乳腺粘液癌不同亚分类的临床病理特征及生存分析

发布时间：2018-01-26 06:57

本文关键词： 乳腺粘液癌临床病理特征预后少细胞型乳腺粘液癌富于细胞型乳腺粘液癌混合型乳腺粘液癌　出处：《吉林大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探讨是否不同类型的乳腺粘液癌(Mucinous breast carcinoma,MBC)均有相同的预后,是否应根据乳腺粘液癌的亚分类来制定个体化的治疗策略。方法:本研究回顾性分析了2005年5月到2015年12月期间共136例在吉林大学第一医院行手术治疗的MBC患者的病例资料,并将2062例同期诊断为非特殊类型乳腺导管癌(Invasive ductal carcinoma-not otherwise specified,IDC-NOS)的病例设为对照组,比较两者的临床病理学特征及不同乳腺粘液癌亚型与IDC-NOS间的生存差异。结果:与IDC-NOS相比,MBC具有病理分期早,肿瘤直径大,淋巴结转移率低,ER、PR阳性率高,Her-2阳性率低,Ki-67低表达率高及预后好的特点。PMBC具有比MMBC更早的病理分期、更低的淋巴结转移率和组织学分级,且接受保乳手术和放射治疗的患者更多,接受化学治疗的患者更少。IDC-NOS、MMBC、PMBC-B、PMBC-A的5年DFS分别为85.9%、85.2%、96.8%、100%,5年OS分别为89.4%、89.8%、100%、100%。基于亚分类相比,PMBC具有比IDC-NOS更好的DFS(P=0.009)和OS(P=0.015),PMBC具有比MMBC更好的DFS(P=0.006)和OS(P=0.009)。PMBC-A具有比IDC-NOS更好的DFS(P=0.015)和OS(P=0.035),PMBC-A具有比MMBC更好的DFS(P=0.013)和OS(P=0.039)。PMBC-B与MMBC、IDC-NOS之间的DFS和OS则无统计学差异。MMBC、PMBC-B、PMBC-A三组的DFS(P=0.016)和OS(P=0.028)差异具有统计学意义。对于II期的MBC和IDC-NOS患者,MBC显示出比IDC-NOS更好的DFS(P=0.048)。对于年龄≤51岁的MBC和IDC-NOS患者,MBC显示出比IDC-NOS更好的DFS(P=0.041)。结论:1.与IDC-NOS相比,MBC的病理分期更早,肿瘤直径更大,淋巴结转移率更低,ER、PR阳性率更高,Her-2阳性率更低,Ki-67低表达率更高,但预后差异无统计学意义。2.与MMBC相比,PMBC的病理分期更早、淋巴结转移率更低和组织学分级更低,接受保乳手术的患者更多,接受化学治疗和放射治疗的患者更少,预后更好。3.PMBC-A型与IDC-NOS及MMBC相比,其预后更好;但PMBC-B型与IDC-NOS及MMBC相比,其预后差异无统计学意义。4.TNM分期和ER状态是影响MBC患者DFS的独立预后因素。淋巴结状态、ER状态、年龄是影响MBC患者OS的独立预后因素。因此,并非所有的MBC均为具有良好预后的组织学类型,应考虑基于亚分类,制定相应的治疗策略。
[Abstract]:Objective: to investigate whether different types of mucinous breast carcinoma of the breast have the same prognosis. Whether individual treatment strategies should be developed based on the subclassification of breast mucinous carcinoma. Methods:. This study retrospectively analyzed the data of 136 MBC patients who underwent surgical treatment in the first Hospital of Jilin University from May 2005 to December 2015. 2062 cases were diagnosed as non-special type breast ductal carcinoma at the same time. Invasive ductal carcinoma-not otherwise specified. IDC-NOS was used as the control group to compare the clinicopathological characteristics of the two groups and the survival differences between the two subtypes of breast mucinous carcinoma and IDC-NOS. Results: compared with IDC-NOS. MBC had early pathological stage, large tumor diameter, low lymph node metastasis, high positive rate of ERP and low positive rate of Her-2. The characteristics of low expression rate and good prognosis of Ki-67. PMBC has earlier pathological stage, lower lymph node metastasis rate and lower histological grade than MMBC. More patients received breast conserving surgery and radiotherapy, and fewer patients received chemotherapy. The 5 year DFS of PMBC-A was 85.9% and the value of 85.2% was 96.8100%. In 5 years OS was 89.4% and 89.8%, respectively. Compared with subtaxonomy, PMBC has a better IDC-NOS P0. 009 and OSP0. 015). PMBC is better than MMBC P0. 006) and OS(P=0.009).PMBC-A is better than IDC-NOS. And OSG P0. 035). PMBC-A has better OS(P=0.039).PMBC-B and MMBC than MMBC. There was no statistical difference between DFS and OS between IDC-NOS. There was a statistically significant difference in PMBC-A between the three groups (MBC 0.016) and IDC-NOS (0.028). For patients with MBC and IDC-NOS in stage II, there was a significant difference between the two groups. MBC showed better than IDC-NOS in patients with MBC and IDC-NOS, who were less than 51 years old. Compared with IDC-NOS, MBC showed a better pathological stage and larger tumor diameter than that of IDC-NOS. Conclusion: (1) compared with IDC-NOS, the pathological stage of MBC is earlier and the diameter of the tumor is larger than that of IDC-NOS. Lower lymph node metastasis rate higher positive rate of ERN PR higher positive rate of Her-2 lower Ki-67 lower expression rate but no significant difference in prognosis. 2. Compared with MMBC. PMBC had earlier pathological staging, lower lymph node metastasis and lower histological grade, more breast conserving surgery, and less chemotherapy and radiotherapy. The prognosis of PMBC-A was better than that of IDC-NOS and MMBC. But the PMBC-B type was compared with IDC-NOS and MMBC. TNM stage and ER status were independent prognostic factors of DFS in patients with MBC. Age is an independent prognostic factor for OS in patients with MBC. Therefore, not all MBC are histologic types with good prognosis.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.9

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