Department of Oral Pathology, Ninth People's Hospital, Shanghai Jiao Tong University, 200011 Shanghai, China.
Hum Pathol. 2011 Aug;42(8):1169-77. doi: 10.1016/j.humpath.2010.11.014. Epub 2011 Feb 21.
Invasive mammary carcinoma with neuroendocrine differentiation has been controversial in terms of its definition and clinical outcome. In 2003, the World Health Organization histologic classification of tumors designated this entity as neuroendocrine carcinoma of the breast and defined mammary neuroendocrine carcinoma as expression of neuroendocrine markers in more than 50% of tumor cells. It is an uncommon neoplasm. Our recent study showed that it is a unique clinicopathologic entity and has a poor clinical outcome compared with invasive mammary carcinoma with similar pathologic stage. Other investigators have also demonstrated a different molecular profile in this type of tumor from that of invasive ductal carcinoma. It is unknown whether the current prognostic markers for invasive mammary carcinoma are also applicable for neuroendocrine carcinoma of the breast. In the current study, we reviewed the clinicopathologic features and outcome data in 74 cases of mammary neuroendocrine carcinoma from the surgical pathology files at The University of Texas, MD Anderson Cancer Center, to identify relevant prognostic markers for this tumor type. As shown previously by univariate analysis, large tumor size, high nuclear grade, and presence of regional lymph node metastasis are adverse prognostic factors for overall survival and distant recurrence-free survival. In the current study, multivariate analysis revealed that overall survival was predicted by tumor size, lymph node status, and proliferation rate as judged by Ki-67 immunohistochemistry. Only nodal status proved to be a significant independent prognostic factor for distant recurrence-free survival. Neither mitosis score nor histologic grade predicted survival in mammary neuroendocrine carcinoma. Our data suggest that routine evaluation of Ki-67 proliferation index in these unusual tumors may provide more valuable information than mitotic count alone.
具有神经内分泌分化的浸润性乳腺癌在其定义和临床结果方面存在争议。2003 年，世界卫生组织肿瘤组织学分类将该实体指定为乳腺神经内分泌癌，并将乳腺神经内分泌癌定义为超过 50%的肿瘤细胞表达神经内分泌标志物。它是一种罕见的肿瘤。我们最近的研究表明，与具有相似病理分期的浸润性乳腺癌相比，它是一种独特的临床病理实体，临床预后较差。其他研究人员还表明，这种肿瘤的分子谱与浸润性导管癌不同。目前尚不清楚浸润性乳腺癌的预后标志物是否也适用于乳腺神经内分泌癌。在本研究中，我们回顾了德克萨斯大学 MD 安德森癌症中心外科病理档案中 74 例乳腺神经内分泌癌的临床病理特征和结果数据，以确定该肿瘤类型的相关预后标志物。如之前的单因素分析所示，肿瘤大小大、核分级高和存在区域淋巴结转移是总生存和远处无复发生存的不良预后因素。在本研究中，多因素分析显示，肿瘤大小、淋巴结状态和 Ki-67 免疫组化判断的增殖率预测总生存。只有淋巴结状态被证明是远处无复发生存的显著独立预后因素。核分裂计数或组织学分级均不能预测乳腺神经内分泌癌的生存。我们的数据表明，在这些不寻常的肿瘤中常规评估 Ki-67 增殖指数可能比单独评估有丝分裂计数提供更有价值的信息。
