分析妊娠相关性乳腺癌(PABC)患者的临床病理特征、诊断和治疗情况。

回顾性分析2012年1月至2019年1月中山大学肿瘤防治中心诊治的85例PABC患者的病历资料，评估患者的临床病理特征，分析其诊断模式和治疗情况。年龄、BMI及孕周等指标为偏态分布，用M(P₂₅, P₇₅)表示。用Kaplan-Meier法绘制生存曲线，进一步分析初诊早期PABC患者(初诊时无远处转移)乳腺手术后的DFS和初诊晚期患者(初诊时有远处转移)的无进展生存时间。

85例患者诊断为PABC的年龄为33(30，36)岁，BMI为22.5(20.5，24.0)kg/m²。4例患者有乳腺癌家族史。在85例患者中，48.2%(41/85)诊断时处于妊娠期，51.8%(44/85)诊断时处于产后1年内。在妊娠期诊断的患者中，孕周为28(19，32)周，而在产后诊断的患者中，诊断时间为产后4(1，8)个月。病理方面，67例患者为浸润性导管癌，4例浸润性小叶癌，1例黏液癌，6例混合性癌，4例其他类型癌，3例未知；38例患者组织学分级为3级，26例2级，21例组织学分级不明。54例患者为ER/PR阳性，30例HER-2阳性。luminal B1型、三阴型、luminal B2型、HER-2阳性型和luminal A型分别为25、22、21、9、5例，3例分子分型未知。TNM分期Ⅰ期、Ⅱ期、Ⅲ期及Ⅳ期患者分别为10、27、27、16例，另有5例分期未知。59例患者的诊断模式为查体+超声+穿刺活组织检查。本研究有74例患者接受手术，包括59例改良根治术，8例区段切除术+腋窝淋巴结清扫，3例乳房全切术加前哨淋巴结活组织检查，4例区段切除术+前哨淋巴结活组织检查。37例患者仅接受化疗，22例接受化疗+内分泌治疗，11例进行化疗+靶向+内分泌治疗，11例接受化疗+靶向治疗，3例仅接受内分泌治疗，另有1例治疗信息未知。化疗多采用以蒽环类和紫杉类为主的化疗方案。45例患者接受放射治疗且均在产后。在妊娠期诊断的患者中，27例在妊娠期未进行治疗，10例接受新辅助化疗，4例接受了手术治疗。85例患者的随访时间为23.6(12.8，46.4)个月，其中，失访7例(8.2%)。初诊早期PABC患者62例，DFS为36.0个月(95%CI: 29.2～42.8个月)；初诊晚期PABC患者16例，PFS为14.5个月(95%CI: 5.0～23.9个月)。

对于PABC患者，手术或化疗是相对安全的治疗选择。

To analyze the clinicopathologic characteristics, diagnosis and treatment of pregnancy-associated breast cancer (PABC) patients.

We retrospectively analyzed the medical records of 85 patients with PABC who were admitted to the Sun Yat-sen University Cancer Center from January 2012 to January 2019. Their clinicopathological characteristics, diagnosis and treatment were evaluated. The Kaplan-Meier method was used for survival analysis. The median disease-free survival (DFS) of early-stage PABC patients (without distant metastasis in primary diagnosis) and the median progression-free survival (PFS) of advanced PABC patients (with distant metastasis in primary diagnosis) were further estimated.

The age of 85 patients was 33 (30, 36) years old. The body mass index was 22.5 (20.5, 24.0) kg/m². Four patients had a family history of breast cancer. Totally 48.2%(41/85) of patients were diagnosed during pregnancy and the gestation was 28 (19, 32) weeks; 51.8%(44/85) of patients were diagnosed within 1 year after delivery [4 (1, 8) months postpartum]. In terms of pathology, there were 67 cases of invasive ductal carcinomas, 4 invasive lobular carcinomas, 1 mucinous carcinoma, 6 mixed carcinomas, 4 other pathological types and 3 unknown. There were 38 cases of histological grade 3, 26 grade 2, and 21 unknown. A total of 54 patients were ER/PR positive and 30 patients were HER-2 positive. As for molecular typing, there were 25 patients with luminal B1 subtype, 22 triple negative subtype, 21 luminal B2 subtype, 9 HER-2 positive subtype, 5 luminal A subtype, and 3 unknown subtypes. The number of patients at TNM stage Ⅰ, Ⅱ, Ⅲ and Ⅳ was 10, 27, 27 and 16, and other 5 patients had unknown stage. Fifty-nine patients were diagnosed by physical examination + ultrasound + fine needle biopsy. Totally 74 patients underwent surgery, including 59 patients with modified radical mastectomy, 8 with lumpectomy + axillary lymph node dissection, 3 with total mastectomy + sentinel lymph node biopsy, and 4 with lumpectomy + sentinel lymph node biopsy. Only 37 patients received chemotherapy, 22 received chemotherapy combined with endocrine therapy, 11 received chemotherapy, targeted therapy and endocrine therapy, 11 received chemotherapy combined with targeted therapy and 3 received endocrine therapy only; the treatment of one patient was unknown. Most of chemotherapy regimens were based on anthracyclines and taxanes. Forty-five patients underwent radiotherapy after delivery. Among the patients diagnosed during pregnancy, 27 received no treatment during pregnancy, 10 received neoadjuvant chemotherapy regimens and 4 patients underwent surgery. The follow-up time of 85 patients was 23.6 (12.8-46.4) months. Among them, 7 cases (8.2%) were lost to follow-up. The median DFS of 62 early stage PABC patients was 36.0 months (95%CI: 29.2-42.8 months), while the median PFS of 16 advanced breast cancer patients was 14.5 months (95%CI: 5.0-23.9 months).

Surgery and chemotherapy are relatively safe treatment options for PABC patients.