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摘要:
目的 探讨乳腺浸润性微乳头状癌（invasive micropapillary carcinoma，IMPC）的临床病理特征及预后。 方法 回顾性分析2011年1月至2015年12月246例于天津医科大学肿瘤医院收治的乳腺IMPC患者的临床病理资料，分为143例IMPC成分比例> 50%（A组）和103例比例≤50%（B组）两组。多因素分析采用Cox比例风险回归模型，采用Log-rank检验及Kaplan Meier法等进行生存分析。 结果 A组患者的5年无病生存（disease free survival，DFS）和总生存（overall survival，OS）时间均低于B组DFS（76.5% vs.83.6%，P=0.042）和OS（74.1% vs.81.6%，P=0.029）。A组中未行放疗患者的DFS和OS均低于行放疗患者的DFS（χ2=5.219，P=0.022）和OS（χ2=3.963，P=0.047）。Cox比例风险回归模型多因素分析显示，患者人类表皮生长因子受体-2（human epidermal growth factor receptor-2，HER-2）阳性表达（HR=2.989，95% CI：1.400~6.384，P=0.005），乳头侵犯（HR=2.388，95% CI：1.263~ 4.518，P=0.007），4枚以上淋巴结转移（HR=2.076，95% CI：1.080~3.992，P=0.029）为DFS独立危险因素，乳头侵犯（HR=1.951，95% CI：1.054~3.609，P=0.033）为OS独立危险因素，并且乳头侵犯中未行放疗患者的DFS和OS均低于行放疗患者的DFS（χ2=6.541，P=0.011）和OS（χ2=6.455，P=0.012）。 结论 乳腺IMPC作为一种特殊类型乳腺癌，乳头侵犯提示预后较差。IMPC成分比例>50%较比例≤50%乳腺癌患者的预后更差，对于IMPC成分比例>50%或乳头侵犯患者，术后放疗能带来更多生存获益。 Abstract:Objective We aimed to investigate the clinicopathology and prognosis of invasive micropapillary carcinoma (IMPC) of the breast. Methods This was a single-center retrospective study based on the clinicopathological and follow-up data of 246 patients with IMPC who were treated at the Tianjin Medical University Cancer Institute and Hospital between January 2011 and December 2015. The patients were divided into two groups:we included 143 patients with >50% IMPC in group A and the remaining 103 patients in group B. The cox proportional-hazard regression model, Log-rank test, and Kaplan-Meier method were used for analysis. Results The 5-year disease-free survival (DFS; 76.5% vs. 83.6%, P=0.042) and overall survival (OS; 74.1% vs. 81.6%, P=0.029) of group A were lower than those of group B. The DFS (χ2=5.219, P=0.022) and OS (χ2=3.96, P=0.047) of patients who did not receive radiotherapy in group A were lower than those of patients who received radiotherapy. Multivariate Cox regression analysis showed that HER-2 expression (HR=2.989, 95% CI 1.400-6.384, P=0.005), mammilla invasion (HR=2.388, 95% CI 1.263-4.518, P=0.007), and ≥ 4 lymph node metastasis (HR=2.076, 95% CI 1.080-3.992, P=0.029) were independent risk factors for DFS. Mammilla invasion (HR=1.951, 95% CI 1.054-3.609, P=0.033) was an independent risk factor for OS. The DFS (χ2=6.541, P=0.011) and OS (χ2=6.455, P=0.012) in patients with mammilla invasion who did not receive radiotherapy were significantly lower than those of patients who received radiotherapy. Conclusion As a special type of breast cancer, mammilla invasion indicates a poor prognosis. The prognosis of patients with >50% IMPC was worse than that of patients with ≤ 50% IMPC. Postoperative adjuvant radiotherapy may provide survival benefit to patients with IMPC accounting for 50% or mammilla invasion. -
Key words:
- breast carcinoma /
- invasive micropapillary carcinoma /
- prognosis /
- radiotherapy
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表 1 246例乳腺IMPC患者的单因素分析
表 2 乳腺IMPC患者Cox比例风险回归模型多因素分析
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