Si Jing, Guo Rong, Pan Huan, Lu Xiang, Guo Zhiqin, Han Chao, Xue Li, Xing Dan, Wu Wanxin, Chen Caiping
Department of Breast Disease, The First Hospital of Jiaxing & The Affiliated Hospital of Jiaxing University, Jiaxing, China.
Cancer Research Center, The First Hospital of Jiaxing & The Affiliated Hospital of Jiaxing University, Jiaxing, China.
Front Oncol. 2020 Dec 3;10:607502. doi: 10.3389/fonc.2020.607502. eCollection 2020.
Ductal carcinoma with microinvasion (DCISM) was defined as one or more foci of invasion beyond the basement membrane within 1 mm. The size of primary lesion is associated with axillary status and prognosis in patients with invasive breast cancer; thus, it is of interest to determine whether multiple foci of microinvasion are associated with a higher risk of positive axillary status or worse long-term outcomes in patients with DCISM.
This study identified 359 patients with DCISM who had undergone axillary evaluation at our institute from January 2006 to December 2015. Patients were categorized as one focus or multiple foci (≥2 foci) according to the pathological results. Clinicopathological features, axillary status, and disease-free survival rate were obtained and analyzed.
Of 359 patients, 233 (64.90%) had one focus of microinvasion and 126 (35.10%) had multiple foci. Overall, 242 (67.41%) and 117 (32.59%) patients underwent sentinel lymph nodes biopsy (SLNB) and axillary lymph nodes dissection (ALND), respectively. Isolated tumor cells were found in four (1.11%) patients and axillary metastasis rate was 2.51%. Neither axillary evaluation methods ( = 0.244) nor axillary metastasis rate ( = 0.559) was significantly different between patients with one focus and multiple foci. In univariate analysis, patients with multiple foci tended to have larger tumor size ( < 0.001), higher nuclear grade ( = 0.001), and higher rate of lymphatic vascular invasion ( = 0.034). Also, the proportion of positive HER2 ( = 0.027) and Ki67 level ( = 0.004) increased in patients with multiple foci, while in multivariate analysis, only tumor size showed significant difference ( = 0.009). Patients with multiple foci were more likely to receive chemotherapy (56.35 40.77%; = 0.028). At median 5.11 years follow-up, overall survival rate was 99.36%. Patients with multiple microinvasive foci had worse disease-free survival rate compared with one-focus patients (98.29 93.01%, = 0.032).
Even though the numbers of microinvasion were different and patients with multiple foci of microinvasion tended to have larger tumor size, there was no higher risk of axillary involvement compared with patients with one focus of microinvasion, while patients with multiple microinvasive foci had worse DFS rate. Thus, DCISM patients with multiple foci of microinvasion may be the criterion for more aggressive local-regional treatment. Optimization of adjuvant therapy in DCISM patients is required.
微浸润性导管癌（DCISM）被定义为基底膜外1毫米内有一个或多个浸润灶。原发性病变的大小与浸润性乳腺癌患者的腋窝状态及预后相关；因此，确定微浸润多灶是否与DCISM患者腋窝阳性状态风险更高或长期预后更差相关具有重要意义。
本研究纳入了2006年1月至2015年12月在我院接受腋窝评估的359例DCISM患者。根据病理结果将患者分为单灶或多灶（≥2个病灶）。获取并分析临床病理特征、腋窝状态及无病生存率。
359例患者中，233例（64.90%）有一个微浸润灶，126例（35.10%）有多灶。总体而言，分别有242例（67.41%）和117例（32.59%）患者接受了前哨淋巴结活检（SLNB）和腋窝淋巴结清扫（ALND）。4例（1.11%）患者发现孤立肿瘤细胞，腋窝转移率为2.51%。单灶和多灶患者的腋窝评估方法（P = 0.244）及腋窝转移率（P = 0.559）均无显著差异。单因素分析中，多灶患者肿瘤往往更大（P < 0.001）、核分级更高（P = 0.001）、淋巴管侵犯率更高（P = 0.034）。此外，多灶患者中HER2阳性比例（P = 0.027）和Ki67水平（P = 0.004）升高，而多因素分析中仅肿瘤大小有显著差异（P = 0.009）。多灶患者更可能接受化疗（56.35%对40.77%；P = 0.028）。中位随访5.11年时，总生存率为99.36%。与单灶患者相比，微浸润多灶患者的无病生存率更差（98.29%对93.01%，P = 0.032）。
尽管微浸润灶数量不同，且微浸润多灶患者肿瘤往往更大，但与单灶微浸润患者相比，腋窝受累风险并未更高，而微浸润多灶患者的无病生存率更差。因此，微浸润多灶的DCISM患者可能是更积极的局部区域治疗的标准。DCISM患者的辅助治疗需要优化。
