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中华乳腺病杂志(电子版)

中华乳腺病杂志(电子版) ›› 2022, Vol. 16 ›› Issue (02) : 96 -101. doi: 10.3877/cma.j.issn.1674-0807.2022.02.005

论著

乳腺黏液腺癌的临床病理特征及其预后分析
林韬1, 孟祥志2, 石亮1, 刘佳祥2, 王昕2,†(), 崔猛胜1,†()   
  1. 1. 046000　长治，长治医学院附属和平医院乳腺科
    2. 100021　北京，国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院　北京协和医学院肿瘤医院乳腺外科
  • 收稿日期:2020-11-26 出版日期:2022-04-01
  • 通信作者: 王昕, 崔猛胜

Clinicopathological characteristics and prognosis of mucinous breast carcinoma

Tao Lin1, Xiangzhi Meng2, Liang Shi1, Jiaxiang Liu2, Xin Wang2,†(), Mengsheng Cui1,†()   

  1. 1. Department of Breast Surgery, Heping Hospital Affiliated to Changzhi Medical College, Changzhi 046000, China
    2. Department of Breast Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
  • Received:2020-11-26 Published:2022-04-01
  • Corresponding author: Xin Wang, Mengsheng Cui
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引用本文：

林韬, 孟祥志, 石亮, 刘佳祥, 王昕, 崔猛胜. 乳腺黏液腺癌的临床病理特征及其预后分析[J]. 中华乳腺病杂志(电子版), 2022, 16(02): 96-101.

Tao Lin, Xiangzhi Meng, Liang Shi, Jiaxiang Liu, Xin Wang, Mengsheng Cui. Clinicopathological characteristics and prognosis of mucinous breast carcinoma[J]. Chinese Journal of Breast Disease(Electronic Edition), 2022, 16(02): 96-101.

目的

对比分析乳腺黏液腺癌(MBC)与浸润性导管癌(BIDC)的临床特点、治疗方法及影响预后的因素。

方法

回顾性分析2010年1月至2014年12月中国医学科学院肿瘤医院乳腺外科收治的乳腺黏液腺癌与浸润性导管癌各100例的临床资料，采用t检验、秩和检验、χ2检验或Fisher确切概率法比较2组患者的临床病理特征。采用Kaplan Meier法绘制生存曲线，并用Log-rank法比较2组患者的DFS及OS。采用单因素及多因素Cox比例风险模型分析DFS及OS的影响因素。

结果

MBC组与BIDC组患者的年龄、TNM分期、组织学分级、分子分型及手术方式比较，差异均有统计学意义(t＝1.297，Z＝3.567、-8.627，χ2＝10.086、17.737；P均<0.050)。共14例失访，其中MBC组3例，BIDC组11例，随访率为93%(186/200)。12例死亡，其中MBC组2例，BIDC组10例。MBC组5年DFS率为91%，BIDC组为78%,差异有统计学意义(χ2＝7.585, P＝0.006)。MBC组5年OS率为97%，BIDC组为88%，差异有统计学意义(χ2＝7.752，P＝0.005)。MBC组的DFS优于BIDC组(HR＝0.30，95%CI：0.13~0.69，P＝0.004); luminal B型(HER-2阳性)DFS的风险是luminal A型的4.97倍(95%CI：1.71~14.42，P＝0.003)，HER-2过表达型是luminal A型的6.08倍(95%CI：2.22~16.13, P<0.001)；接受改良根治术的患者DFS风险是接受保留乳房手术+前哨淋巴结活组织检查(SLNB)患者的0.36倍(95%CI：0.13~0.99，P＝0.047)。MBC组的OS优于BIDC组(HR＝0.26，95%CI：0.10~0.63，P＝0.003)；luminal B型(HER-2阳性)患者的OS风险是luminal A型的6.90倍(95%CI：1.72~27.67，P＝0.006), HER-2过表达型患者的OS风险是luminal A型的11.44倍(95%CI：3.13~41.89，P<0.001)，三阴性患者的OS风险是luminal A型的6.46倍(95%CI：1.57~26.51，P＝0.010)；接受改良根治术的患者OS风险是接受保留乳房手术+SLNB患者的0.21倍(95%CI：0.06~0.74，P＝0.015)。

结论

MBC患者的预后明显好于BIDC，且生存期较长，与其分子分型有相关性。

关键词: 乳腺肿瘤, 腺癌，黏液, 癌，导管，乳腺, 预后
Objective

To compare the clinical characteristics and treatment methods of mucinous breast carcinoma (MBC) and breast invasive ductal carcinoma (BIDC), and analyze prognostic factors.

Methods

The clinical data of 100 patients with MBC and 100 patients with BIDC in the Department of Breast Surgery, Cancer Hospital, Chinese Academy of Medical Sciences from January 2010 to December 2014 were retrospectively analyzed. The clinicopathological characteristics were compared between two groups using t test, rank sum test, χ2 test or Fisher’s exact test. Survival curves were drawn by Kaplan-Meier method, and DFS and OS were compared between two groups by log-rank test. Univariate and multivariate Cox proportional hazards models were used to analyze related factors affecting DFS and OS.

Results

There were significant differences in age, TNM stage, histological grade, molecular typing and surgical methods between MBC group and BIDC group (t=1.297, Z=3.567, -8.627, χ2=10.086, 17.737; all P<0.050). A total of 14 cases were lost to follow-up, including 3 cases in MBC group and 11 cases in BIDC group, with the follow-up rate of 93% (186/200). There were 12 deaths, including 2 in MBC group and 10 in BIDC group. The 5-year DFS was 91% in MBC group and 78% in BIDC group, indicating a significant difference (χ2=7.585, P=0.006). The 5-year OS was 97% in MBC group and 88% in BIDC group, indicating a significant difference (χ2=7.752, P=0.005). The DFS in MBC group was significantly better than that in BIDC group (HR=0.30, 95%CI: 0.13-0.69, P=0.004); the risk of DFS in luminal B subtype (HER-2 positive) was 4.97 times as high as that of luminal A subtype (95%CI: 1.71-14.42, P=0.003), HER-2 overexpression subtype 6.08 times (95%CI: 2.22-16.13, P<0.001); the risk of DFS in patients receiving modified radical mastectomy was 0.36 times as high as that in patients who received breast-conserving surgery+ sentinel lymph node biopsy (95%CI: 0.13-0.99, P=0.047). The OS in MBC group was significantly better than that in BIDC group (HR=0.26, 95%CI: 0.10-0.63, P=0.003); the risk of OS in patients with luminal B subtype (HER-2 positive) was 6.90 times as high as that of luminal A subtype (95%CI: 1.72-27.67, P=0.006), HER-2 overexpression subtype 11.44 times (95%CI: 3.13-41.89, P<0.001), triple-negative subtype 6.46 times (95%CI: 1.57-26.51, P=0.010); the risk of OS in patients receiving modified radical mastectomy was 0.21 time as high as that in patients who received breast-conserving surgery + sentinel lymph node biopsy (95%CI: 0.06-0.74, P=0.015).

Conclusion

The patients with MBC have a better prognosis and longer survival compared with patients with BIDC, which is related to the molecular subtype.

Key words: Breast neoplasms, Adenocarcinoma, mucinous, Carcinoma, ductal, breast, Prognosis
表1 多因素分析的变量赋值表
变量 变量类型 赋值
病理类型 X 浸润性导管癌组＝1；黏液腺癌＝2
性别 X 男＝1；女＝2
TNM分期 X Ⅰ期＝1；Ⅱ期＝2；Ⅲ期＝3；Ⅳ＝4
组织学分级 X 1级＝1；2级＝2；3级＝3
分子分型 X luminal A型＝1；luminal B型(HER-2阴性)＝2；luminal B型(HER-2阳性)＝3；HER-2过表达型＝4；三阴性＝5
手术方式 X 保留乳房手术+前哨淋巴结活组织检查＝1；单纯切除+前哨淋巴结活组织检查＝2；保留乳房手术+腋窝淋巴结清扫＝3；改良根治术＝4；保留乳头、乳晕乳房切除术＝5
生存结局 Y 生存＝0;死亡＝1
表2 乳腺黏液腺癌与浸润性导管癌患者的临床病理特征比较
临床病理特征 黏液腺癌组(n＝100) 浸润性导管癌组(n＝100) 检验值 P值
年龄(岁，±s) 50.5±12.6 47.9±15.6 t＝1.297 <0.001
TNM分期        
  Ⅰ期 32 15 Z＝3.567 <0.001
  Ⅱ期 46 44
  Ⅲ期 21 34
  Ⅳ期 1 7
组织学分级        
  1级 87 26 Z＝-8.627 <0.001
  2级 11 49
  3级 2 25
分子分型        
  luminal A型 54 43 χ2＝10.086 0.039
  luminal B型(HER-2阴性) 13 9
  luminal B型(HER-2阳性) 12 7
  HER-2过表达型 8 19
  三阴性 13 22
手术方式        
  保留乳房手术+SLNB 48 32 χ2＝17.737 0.001
  单纯切除+ SLNB 21 15
  保留乳房手术+ALND 7 9
  改良根治术 15 40
  NSM+SLNB 9 4
性别        
  男 4 2 χ2＝2.000 0.157
  女 96 98
图1 100例MBC与100例BIDC患者的无瘤生存曲线比较注：χ2＝7.586, P＝0.006；MBC是乳腺黏液腺癌；BIDC是乳腺浸润性导管癌
图2 100例MBC与100例BIDC患者的总生存曲线比较注：χ2＝7.752, P＝0.005；MBC是乳腺黏液腺癌；BIDC是乳腺浸润性导管癌
表3 200例乳腺癌患者无瘤生存的影响因素分析
变量 单因素分析 多因素分析
HR(95%CI) P值 HR(95%CI) P值
病理类型        
  浸润性导管癌 1.00   1.00  
  黏液腺癌 0.36(0.17~0.77) 0.008 0.30(0.13~0.69) 0.004
性别        
  男 1.00      
  女 21.18(0.13~33.01) 0.494    
年龄a 0.99(0.97~1.02) 0.563    
TNM分期        
  Ⅰ期 1.00 0.253    
  Ⅱ期 1.47(0.61~3.52) 0.389    
  Ⅲ期 0.66(0.22~1.97) 0.457    
  Ⅳ期 2.13(0.55~8.25) 0.274    
组织学分级        
  1级 1.00 0.099    
  2级 0.53(0.23~1.23) 0.139    
  3级 0.28(0.07~1.18) 0.083    
分子分型        
  luminal A型 1.00 0.009 1.00 0.003
  luminal B型(HER-2阴性) 1.84(0.46~7.37) 0.388 1.39(0.34~5.64) 0.642
  luminal B型(HER-2阳性) 5.93(2.05~17.16) 0.001 4.97(1.71~14.42) 0.003
  HER-2过表达型 3.99(1.49~10.62) 0.006 6.08(2.22~16.63) <0.001
  三阴性 1.87(0.57~6.13) 0.304 2.39(0.71~8.02) 0.157
手术方式        
  保留乳房手术+SLNB 1.00 0.145 1.00 0.223
  单纯切除+ SLNB 0.73(0.30~1.75) 0.480 0.74(0.30~1.80) 0.503
  保留乳房手术+ALND 0.65(0.19~2.21) 0.490 0.82(0.24~2.86) 0.759
  改良根治术 0.30(0.11~0.81) 0.017 0.36(0.13~0.99) 0.047
  NSM+SLNB 0.26(0.03~1.93) 0.187 0.20(0.03~1.57) 0.126
表4 200例乳腺癌患者总生存的影响因素分析
变量 单因素分析 多因素分析
HR(95%CI) P值 HR(95%CI) P值
病理类型        
  浸润性导管癌 1.00   1.00  
  黏液腺癌 0.32(0.14~0.75) 0.008 0.26(0.10~0.63) 0.003
性别        
  男 1.00      
  女 21.20(0.19~48.99) 0.512    
年龄a 1.00(0.98~1.03) 0.863    
TNM分期        
  Ⅰ期 1.00 0.169    
  Ⅱ期 1.80(0.66~4.92) 0.252    
  Ⅲ期 0.77(0.22~2.66) 0.677    
  Ⅳ期 3.01(0.72~12.62) 0.131    
组织学分级        
  1级 1.00 0.093    
  2级 0.42(0.16~1.10) 0.078    
  3级 0.33(0.08~1.41) 0.135    
分子分型        
  luminal A型 1.00 0.023 1.00 0.004
  luminal B型(HER-2阴性) 3.74(0.76~18.56) 0.106 2.62(0.52~13.08) 0.242
  luminal B型(HER-2阳性) 8.52(2.13~34.12) 0.002 6.90(1.72~27.67) 0.006
  HER-2过表达型 7.31(2.04~26.23) 0.002 11.44(3.13~41.89) <0.001
  三阴性 4.62(1.15~18.50) 0.031 6.46(1.57~26.51) 0.010
手术方式        
  保留乳房手术+SLNB 1.00 0.052 1.00 0.070
  单纯切除+ SLNB 0.53(0.20~1.42) 0.205 0.50(0.18~1.39) 0.183
  保留乳房手术+ALND 0.43(0.10~1.86) 0.260 0.59(0.13~2.63) 0.492
  改良根治术 0.18(0.05~0.63) 0.007 0.21(0.06~0.74) 0.015
  NSM+ SLNB 0.26(0.03~1.96) 0.192 0.17(0.02~1.31) 0.088
[3]
Cao AY, He M, Liu ZB, et al. Outcome of pure mucinous breast carcinoma compared to infiltrating ductal carcinoma: a population-based study from China[J]. Ann Surg Oncol, 2012，19：3019-3027.
[4]
Hanagiri T, Ono K, Baba T, et al. Clinicopathologic characteristics of mucinous carcinoma of the breast[J]. Int Surg, 2010, 95(2)：126-129.
[5]
Bray F，Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018：GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2018, 68 (6)：394-424.
[6]
Dent R, Trudeau M, Pritchard KI. Triple-negative breast cancer: clinical features and patterns of recurrence[J]. Clin Cancer Res, 2018, 13 (15 Pt 1)：4429-4434.
[7]
D’Souza V, Daudt H, Kazanjian A. Survivorship care plans for breast cancer patients: understanding the quality of the available evidence[J]. Curr Oncol，2017，24(6)：e446-e465.
[8]
Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015[J]. CA Cancer J Clin, 2016, 66 (2)：115-132.
[9]
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018[J]. CA Cancer J Clin, 2018, 68(1)：7-30.
[10]
Reiner AS, Sisti J, John EM, et al.Breast cancer family history and contralateral breast cancer risk in young women：an update from the women’s environmental cancer and radiation epidemiology study[J]．J Clin Oncol, 2018, 36(15)：1513-1520.
[11]
Park S, Koo J, Kim JH，et al. Clinicopathological characteristics of mucinous carcinoma of the breast in Korea: comparison with invasive ductal carcinoma-not otherwise specified[J]. J Korean Med Sci, 2010, 25(3): 361-368.
[12]
Li CI. Risk of mortality by histologic type of breast cancer in the United States[J]．Horm Cancer, 2010，1(3): 156-165.
[13]
Bussolati G, Sapino A. mucinous carcinoma and carcinomas with signet-ringcelldifferentiation// Lakhani SR，Ellis IO，Schnitt SJ，et al. WHO classification of tumours of the breast[M]. 4th ed. Lyon: IARC Press, 2012: 60-61.
[14]
Park S, Koo J, Kim JH. Clinicopathological characteristics of mucinous carcinoma of the breast in Korea: comparison with invasive ductal carcinoma-not otherwise specified[J]. J Korean Med Sci, 2010, 25(3): 361-368.
[15]
Kashiwagi S, Onoda N, Asano Y, et al. Clinical significance of the sub-classification of 71 cases mucinous breast carcinoma[J]. Springerplus, 2013, 2: 481.
[1]
Emens LA. Breast cancer immunotherapy：facts and hopes[J]．Clin Cancer Res, 2018, 24 (3)：3001.
[2]
Andersson Y, Frisell J, Sylvan M. Breast cancer survival in relation to the metastatic tumor burden in axillary lymph nodes[J]. Breast Cancer Res Treat, 2018, 171 (2)：359-369.
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