Hua B, Lu X, Xiao W Z, He S R, Wang Z
Breast Center, Beijing Hospital, National Center of Gerontology, Beijing 100730, China.
Zhonghua Wai Ke Za Zhi. 2017 Oct 1;55(10):770-774. doi: 10.3760/cma.j.issn.0529-5815.2017.10.011.
To analyze the differences of clinicopathological characters and prognostic factors between invasive micropapillary carcinoma of the breast (IMPC) and invasive ductal carcinoma (IDC) not otherwise specified of the breast. Patients who were treated from June 2008 to April 2016 in Breast Center of Beijing Hospital were retrospectively analyzed to evaluate the differences between IMPC (=59) and IDC (=1 080). Follow-up was done every 3 to 6 months postoperatively with a deadline of July 31, 2016. The curves of disease free survival (DFS) and overall survival (OS) were drawn by Kaplan-Meier method, and survival rates were compared by means of the Log-rank test. Potential prognostic variables which were identified on univariate analysis were analyzed with Cox's proportional hazards regression model for multivariate analysis. More lymph nodes were involved in IMPC group (χ(2)=12.168, =0.007) which led to more later stage in this group (χ(2)=8.950, =0.011). IMPC group displayed a significantly increased rate of lymphovascular invasion (LVI) compared to IDC group (χ(2)=13.511, = 0.001). The expression rate of estrogen receptor (ER) and progesterone receptor (PR) was higher in IMPC group than that in IDC group (89.8% . 76.3% and 88.1% . 70.7%, respectively, χ(2)=5.786, 8.332, all <0.05). In multivariate analysis performed with the variables found significant in univariate analysis, the only variable found significantly affecting DFS of IMPC group was the T stage (T1-2 and T3-4, =5.217, 95%: 1.401 to 19.430, =0.014), while in IDC group, pathological stage (stage Ⅰ to Ⅱ and stage Ⅲ to Ⅳ, =1.870, 95% : 1.262 to 2.771, =0.002), lymph node positive ratio (LNR) (=2.222, 95%: 1.561 to 3.162, =0.000), PR (=1.856, 95% 1.118 to 3.082, =0.017), and age (<50 years old and ≥50 years old, =0.695, 95% 0.488 to 0.989, =0.043) were prognostic factors. There were two variables found significantly affecting OS of IMPC group, which were T stage (=3.713, 95% 1.539 to 8.959, =0.004) and LNR (=2.850, 95%: 1.033 to 7.862, =0.043). While in IDC group, LNR was the only variable found significantly affecting OS (=2.129, 95% 1.324 to 3.425, =0.002). Compared with IDC, the patients with IMPC were more likely to have local or regional recurrence (=0.006). Although the median DFS interval was longer in IDC group (χ(2)=9.739, =0.002), the median OS interval was comparable between the two groups (χ(2)=0.787, =0.375). Although IMPC has lymphotropic feature, tendency of LVI and local or regional recurrence, it has an OS which is comparable with IDC.
分析乳腺浸润性微乳头状癌（IMPC）与乳腺非特殊类型浸润性导管癌（IDC）的临床病理特征及预后因素的差异。回顾性分析2008年6月至2016年4月在北京医院乳腺中心接受治疗的患者，以评估IMPC组（n = 59）和IDC组（n = 1080）之间的差异。术后每3至6个月进行随访，截止日期为2016年7月31日。采用Kaplan-Meier法绘制无病生存（DFS）曲线和总生存（OS）曲线，并通过Log-rank检验比较生存率。对单因素分析中确定的潜在预后变量，采用Cox比例风险回归模型进行多因素分析。IMPC组有更多淋巴结受累（χ² = 12.168，P = 0.007），导致该组更多处于晚期（χ² = 8.950，P = 0.011）。与IDC组相比，IMPC组的淋巴管侵犯（LVI）率显著增加（χ² = 13.511，P = 0.001）。IMPC组雌激素受体（ER）和孕激素受体（PR）的表达率高于IDC组（分别为89.8%、76.3%和88.1%、70.7%，χ² = 5.786、8.332，均<0.05）。在对单因素分析中发现有意义的变量进行多因素分析时，发现唯一显著影响IMPC组DFS的变量是T分期（T1-2和T3-4，P = 5.217，95%CI：1.401至19.430，P = 0.014），而在IDC组中，病理分期（Ⅰ至Ⅱ期和Ⅲ至Ⅳ期，P = 1.870，95%CI：1.262至2.771，P = 0.002）、淋巴结阳性率（LNR）（P = 2.222，95%CI：1.561至3.162，P = 0.000）、PR（P = 1.856，95%CI：1.118至3.082，P = 0.017）和年龄（<50岁和≥50岁，P = 0.695，95%CI：0.488至0.989，P = 0.043）是预后因素。发现有两个变量显著影响IMPC组的OS，即T分期（P = 3.713，95%CI：1.539至8.959，P = 0.004）和LNR（P = 2.850，95%CI：1.033至7.862，P = 0.043）。而在IDC组中，LNR是唯一显著影响OS的变量（P = 2.129，95%CI：1.324至3.425，P = 0.002）。与IDC相比，IMPC患者更易发生局部或区域复发（P = 0.006）。尽管IDC组的中位DFS间隔更长（χ² = 9.739，P = 0.002），但两组的中位OS间隔相当（χ² = 0.787，P = 0.375）。尽管IMPC具有嗜淋巴性特征、LVI倾向以及局部或区域复发倾向，但其OS与IDC相当。
