乳腺浸润性微乳头状癌的病理特征与其转移、预后的相关性研究

摘要

目的 探讨乳腺浸润性微乳头状癌(MPC)的病理特征与其转移、预后的相关性.方法 回顾性分析47例MPC患者病理资料,对标本进行免疫组化检测,分析病理变化、腋窝淋巴结转移及预后情况.结果 47例MPC患者中,单纯的MPC占44.68％,伴有浸润性导管癌占34.04％,伴有导管原位癌及粘液癌分别占10.64％;MPC在肿瘤中所占比例＜50％者占46.81％,≥50％者占53.19％;免疫组化显示雌激素抗体(ER)、孕激素受体(PR)、p53抑癌基因(p53)、细胞增殖相关抗原(Ki67)、癌基因cerbB2 (cerbB2)阳性率分别为85.11％、80.85％、82.98％、55.32％,Ki67对肿瘤细胞生长指数进行标记显示指数为5％～95％;腋窝淋巴结转移阳性率为93.62％,不同的MPC成分患者及肿瘤直径不同患者淋巴结转移阳性率比较差异无统计学意义(P＞0.05),淋巴结转移个数比较差异具有统计学意义(P＜0.05);术后中位随访时间32个月、1年、2年、3年生存率及无瘤生存率分别为92.68％、87.80％、82.93％和73.17％、78.05％、70.73％;不同的MPC成分患者及肿瘤直径不同患者3年生存率、无瘤生存率比较差异无统计学意义(P＞0.05).结论 MPC具有淋巴转移能力强及转移阳性率高、预后相对较差的特点,高侵袭能力及淋巴结转移、预后与肿瘤自身的大小和MPC成分多少无直接相关性,但对淋巴结转移个数有影响,提示临床医师及病理医师要对这一特征进行关注.%Objective To explore the correlation of pathological characteristics with metastasis,prognosis of invasive micropapillary carcinoma (MPC) of the mammary gland.Methods The clinical data of 47 patients with MPC were retrospectively analyzed.The specimens were detected by immunohistochemistry to analyze the pathological changes,axillary lymph node metastasis,and prognosis.Results Of the 47 patients,44.68％ (47 cases) had MPC only,34.04％ were accompanied by infiltrating ductal carcinoma,and 10.64％ were complicated with ductal carcinoma in situ or mucinous carcinoma accounts,respectively.Proportion of MPC in tumor ＜50％ accounted for 46.81％,≥50％ accounted for 50％; Immunohistochemistry showed that the positive rate of ER,PR,P53,cerbB2 was 85.11％,80.85％,82.98％,55.32％,respectively.The tumor cell growth index was marked by Ki67,and the index was showed to be 5％-95％.The positive rate of axillary lymph node metastasis was 93.62％.The positive rate of lymph node metastasis showed no statistically significant difference in patients with different composition of MPC and different tumor diameter (P＞0.05),but the number of lymph node metastasis did (P＜0.05).The median follow-up was 32 months postoperatively,the 1-year,2-year,3-year survival rates and disease-free survival rates were 92.68％,87.80％,82.93％,73.17％,78.05％,70.73％,respectively.The 3-year survival rates and disease-free survival rates showed no statistically significant difference between patients with different composition of MPC and that with different tumor diameter (P＞0.05).Conclusion MPC has strong ability and high positive rate of lymph node metastases,with relatively poor prognosis.The size and composition of MPC has no direct relevance with high invasion,lymph node metastasis and prognosis of the tumor,but exerts an impact on the number of lymph node metastasis,which should be paid attention to by the clinical physicians and pathologists.