乳腺导管原位癌微浸润的危险因素分析

发布时间：2018-07-23 16:04

【摘要】：背景与目的乳腺癌是女性最常见的恶性肿瘤。乳腺导管原位癌作为一种非浸润性肿瘤,在欧美国家约占新诊断乳腺癌的20%-30%,这可能与乳腺钼靶摄片技术的广泛应用有关。乳腺癌微浸润这一概念最初由Lagios提出,美国癌症联合会(American Joint Committee on Cancer,AJCC)肿瘤组织学分类将微浸润定义为:乳腺间质中存在一个或多个清晰且独立的肿瘤细胞浸润灶,每灶最大直径≤1mm。目前对于术后病理诊断为乳腺导管原位癌(DCIS)及DCIS伴可疑浸润的患者,预估其有无浸润及如何制定合适的治疗方案成为了亟待解决的问题,近年来虽有研究者对以上问题进行了分析,但结论仍存在争议。本研究通过对郑州大学第一附属医院2008年至2012年收治并诊断为乳腺导管原位癌及乳腺导管原位癌伴微浸润的138例患者进行回顾性研究,通过总结其术前临床资料及术后临床病理特点对乳腺导管原位癌间质浸润的危险因素进行了分析,并对乳腺导管原位癌微浸润患者发生远处转移的影响因素进行了探讨。对象与方法本研究收集郑州大学第一附属医院2008年4月至2012年8月期间所有接受手术且经病理确诊为乳腺导管原位癌、乳腺导管原位癌伴微浸润共138例患者临床资料,根据是否伴有微浸润分为乳腺导管原位癌组(63例)、乳腺导管原位癌伴微浸润组(75例)。患有双侧乳腺癌、既往曾接受乳腺癌或其他恶性肿瘤放化疗者、于外院已进行原发肿块手术切除及既往接受过乳腺恶性肿瘤切除术的患者除外。每位患者的年龄、月经状况、肿瘤大小、是否多发、是否伴有恶性钙化、是否伴有Paget’s病、病理组织学分类、免疫组化指标(ER、PR、HER-2、Ki-67等)、辅助治疗方式、腋窝淋巴结状态及是否复发或转移等信息汇总后均输入计算机,进行统计学处理,分析乳腺导管原位癌微浸润的危险因素,并对其远处转移的影响因素进行了探讨。结果DCIS患者中多发病灶的存在与肿瘤间质微浸润的发生有关(P=0.005)。DCIS-Mi组中PR(P=0.004)及Ki-67(P=0.012)呈现高表达。DCIS-Mi组中位随访时间为62个月(3-90个月),13例术后出现腋窝淋巴结转移;直到随访终点,有3例出现远处转移,其中2例表现为骨转移,1例出现骨转移合并多发肝转移。肿瘤最大直径小于3.5cm的患者生存率高于肿瘤最大直径大于等于3.5cm的患者(χ2=11.88,P=0.003)。结论1.具有多发可疑病灶的乳腺导管原位癌伴或不伴可疑浸润的患者存在微浸润可能性大;2.肿瘤最大直径小于3.5cm的患者可能有更高的生存率,但未发现其与乳腺导管原位癌微浸润局部复发或转移有关。
[Abstract]:Background & objective Breast cancer is the most common malignant tumor in women. As a non-invasive tumor, ductal carcinoma in situ accounts for about 20% to 30% of newly diagnosed breast cancer in Europe and America, which may be related to the wide application of mammography. The concept of microinvasion of breast cancer was first proposed by Lagios, and the tumor histological classification of the (American Joint Committee on Cancer Federation defines microinfiltration as the presence of one or more distinct and independent tumor cell infiltrations in the stroma of the breast. The maximum diameter of each lesion was less than 1 mm. At present, for the patients with breast ductal carcinoma in situ (DCIS) and breast ductal carcinoma in situ (DCIS) with suspected infiltration, it is an urgent problem to estimate the infiltration and how to make appropriate treatment plan. Although some researchers have analyzed these problems in recent years, the conclusion is still controversial. A retrospective study was carried out in 138 patients with breast ductal carcinoma in situ and breast ductal carcinoma in situ with microinfiltration in the first affiliated Hospital of Zhengzhou University from 2008 to 2012. The risk factors of interstitial invasion of breast ductal carcinoma in situ were analyzed by summarizing the clinical data before and after operation, and the influencing factors of distant metastasis in patients with microinvasion of breast ductal carcinoma in situ were discussed. Participants and methods from April 2008 to August 2012, 138 patients with breast ductal carcinoma in situ and breast ductal carcinoma in situ with microinvasion were collected from the first affiliated Hospital of Zhengzhou University. The patients were divided into breast ductal carcinoma in situ group (63 cases) and breast ductal carcinoma in situ group (75 cases). Patients with bilateral breast cancer who have received radiotherapy and chemotherapy for breast cancer or other malignant tumors, except those who have undergone surgical resection of primary masses and previous excision of malignant breast tumors. Age, menstrual status, tumor size, multiple tumors, malignant calcification, Paget's 's disease, histopathological classification, immunohistochemical markers (ERPER-2Ki-67, etc.), adjuvant treatment, etc. The status of axillary lymph nodes, recurrence or metastasis of breast ductal carcinoma in situ were analyzed by computer. The risk factors of microinvasion of breast ductal carcinoma in situ were analyzed, and the influencing factors of distant metastasis were discussed. Results the presence of multiple lesions in patients with DCIS was related to the occurrence of interstitial microinvasion (P0. 005). In DCIS-Mi group PR (P0. 004) and Ki-67 (P0. 012) showed high expression. The median follow-up time of DCIS-Mi group was 62 months (3-90 months) with axillary lymph node metastasis. There were 3 cases with distant metastasis, 2 cases with bone metastasis and 1 case with multiple liver metastasis. The survival rate of patients with tumor diameter less than 3.5cm was higher than that of patients with tumor diameter greater than or equal to 3.5cm (蠂 2 + 11.88% P0. 003). Conclusion 1. Patients with ductal carcinoma in situ with multiple suspected lesions or without suspected invasion have a high probability of microinvasion. Patients with tumor diameter smaller than 3.5cm may have a higher survival rate, but no association with local recurrence or metastasis of breast ductal carcinoma in situ.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.9

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