Ultrasonic features of microcalcification and prognostic factors of breast cancer

目的探讨乳腺癌微钙化超声征象特点及其预后的相关因素。方法选取青海省第五人民医院2016年1月至2018年1月收治的乳腺癌患者153例作为研究对象。采用彩色多普勒超声仪检测病变特点及微钙化情况。所有患者均行手术治疗,术后随访至2018年9月,根据预后分为预后良好组(119例)与预后不良组(34例)。采用Logistic回归方法分析预后危险因素。结果超声微钙化征象者89例,表现主要为点状强回声,可位于肿块周边或者肿块内,或散在于腺体内。2组微钙化比例差异无统计学意义(P> 0. 05)。预后不良组年龄≤35岁、临床分期Ⅲ~Ⅳ期、肿瘤直径> 5 cm、腋窝淋巴结转移、雌激素受体阳性、孕激素受体阳性、Ki-67蛋白阳性比例均明显高于预后良好组,差异均有统计学意义(均P <0. 05)。多因素Logistic分析结果显示,年龄≤35岁(比值比=1. 684,95%置信区间:1. 251~2. 764,P=0. 013)、临床分期Ⅲ~Ⅳ期(比值比=2. 564,95%置信区间:1. 768~4. 165,P <0. 001)、肿瘤直径> 5 cm(比值比=2. 987,95%置信区间:1. 980~4. 762,P <0. 001)、腋窝淋巴结转移(比值比=1. 796,95%置信区间:1. 398~3. 071,P <0. 001)、雌激素受体阳性(比值比=2. 108,95%置信区间:1. 516~3. 768,P <0. 001)、孕激素受体阳性(比值比=3. 465,95%置信区间:2. 179~5. 102,P <0. 001)和Ki-67蛋白阳性(比值比=1. 497,95%置信区间:1. 082~2. 184,P=0. 027)均为乳腺癌预后不良的危险因素。结论乳腺癌微钙化超声征象以点状强回声为主,预后受多种因素影响,其中年龄、临床分期、肿瘤大小、腋窝淋巴结转移、雌激素受体、孕激素受体和Ki-67蛋白阳性为影响预后的危险因素。

Objective To investigate the characteristics of ultrasonic signs of microcalcification and the prognostic factors of breast cancer.Methods From January 2016 to January 2018,153 patients with breast cancer were enrolled in the Fifth People’s Hospital of Qinghai Province.Color Doppler ultrasound was performed to examine the tumor and microcalcification.All patients had surgery and they were followed up until September 2018 and divided into good prognosis group(n=119)and poor prognosis group(n=34).Risk factors of prognosis were analyzed through logistic regression.Results There were 89 cases showing microcalcification which presented as punctate strong echos located around or in tumor or scattered in gland.Rate of microcalcification was similar between the two groups(P>0.05).Rates of age≤35 years old,clinical stageⅢ-Ⅳ,tumor diameter>5 cm,axillary lymph node metastasis,positive estrogen receptor,positive progesterone receptor and positive Ki-67 protein in the poor prognosis group were significantly higher than those in the good prognosis group(all P<0.05).Multivariate logistic analysis showed that age≤35 years old(odds ratio=1.684,95%confidence interval:1.251-2.764,P=0.013),clinical stageⅢ-Ⅳ(odds ratio=2.564,95%confidence interval:1.768-4.165,P<0.001),tumor diameter>5 cm(odds ratio=2.987,95%confidence interval:1.980-4.762,P<0.001),axillary lymph node metastasis(odds ratio=1.796,95%confidence interval:1.398-3.071,P<0.001),positive estrogen receptor(odds ratio=2.108,95%confidence interval:1.516-3.768,P<0.001),progesterone receptor(odds ratio=3.465,95%confidence interval:2.179-5.102,P<0.001)and Ki-67 protein(odds ratio=1.497,95%confidence interval:1.082-2.184,P=0.027)were risk factors of poor prognosis in patients with breast cancer.Conclusions Ultrasound signs of microcalcification in breast cancer are mainly punctate strong echoes.Age,clinical stage,tumor size,axillary lymph node metastasis,estrogen receptor,progesterone receptor receptor and Ki-67 protein are risk factors of the prognosis.