乳腺浸润性微乳头状癌与浸润性癌(非特殊型)腋窝淋巴结转移相关因素的病例对照研究

张燕娜; 王常珺; 周易冬; 茅枫; 孙强; 毕娅兰; 梁智勇

doi:10.3969/j.issn.1674-9081.2015.03.002

乳腺浸润性微乳头状癌与浸润性癌(非特殊型)腋窝淋巴结转移相关因素的病例对照研究

Axillary Lymph Node Metastasis of Invasive Micropapillary Carcinoma and Invasive Carcinoma of No Special Type: A Case-control Study

摘要

摘要:
目的探讨乳腺浸润性微乳头状癌(invasive micropapillary carcinoma, IMPC)和浸润性癌(非特殊型)(invasive carcinoma of no special type, NST)的临床病理特征差异及其与腋窝淋巴结转移的相关性。
方法回顾性分析2010年8月至2013年8月北京协和医院92例IMPC手术患者的临床病理资料, 随机选取368例同期手术的NST患者作为对照组。比较IMPC和NST的临床病理特征并分析其腋窝淋巴结转移的影响因素。
结果 IMPC与NST在肿瘤大小(2.9±1.9)cm比(2.1±1.4)cm, P=0.001、脉管浸润率(85.9%比6.0%, P < 0.001)、腋窝淋巴结转移率(71.7%比47.3%, P < 0.001)及转移个数(8.2±9.9比2.9±5.7, P < 0.001)、孕激素受体表达(P=0.047)、人类表皮生长因子受体2(human epidermal growth factor receptor-2, HER-2)表达(P=0.009)、Ki-67指数(P < 0.001)以及TNM分期(P < 0.001)、分子分型(P < 0.001)方面的差异均具有统计学意义。肿瘤组织中IMPC成分≤ 24%、25%~49%、50%~75%以及≥ 76%者淋巴结转移率分别为73.9%、56.3%、72.2%和77.1%, IMPC的腋窝淋巴结转移率与其在肿瘤中所占比例无关(P=0.347), 与肿瘤T分期(P=0.001)、HER-2表达(P=0.029)、分子分型(P=0.003)、P53表达(P=0.003)以及Ki-67指数(P=0.045)相关。NST的腋窝淋巴结转移与肿瘤T分期(P < 0.001)、组织学分级(P=0.001)、脉管浸润(P < 0.001)、雌激素受体α(P=0.007)、孕激素受体(P=0.031)、HER-2表达(P=0.008)及分子分型(P < 0.001)均相关。
结论 IMPC是一种具有高脉管侵袭性、高腋窝淋巴结转移率的浸润性乳腺癌, 具有与NST不同的病理特征。IMPC成分的多少并不影响腋窝淋巴结转移的程度, 其腋窝淋巴结转移的影响因素明显少于NST。

Abstract:
Objective To explore the difference in clinicopathological characteristics between invasive micropapillary carcinoma (IMPC) and invasive carcinoma of no special type (NST), and analyze its association with axillary lymph node metastasis.
Methods The clinicopathological data of 92 IMPC cases treated within the period from August 2010 to August 2013 in Peking Union Medical College Hospital were retrospectively analyzed. From patients in the same period, 368 NST cases were randomly selected as control group. The difference in clinicopathological characteristics between IMPC and NST were compared, and the factors associated with axillary lymph node metastasis were analyzed.
Results There were significant differences in tumor size(2.9±1.9)cm vs. (2.1±1.4)cm, P=0.001, lymph-vascular invasion rate(85.9% vs. 6.0%, P < 0.001), axillary lymph node metastatic rate (71.7% vs. 47.3%, P < 0.001), number of involved lymph node(8.2±9.9 vs. 2.9±5.7, P < 0.001), progestogen receptor expression (P=0.047), human epidermal growth factor receptor-2 (HER-2) expression (P=0.009), Ki-67 index (P < 0.001), TNM staging (P < 0.001), and molecular subtype (P < 0.001) between IMPC and NST. The axillary lymph node metastatic rates of tumor containing ≤ 24%, 25%-49%, 50%-75% and ≥ 76% IMPC component were 73.9%, 56.3%, 72.2% and 77.1%, respectively. The axillary lymph node metastatic rate was not correlated with the percentage of IMPC component (P=0.347), but correlated with T-staging(P=0.001), HER-2 expression (P=0.029), molecular subtype (P=0.003), P53 expression(P=0.003), and Ki-67 index (P=0.045). The axillary lymph node metastasis of NST was found correlated with T-staging(P < 0.001), histological grade (P=0.001), lymph-vascular invasion (P < 0.001), estrogen receptor α expression (P=0.007), progestogen receptor expression (P=0.031), HER-2 expression (P=0.008), and molecular subtype (P < 0.001).
Conclusions IMPC is a distinct variant of invasive breast carcinoma with a high propensity for lymph-vascular invasion and axillary lymph node involvement. IMPC and NST have different clinicopathological characteristics. The percentage of IMPC component does not correlate with axillary lymph node metastasis. Compared with NST, there are less clinicopathological determinants for axillary lymph node metastasis in IMPC.

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