【作者】 陈凌； 范宇； 郎荣刚； 郭晓静； 孙玉兰； 付丽；

【机构】 天津医科大学附属肿瘤医院乳腺病理研究室；

【摘要】 目的:研究浸润性微乳头状癌的临床病理特征及其与预后间的关系。方法:回顾性复习天津医科大学附属肿瘤医院1989年～2002年间乳腺癌手术切除病例,按2003年 WHO乳腺组织病理学分类形态学标准诊断IMPC。观察并分析浸润性微乳头状癌的临床病理学特征及其随访资料。纯型IMPC与混合型IMPC临床病理资料的比较用x2检验及独立样本t检验,Kaplan—Meier单因素生存分析及Cox回归模型多因素生存分析临床病理学特征与预后的关系。结果:共诊断IMPC100例(其中纯型22例,混合型78例), 占同期乳腺癌的1．3％。84例(84％)伴腋下淋巴结转移,其中纯型19例,混合型65例。淋巴结转移数平均13．7±14． 1个(0～55个),其中纯型平均18．2±15．8个(0～55个),混合型12．4±13．4个(0～54个)。69例(69％)有不同程度的淋巴管侵犯,其中纯型18例,混合型51例,有完整随访资料的98例IMPC(平均60．1个月)随访结果显示,11例(11． 2％)术后平均26．4月(4～85月)局部复发,其中纯型3例 (平均51月,16～85月),混合型8例(平均17．1月,4～67月), 38例(38．8%)术后平均36．0月(0月～90月)发生远处转移, 其中纯型14例(平均35．9月．0～90月),混合型24例(平均 36．0月,0～86月)。36例(36．7％)因肿瘤的复发转移而死亡,2例因心脑血管疾病死亡,平均生存42．6月,其中纯型死亡14例,平均生存61．3月,混合型死亡22例,平均生存59．7月。经统计纯型与混合型相比更易发生远处转移(P =0．00 5),但两者在最早发生转移的时间方面无差别。 IMPC术后5年生存率59％,10年生存率48％,单因素生存分析发现IMPC患者的生存与家族史(P=0．017)、临床分期(P=0．002)、病理学分期(P=0．000)、IMPC成分所占比例(P=0．020)、淋巴管侵犯(P=0.008)有关,且经化疗及内分泌治疗的患者其预后明显好于未治疗的患者 (P=0．045,P=0．037),多因素生存分析结果显示IMPC患者死亡风险与年龄、淋巴管侵犯、及病理学分期呈正比例(P =0．001,P=0．034,P=0．000)。结论:IMPC是一种预后极差的乳腺恶性肿瘤,其生物学行为与IMPC所占比例有关,纯型IMPC预后较混合型差,另外患者的预后还与年龄、淋巴管侵犯及病理学分期有关。个体性化疗及内分泌治疗可能是提高生存率的有效方法。更多还原

【Abstract】 Objective: To investigate the relationship between the clinicopathologic characteristics of invasive micropapillary carcinoma of breast (IMPC) and the prognosis. Methods: 100 cases invasive micropapillary carcinomas of the breast from 1989 - 2002 in Tianjin Medical University Cancer Hospital were identified by retrospective review. It was diagnosised according World Health Organization classification of breast tumors pressed in 2003. The clinicopathologic features and the follow-up of IMPC were analyzed. The clinicopathologic features of pure-IMPC and mix-IMPC were compared by x 2 Test and Independent- Samples T Test. Kaplan-Meier and Cox’s regression model for survival analysis were used. Results: 100 cases IMPC were diagnosed and classified pure-IMPC (22 cases) and mix-IMPC (78 cases), incidence of IMPC is 13% in our study. Incidence of nodal metastases was 84%(84/100), pure-IMPC was 19 cases and mix-IMPC was 65 cases, as well as the number of metastatic node was on average 13.7 ± 14.1(0 - 55), pure-IMPC and mix-IMPC were on average 18.2 ± 15.8 and 12.4 ± 13.4, respectively. The incidence of lymphovascular invasion was 69% (69/100), pure-IMPC was 18 cases and mix-IMPC was 51 cases. Follow-up was available in 98 patients (mean follow-up 60.1 months). 11 patients (11.2%) had local recurrences within mean 26.4m post-operation, of all pure-IMPC was 3 cases (mean interval to recurrences 51m), mix-IMPC was 8 cases (mean 17.1m). 38 patients (38.8%) had distant metastases within mean 36.0m post-operation, of all pure-IMPC was 14 cases (mean interval to distant metastases 35.9m), mix-IMPC was 8 cases (mean 36.0m). 36 patients (36.7%) died of aggravation of IMPC (mean interval to death 42.6m), of all pure-IMPC was 14 cases (mean interval to death 61.3m), mix-IMPC was 22 cases (mean interval to death 59.7). It was easier for pure-IMPC to distant metastases compared with mix-IMPC (P = 0. 005),but it had no significant difference in mean interval to distant metastases. Univariate analysis showed that survival of IMPC patients was related to family history (P=0. 017), clinical group (P = 0.002), pathological group (P = 0.000), proportion of IMPC component (P = 0.020), lymphovascular invasion (P = 0.008), moreover the survival of patients treated by chemotherapy and endocrine therapy was longer than the patients without treated significantly (P=0.045, P=0.037). Multivariate analyses showed that the risk of death was positive correlated with age, lymphovascular invasion and pathological group. Conclusion: IMPC is a kind of carcinoma having very poor prognosis, biologic behavior is related with proportion of IMPC component, and the prognosis of pure-IMPC is poorer than mix-IMPC, in addition prognosis is related with age, lymphovascular invasion and pathological group. Individual chemotherapy and endocrine therapy may be the effective way to improve the survival rate.更多还原