贾宏琴, 李伟东, 谷峰, 李帅, 韩芸蔚, 付丽. 新辅助化疗对乳腺浸润性微乳头状癌的预后影响及其疗效分析[J]. 中国肿瘤临床, 2019, 46(11): 562-567. DOI: 10.3969/j.issn.1000-8179.2019.11.321
引用本文: 贾宏琴, 李伟东, 谷峰, 李帅, 韩芸蔚, 付丽. 新辅助化疗对乳腺浸润性微乳头状癌的预后影响及其疗效分析[J]. 中国肿瘤临床, 2019, 46(11): 562-567. DOI: 10.3969/j.issn.1000-8179.2019.11.321
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Jia Hongqin, Li Weidong, Gu Feng, Li Shuai, Han Yunwei, Fu Li. Prognosis and efficacy of neoadjuvant chemotherapy in patients with invasive micropapillary carcinoma of breast[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2019, 46(11): 562-567. DOI: 10.3969/j.issn.1000-8179.2019.11.321
Citation: Jia Hongqin, Li Weidong, Gu Feng, Li Shuai, Han Yunwei, Fu Li. Prognosis and efficacy of neoadjuvant chemotherapy in patients with invasive micropapillary carcinoma of breast[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2019, 46(11): 562-567. DOI: 10.3969/j.issn.1000-8179.2019.11.321
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新辅助化疗对乳腺浸润性微乳头状癌的预后影响及其疗效分析

Prognosis and efficacy of neoadjuvant chemotherapy in patients with invasive micropapillary carcinoma of breast

    摘要
  • 摘要:
      目的  采用倾向性评分匹配法（propensity score matching，PSM）探讨新辅助化疗（neoadjuvant chemotherapy，NAC）对乳腺浸润性微乳头状癌（invasive micropapillary carcinoma，IMPC）的预后影响及其疗效。
      方法  回顾性分析2011年1月至2014年3月251例于天津医科大学肿瘤医院诊治的乳腺IMPC患者的临床病理资料，分为NAC组（67例）和非NAC组（184例）。比较NAC组患者行NAC前后的肿瘤大小改变，采用PSM均衡组间混杂因素后比较NAC组和非NAC组患者的预后差异。
      结果  NAC组患者经NAC后，肿瘤最大径平均值从5.0 cm减小至4.2 cm（P=0.035），但T分期改变差异无统计学意义（P=0.064）。经PSM后共有49对（98例）患者获得匹配，两组基线资料差异均无统计学意义。单因素生存分析显示，患者的5年累积无复发生存（recurrence-free survival，RFS）率，匹配前、后NAC组（77.6% vs. 89.2%）与非NAC组（72.1% vs. 91.0%）比较差异均无统计学意义（均P>0.05）。匹配前、后NAC组的5年累积无远处转移生存（distant metastasis-free survival，DMFS）率分别为53.4%、50.0%，显著低于非NAC组69.1%、59.2%（均P < 0.05），且匹配后采用Cox比例回归风险模型进行多因素生存分析显示NAC是IMPC患者DMFS的独立预后因素。
      结论  乳腺IMPC是一种对化疗不敏感的特殊类型肿瘤。NAC后虽然部分IMPC肿瘤有所减小，但未使IMPC患者的RFS获益，甚至增加患者的远处转移风险，因此乳腺IMPC患者应尽早手术切除，而不推荐行NAC。

     

    Abstract:
      Objective   To investigate the prognosis of patients who receive neoadjuvant chemotherapy (NAC) for invasive micropapillary carcinoma (IMPC) of the breast using a propensity score matching (PSM) method and to analyze the effects of NAC.
      Methods  Clinical and pathological data of a total of 251 cases of IMPC of the breast were collected for this study, from January 2011 to March 2014 in Tianjin Medical University Cancer Institute and Hospital, of which the NAC group comprised 67 cases and the non-NAC group comprised 184 cases. Tumor sizes before and after NAC were compared in the NAC group. Prognostic differences were compared between the NAC group and non-NAC group before and after PSM balancing the baseline.
      Results  The mean value of the maximum dimensions significantly reduced from 5.0cm to 4.2cm in the NAC group after NAC (P=0.035), but there was no statistically significant difference in T stage changes (P=0.064). A total of 49 pairs of patients were matched after PSM, and differences in the baseline data of the paired group were not significant. Univariate survival analysis showed no significant difference in the recurrence-free survival (RFS) rate between the NAC group (77.6% vs. 89.2%) and non-NAC group (72.1% vs. 91.0%) before and after PSM (all P>0.05). The 5-year distant metastasis-free survival (DMFS) rates in the NAC group before and after PSM were 53.4% and 50.0%, respectively, which were both significantly lower than those in the non-NAC group 69.1%, 59.2% (all P < 0.05), and multivariate survival analysis showed that undergoing NAC was an independent prognostic factor of DMFS after PSM.
      Conclusion  Breast IMPC is a special type of tumor that is not sensitive to chemotherapy. Although some tumors decrease after NAC, IMPC patients do not benefit from NAC in terms of RFS; NAC may even increase the risk of distant metastasis. Therefore, IMPC patients should undergo surgical treatment as soon as possible, and NAC is not recommended.

     

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