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乳腺原发性神经内分泌癌与浸润性癌(非特殊型)临床病理特点和淋巴结转移相关因素的病例对照研究

彭理 赵佳琳 赵大春 张震 茅枫 孙强

彭理, 赵佳琳, 赵大春, 张震, 茅枫, 孙强. 乳腺原发性神经内分泌癌与浸润性癌(非特殊型)临床病理特点和淋巴结转移相关因素的病例对照研究[J]. 协和医学杂志, 2021, 12(1): 122-128. doi: 10.12290/xhyxzz.20190108
引用本文: 彭理, 赵佳琳, 赵大春, 张震, 茅枫, 孙强. 乳腺原发性神经内分泌癌与浸润性癌(非特殊型)临床病理特点和淋巴结转移相关因素的病例对照研究[J]. 协和医学杂志, 2021, 12(1): 122-128. doi: 10.12290/xhyxzz.20190108
PENG Li, ZHAO Jia-lin, ZHAO Da-chun, ZHANG Zhen, MAO Feng, SUN Qiang. Clinicopathological Features and Lymph Node Metastasis-related Factors of Primary Neuroendocrine Breast Cancer and Invasive Breast Cancer of Nonspecial Type: A Case-control Study[J]. Medical Journal of Peking Union Medical College Hospital, 2021, 12(1): 122-128. doi: 10.12290/xhyxzz.20190108
Citation: PENG Li, ZHAO Jia-lin, ZHAO Da-chun, ZHANG Zhen, MAO Feng, SUN Qiang. Clinicopathological Features and Lymph Node Metastasis-related Factors of Primary Neuroendocrine Breast Cancer and Invasive Breast Cancer of Nonspecial Type: A Case-control Study[J]. Medical Journal of Peking Union Medical College Hospital, 2021, 12(1): 122-128. doi: 10.12290/xhyxzz.20190108

乳腺原发性神经内分泌癌与浸润性癌(非特殊型)临床病理特点和淋巴结转移相关因素的病例对照研究

doi: 10.12290/xhyxzz.20190108
详细信息
    通讯作者:

    孙强 电话:010-69158721, E-mail: sunqiangpumc@sina.com

  • 中图分类号: R-1; R394; R737.9

Clinicopathological Features and Lymph Node Metastasis-related Factors of Primary Neuroendocrine Breast Cancer and Invasive Breast Cancer of Nonspecial Type: A Case-control Study

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  • 摘要:   目的  探讨原发性乳腺神经内分泌癌(primary neuroendocrine breast carcinoma, pNEBC)的临床病理特点以及淋巴结转移相关影响因素,为pNEBC的治疗及预后评价提供依据。  方法  回顾性选取2004年11月至2016年10月于北京协和医院乳腺外科手术治疗并诊断为pNEBC的患者为研究组(pNEBC组),1:4配对同期手术并诊断为乳腺浸润性癌(非特殊型)(invasive carcinoma of no special type,NST)的患者为对照组(NST组),比较两组患者的临床病理特点及淋巴结转移相关影响因素。  结果  共50例符合纳入和排除标准的pNEBC患者入选本研究,按照1:4配对原则入选同期NST患者200例。两组患者年龄、瘤体直径、组织学分级、淋巴结清扫数目及TNM分期均无统计学差异(P均>0.05)。pNEBC组淋巴结转移15例(30.0%,15/50);雌激素受体(estrogen receptor,ER)阳性表达率为96.0%(48/50),孕激素受体(progesterone receptor,PR)阳性表达率为84.0%(42/50),人表皮生长因子受体2(human epidermal growth factor receptor-2,Her-2)阳性表达率为10.4%(5/48),嗜铬素A阳性表达率为58.0%(29/50),突触素阳性表达率为97.9%(47/48)。对于影响淋巴结转移的相关因素,组织学分级、ER表达、PR表达、Her-2表达、Ki-67指数、分子分型差异在两组中均无统计学意义(P均>0.05),T分期在NST组患者中存在显著差异(P=0.006),在pNEBC组中无显著差异(P=0.872)。  结论  pNEBC患者ER、PR阳性表达率高,Her-2阳性表达率低,突触素阳性表达率较嗜铬素A高,其生物学行为尚需进一步研究,联合检测上述免疫组化指标并结合淋巴结状况,可能有助于pNEBC的预后评估。
    利益冲突  无
  • 图  1  乳腺原发性神经内分泌癌的镜下表现(×150)

    A.HE染色可见大量癌细胞,呈管状及小梁状结构;B.免疫组化染色ER,肿瘤细胞呈强阳性;C.免疫组化染色PR,肿瘤细胞中度阳性;D.免疫组化染色Her-2,肿瘤细胞无明显着色;E.免疫组化染色嗜铬素A,肿瘤细胞弥漫阳性;F.免疫组化染色突触素,肿瘤细胞弥漫阳性

    图  2  pNEBC组与NST组总生存率(A)和无病生存率(B)比较pNEBC、NST:同表 1

    表  1  pNEBC组与NST组患者临床特征比较*

    临床特征 pNEBC组(n=50) NST组(n=200) P
    年龄(x±s,岁) 56.4±13.7 54.9±12.8 0.453
    肿瘤最大直径[n(%)] 0.141
      ≤2 cm 29(59.2) 137(68.8)
      >2~5 cm 18(36.7) 60(30.2)
      >5 cm 2(4.1) 2(1.0)
    组织学分级[n(%)] 0.013
      Ⅰ 14(35.0) 27(15.0)
      Ⅱ 17(42.5) 95(52.8)
      Ⅲ 9(22.5) 58(32.2)
    淋巴结清扫数目(x±s,个) 18.61±9.66 16.71±9.36 0.249
    淋巴结转移数目[n(%)] 0.869
      0 26(63.4) 106(65.0)
      1~3个 8(19.5) 27(16.6)
      4~9个 4(9.8) 21(12.9)
      ≥10个 3(7.3) 9(5.5)
    TNM分期[n(%)] 0.077
      Ⅰ 14(35.0) 68(41.2)
      Ⅱ 18(45.0) 65(39.4)
      Ⅲ 6(15.0) 32(19.4)
      Ⅳ 2(5.0) 0(0)
    *分组统计中存在部分病例资料缺失,按实际数量进行统计;pNEBC:原发性乳腺神经内分泌癌;NST:乳腺浸润性癌(非特殊型)
    下载: 导出CSV

    表  2  50例pNEBC患者淋巴结转移率影响因素分析*

    指标 淋巴结转移率[%(n/N)] P
    T分期 0.872
      T1 33.3(6/18)
      T2 42.1(8/19)
      T3/ T4 50.0(1/2)
    组织学分级 0.229
      Ⅰ 14.3(2/14)
      Ⅱ 41.2(7/17)
      Ⅲ 22.2(2/9)
    ER表达 1.000
      阳性 35.9(14/39)
      阴性 50.0(1/2)
    PR表达 0.639
      阳性 33.3(11/33)
      阴性 50.0(4/8)
    Her-2表达 0.871
      阳性 44.4(4/9)
      阴性 34.4(11/32)
    Ki-67指数 0.753
      <14% 35.3(6/17)
      ≥14% 40.9(9/22)
    分子分型 0.865
      Luminal A型 30.8(4/13)
      Luminal B型 40.9(9/22)
      三阴性 50.0(1/2)
    *分组统计中存在部分病例信息缺失,按照实际数量进行统计;pNEBC:同表 1;ER:雌激素受体;PR:孕激素受体;Her-2:人表皮生长因子受体2
    下载: 导出CSV

    表  3  200例NST患者淋巴结转移率影响因素分析*

    指标 淋巴结转移率[%(n/N)] P
    T分期 0.006
      T1 25.6(23/90)
      T2 47.1(32/68)
      T3/ T4 66.7(2/3)
    组织学分级 0.098
      Ⅰ 14.8(4/27)
      Ⅱ 30.5(29/95)
      Ⅲ 37.9(22/58)
    ER表达 0.090
      阳性 38.7(48/124)
      阴性 23.7(9/38)
    PR表达 0.381
      阳性 33.3(41/123)
      阴性 41.0(16/39)
    Her-2表达 0.692
      阳性 37.5(9/24)
      阴性 33.3(44/132)
    Ki67指数 0.648
      <14% 31.7(13/41)
      ≥14% 35.7(41/115)
    分子分型 0.908
      Luminal A型 30.8(12/39)
      Luminal B型 37.1(33/89)
      Her-2过表达型 33.3(2/6)
      三阴性 30.0(6/20)
    *分组统计中存在部分病例信息缺失,按照实际数量进行统计;NST:同表 1;ER、PR、Her-2:同表 2
    下载: 导出CSV
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出版历程
  • 收稿日期:  2019-06-14
  • 录用日期:  2019-10-10
  • 网络出版日期:  2020-10-14
  • 刊出日期:  2021-01-30

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