Department of Breast Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, 200090, China.
Department of Breast Surgery, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, 200040, China.
Breast Cancer. 2021 Jul;28(4):848-858. doi: 10.1007/s12282-021-01222-3. Epub 2021 Feb 12.
To summarize the clinicopathological characteristics, prognosis, and management of breast adenosquamous carcinoma (ASC).
A population-based study was performed using retrospectively extracted data from the Surveillance, Epidemiology, and End Results database for breast cancer patients with histological diagnoses of ASC, infiltrating duct carcinoma (IDC) and squamous cell carcinoma (SCC) from 2004 to 2016.
ASC presented similar tumor size but low histological grade and less lymph node metastasis compared to IDC. ASC expressed less positive rate of hormone receptors and barely HER2, which was similar with SCC. ASC patients underwent the similar surgical and systematic treatment as IDC, only with less radiotherapy. Median follow-up data of 78 months showed that the prognosis of IDC patients was better than that of ASC patients (all p < 0.05 for BCSM and OS). ASC was not an independent prognosis factor of breast cancer. After propensity score matching (PSM), no significant difference in BCSM nor OS was observed between ASC and IDC groups. In HR-negative patients, the prognosis of ASC was similar with that of IDC, and both were superior to SCC. In HR-positive patients, the 5-year survival rate of ASC was 63.5%, which was far less than that in ASC of HR-negative (81.0%). Multivariate analysis showed that older age (age > 60) and advanced AJCC-stage were independent factors of poor prognosis in ASC, breast-conserving surgery was also ideally suited for ASC.
ASC has unique clinicopathological characteristics and prognosis. It is imperative to focus on a more precise and personalized treatment management of ASC patients.
总结乳腺腺鳞癌（ASC）的临床病理特征、预后和治疗方法。
采用回顾性研究方法，从 2004 年至 2016 年，从监测、流行病学和最终结果（SEER）数据库中提取乳腺 ASC、浸润性导管癌（IDC）和鳞状细胞癌（SCC）患者的组织学诊断数据。
与 IDC 相比，ASC 表现出相似的肿瘤大小，但组织学分级较低，淋巴结转移较少。ASC 表达的激素受体阳性率较低，几乎没有 HER2，与 SCC 相似。ASC 患者接受的手术和系统治疗与 IDC 相似，仅放疗较少。中位随访 78 个月的数据显示，IDC 患者的预后优于 ASC 患者（所有 BCSM 和 OS 的 p 值均 < 0.05）。ASC 不是乳腺癌的独立预后因素。经过倾向评分匹配（PSM）后，ASC 和 IDC 组在 BCSM 和 OS 方面无显著差异。在 HR 阴性患者中，ASC 的预后与 IDC 相似，均优于 SCC。在 HR 阳性患者中，ASC 的 5 年生存率为 63.5%，远低于 HR 阴性的 ASC（81.0%）。多因素分析显示，年龄较大（年龄 > 60 岁）和 AJCC 晚期是 ASC 预后不良的独立因素，保乳手术也非常适合 ASC。
ASC 具有独特的临床病理特征和预后。有必要针对 ASC 患者进行更精确和个性化的治疗管理。
