Department of Surgery, University of California Davis, Davis, CA, USA.
Med Oncol. 2011 Sep;28(3):738-44. doi: 10.1007/s12032-010-9526-z.
Prognostic factors specific to medullary carcinoma of the breast (MCB) are unknown. Our objective was to identify patient and tumor factors predictive of overall survival (OS) in a large cohort of MCB patients. The Surveillance, Epidemiology, and End Results database was used to identify patients with MCB diagnosed from 1988 to 2004. Patient, tumor, and treatment factors were compared by univariate analysis via the Kaplan–Meier method and survival differences detected using the log-rank test. A multivariate Cox proportional hazards model controlled for patient age, race, type of surgery, radiotherapy, tumor size, number of lymph node metastases (LNM), lymph node yield (LNY), estrogen receptor (ER) and progesterone receptor (PR) status, and extent of disease. On univariate analysis of 3,348 patients, factors influencing OS included age, race, tumor size, ER status, type of surgery, radiotherapy, LNM, LNY, and extent of disease (P<0.001). On multivariate analysis, advancing age (P<0.001), black race (P<0.001), regional metastases (P<0.001), distant metastases (P<0.001), increasing tumor size (P<0.001), ER positivity (P=0.003), and increasing LNM (P<0.001) were associated with decreased OS. An OS benefit was seen in PR-positive patients (P=0.002) and in those with increasing LNY (P<0.001). Even among node-negative patients, increasing LNY was associated with improved OS (P<0.001). Tumor size, LNM, regional and distant metastases, PR status, age, and race are important prognostic factors in MCB. ER positivity was associated with decreased OS, which may reflect inaccuracy in diagnosing MCB or a significant biologic variant. The improved OS seen with increasing LNY in node-negative patients suggests MCB may be currently understaged.
乳腺髓样癌（MCB）的特定预后因素尚不清楚。我们的目的是在大量 MCB 患者中确定预测总生存（OS）的患者和肿瘤因素。使用监测、流行病学和最终结果数据库来确定 1988 年至 2004 年间诊断为 MCB 的患者。通过 Kaplan-Meier 方法进行单变量分析比较患者、肿瘤和治疗因素，并使用对数秩检验检测生存差异。多变量 Cox 比例风险模型控制了患者年龄、种族、手术类型、放疗、肿瘤大小、淋巴结转移（LNM）数量、淋巴结收获量（LNY）、雌激素受体（ER）和孕激素受体（PR）状态以及疾病程度。在对 3348 例患者的单因素分析中，影响 OS 的因素包括年龄、种族、肿瘤大小、ER 状态、手术类型、放疗、LNM、LNY 和疾病程度（P<0.001）。多因素分析显示，年龄增长（P<0.001）、黑种人（P<0.001）、区域转移（P<0.001）、远处转移（P<0.001）、肿瘤大小增加（P<0.001）、ER 阳性（P=0.003）和 LNM 增加（P<0.001）与 OS 降低相关。PR 阳性患者（P=0.002）和 LNY 增加的患者（P<0.001）的 OS 获益。即使在淋巴结阴性的患者中，LNY 的增加也与 OS 的改善相关（P<0.001）。肿瘤大小、LNM、区域和远处转移、PR 状态、年龄和种族是 MCB 的重要预后因素。ER 阳性与 OS 降低相关，这可能反映了 MCB 诊断的不准确性或显著的生物学变异。在淋巴结阴性患者中，LNY 增加与 OS 改善相关，这表明 MCB 目前可能分期不足。
