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混合性浸润性导管癌和小叶癌具有不同的临床特征,且根据雌激素受体状态分层时预测预后更差。

Mixed invasive ductal and lobular carcinoma has distinct clinical features and predicts worse prognosis when stratified by estrogen receptor status.

机构信息

Department of Breast Surgery, Fudan University Shanghai Cancer Center; Cancer Institute, Fudan University Shanghai Cancer Center, 270 Dong-an Road, Shanghai, 200032, People's Republic of China.

Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China.

出版信息

Sci Rep. 2017 Sep 4;7(1):10380. doi: 10.1038/s41598-017-10789-x.

Abstract

In order to investigate clinicopathological characteristics and prognosis of mixed invasive ductal and lobular carcinoma (IDC-L), 209,109 primary breast cancer patients diagnosed with invasive ductal carcinoma (IDC), invasive lobular carcinoma (ILC) or IDC-L were included. It was found that IDC-L patients had lower tumor grade and higher hormone receptor positive proportions than IDC patients. Moreover, IDC-L patients were younger and had a similar hormone receptor status compared with ILC patients. Kaplan-Meier plots showed that the breast cancer-specific survival (BCSS) of IDC-L patients was significantly better than IDC patients (P < 0.001) and tended to be better than ILC patients (P = 0.166). However, after adjusting for clinicopathological factors, survival advantage of IDC-L disappeared. Subgroup analysis indicated that IDC-L had higher hazard ratios (HRs) than IDC in grade 1, grade 2, ER-positive and ER-negative subgroups. Survival analysis in ER-positive and ER-negative subgroups showed that IDC-L predicted a worse prognosis than IDC. In conclusion, IDC-L is a distinct histological subtype compared with IDC and ILC. Lower grade and higher ER-positive proportions mainly contribute to its better prognosis. In both ER-positive and ER-negative subgroups, IDC-L predicts worse prognosis than IDC, which suggested the inadequacy of IDC-based therapy and the need of escalated therapy.

摘要

为了研究混合性浸润性导管癌和浸润性小叶癌(IDC-L)的临床病理特征和预后,纳入了 209109 例经组织学诊断为浸润性导管癌(IDC)、浸润性小叶癌(ILC)或 IDC-L 的原发性乳腺癌患者。研究发现,IDC-L 患者的肿瘤分级较低,激素受体阳性比例较高。此外,IDC-L 患者比 ILC 患者更年轻,且激素受体状态相似。Kaplan-Meier 生存曲线表明,IDC-L 患者的乳腺癌特异性生存率(BCSS)明显优于 IDC 患者(P<0.001),且倾向于优于 ILC 患者(P=0.166)。然而,在校正临床病理因素后,IDC-L 的生存优势消失。亚组分析表明,在肿瘤分级 1 级、2 级、ER 阳性和 ER 阴性亚组中,IDC-L 的风险比(HR)高于 IDC。在 ER 阳性和 ER 阴性亚组的生存分析中,IDC-L 预示着比 IDC 更差的预后。总之,IDC-L 是一种与 IDC 和 ILC 不同的组织学亚型。较低的分级和较高的 ER 阳性比例主要导致其较好的预后。在 ER 阳性和 ER 阴性亚组中,IDC-L 预示着比 IDC 更差的预后,这表明基于 IDC 的治疗方法不足,需要采用强化治疗。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5f07/5583173/e3940594601c/41598_2017_10789_Fig1_HTML.jpg

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