乳腺浸润性微乳头状癌临床病理特征及其预后分析

摘要

目的:探讨乳腺浸润性微乳头状癌(invasive micropapillary carcinoma,IMPC)的临床病理特征及预后分析.方法:回顾性分析河北医科大学第四医院2009年1月至2011年12月确诊的65例乳腺IMPC患者,采用免疫组织化学法检测上皮膜抗原(ep?ithelial membrane antigen,EMA)表达以确定微乳头成分在肿瘤中所占比例.按微乳头比例≤10%、11%~30%、31%~50%、>50%将患者分为4组,并同时检测ER、PR、HER-2的表达.Kaplan-Meier单因素生存分析中行Log rank检验,采用多因素Cox风险回归模型行生存时间的影响因素分析.结果:65例乳腺IMPC患者中单纯IMPC 12例,IMPC伴浸润性导管癌46例,IMPC伴其他浸润性癌7例.乳腺IMPC中微乳头比例≤10%组为7.69%(5/65)、11%~30%组为44.62%(29/65)、31%~50%组为26.15%(17/65)、>50%组为21.54%(14/65),4组乳腺IMPC患者中淋巴结转移阳性率差异具有统计学意义(P<0.01).免疫组织化学法结果显示, ER、PR和HER-2在乳腺IMPC组织中的阳性率分别为76.92%(50/65)、67.69%(44/65)和24.62%(16/65),差异具有统计学意义(P<0.05).Kaplan-Meier单因素分析显示患者生存时间与淋巴结转移数,微乳头比例,脉管瘤栓,ER、PR、HER-2的表达相关(P<0.05).结论:淋巴结转移数,微乳头比例,脉管瘤栓,ER、PR及HER-2的表达均与乳腺IMPC的预后相关.%Objective:To investigate the clinicopathological characteristics and prognosis of invasive micropapillary carcinoma (IMPC) of the breast. Methods:Data of 65 IMPC cases obtained from the Fourth Hospital of Hebei Medical University between Janu-ary 2009 and December 2011 were retrospectively analyzed. The expression of epithelial membrane antigen (EMA) was evaluated us-ing immunohistochemistry (IHC) to detect the micropapillary component in the tumor. The patients were divided into 4 groups based on the percentage of micropapillary component:≤10%, 11%-30%, 31%-50%, and>50%. Expressions of estrogen receptor (ER), pro-gesterone receptor (PR), and HER-2 were analyzed by IHC. Kaplan-Meier method, Log rank test, and multivariate Cox proportional hazard model were used to determine the factors affecting post-treatment survival. Results:Of the 65 cases, 12 were simple IMPC, 46 were IMPC with invasive ductal carcinoma, and 7 were other invasive carcinoma cases. The≤10%, 11%-30%, 31%-50%, and>50%micropapillary component groups comprised 7.69%(5/65), 44.62%(29/65), 26.15%(17/65), and 21.54%(14/65) of the total cases, re-spectively. Statistically significant differences were found in the four groups (P<0.01). IHC results showed that the positive rates of ER, PR, and HER-2 in the IMPC tissues were 76.92%(50/65), 67.69%(44/65), and 24.62%(16/65), respectively. Statistical differences ex-isted among the groups (P<0.05). Kaplan-Meier method indicated that positive rate of lymph node metastasis, the proportion of IMPC, vascular invasion, and the expression of ER, PR, and HER-2 significantly affect survival time of IMPC cases (P<0.05). Conclusion:Positive rate of nodal metastasis, the proportion of IMPC, vascular invasion, and the expression of ER, PR, and HER-2 are correlated with the prognosis of IMPC.