多灶和多中心性乳腺癌与单灶乳腺癌的临床特征差异分析
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摘要
【目的】比较多灶性、多中心性乳腺癌(MMBC)与单灶乳腺癌(UBC)的临床、MRI与病理的差异。【方法】回顾性分析2016年4月至2018年2月经病理证实的MMBC患者55例,UBC患者68例,比较两者的常规病理类型、分子亚型和MRI强化表现的特点与差异。采用对应分析(CA)研究两者与临床治疗方式的关系。【结果】MMBC与UBC患者的常规病理类型具有统计学差异(P <0.001),MMBC最大病灶病理类型中高级别浸润性导管癌比例明显低于UBC;两者的分子亚型、分子亚型与MRI强化方式无统计学差异(P=0.265,P=0.152);两者的肿块样强化方式具有统计学差异(P=0.013)。CA显示MMBC和UBC的分子亚型影响临床治疗方式,其中HER-2(+)、Luminal B型乳腺癌治疗方式关联性较高,三阴性乳腺癌治疗方式关联性较低。【结论】MMBC最大病灶的病理类型较UBC侵袭性低,MMBC和UBC的不同分子亚型的治疗方式差异较大,乳腺癌治疗应基于肿瘤生物学特性行个体化治疗。
【Objective】To explore the differences of clinical medicine,magnetic resonance imaging(MRI)and pathology in multifocal and multicentric breast cancer(MMBC)and unifocal breast cancer(UBC).【Methods】In this retrospective analysis,55 MMBC and 68 UBC patients with pathology confirmed from April 2016 to February 2018 were enrolled,and the characteristics and difference of routine pathological types,molecular subtypes and MR enhancement types were compared. The relationships between MMBC,UBC and the methods of clinical treatment were studied by correspondence analysis(CA).【Results】Significant difference was observed between routine pathological types of MMBC and UBC(P < 0.001). The high grade invasive ductal carcinoma was more frequent in maximal lesions of MMBC than in UBC lesions,whereas there was no statistical correlation between molecular subtypes,molecular subtypes and MR enhancement types(P = 0.265,P = 0.152). However,there was statistical difference in masses enhancemen(tP = 0.013). CA showed that the molecular subtypes of MMBC and UBC were the key factors for clinical treatment. In addition,HER-2(+)and Luminal B type breast cancer showed high correlation with treatment method,while triple-negative showed low correlation with treatment method.【Conclusions】The pathology types of the maximal lesions of MMBC were less aggressive than UBC lesions. There was significant correlation between clinical treatment and molecular subtypes of MMBC and UBC.Therefore,individualized treatments are recommended on the basis of biological characteristics in both MMBC and UBC.
【Objective】To explore the differences of clinical medicine,magnetic resonance imaging(MRI)and pathology in multifocal and multicentric breast cancer(MMBC)and unifocal breast cancer(UBC).【Methods】In this retrospective analysis,55 MMBC and 68 UBC patients with pathology confirmed from April 2016 to February 2018 were enrolled,and the characteristics and difference of routine pathological types,molecular subtypes and MR enhancement types were compared. The relationships between MMBC,UBC and the methods of clinical treatment were studied by correspondence analysis(CA).【Results】Significant difference was observed between routine pathological types of MMBC and UBC(P < 0.001). The high grade invasive ductal carcinoma was more frequent in maximal lesions of MMBC than in UBC lesions,whereas there was no statistical correlation between molecular subtypes,molecular subtypes and MR enhancement types(P = 0.265,P = 0.152). However,there was statistical difference in masses enhancemen(tP = 0.013). CA showed that the molecular subtypes of MMBC and UBC were the key factors for clinical treatment. In addition,HER-2(+)and Luminal B type breast cancer showed high correlation with treatment method,while triple-negative showed low correlation with treatment method.【Conclusions】The pathology types of the maximal lesions of MMBC were less aggressive than UBC lesions. There was significant correlation between clinical treatment and molecular subtypes of MMBC and UBC.Therefore,individualized treatments are recommended on the basis of biological characteristics in both MMBC and UBC.
引文
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[17]李智勇,白雪.三阴性乳腺癌分子分型的研究进展[J].新医学,2018,49(2):77-81.Li ZY,Bai X.Research progress on molecular typing of triple-negative breast Cancer[J].N Med,2018,49(2):77-81.
[2]Marinovich ML,Macaskill P,Bernardi D,et al.Systematic review of agreement between tomosynthesis and pathologic tumor size for newly diagnosed breast cancer and comparison with other imaging tests[J].Expert Rev Med Devices,2018,15(7):489-496.
[3]韦苇,黄仲奎,谢东,等.动态增强MRI结合DWI对乳腺疾病BI-RADS分类诊断的价值[J].广东医学,2016,37(2):256-259,260.Wei W,Huang ZK,Xie D,et al.The diagnostic value of dynamic enhanced MRI combined with DWI for the BI-RADS differentiation of breast disease[J].Guangdong Med J,2016,37(2):256-259,260.
[4]Beyhan A,Bianca L,Blohmer JU,et al.Impact of multifocal or multicentric disease on surgery and locoregional,distant and overall survival of 6,134breast cancer patients treated with neoadjuvant chemotherapy[J].Ann Surg Oncol,2015,22(4):1118-1127.
[5]Benveniste AP,Dryden MJ,Bedrosian I,et al.Surveillance of women with a personal history of breast cancer by tumour subtype[J].Clin Radiol,2017,72(3):266.e1-266.e6.
[6]Amin MB,Edge S,Greene F,et al.AJCC Cancer Staging Manual[M].8th ed.New York:Springer,2017:589-590.
[7]Machida Y,Tozaki M,Shimauchi A,et al.Two distinct types of linear distribution in nonmass enhancement at breast Mr imaging:difference in positive predictive value between linear and branching patterns[J].Radiology,2015,276(3):686-694.
[8]Goldhirsch A,Winer EP,Coates AS,et al.Personalizing the treatment of women with early breast cancer:highlights of the St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2013[J].Ann Oncol,2013,24(9):2206-2223.
[9]Mancini R,Pattaro G,Diodoro MG,et al.Tumor regression grade after neoadjuvant chemoradiation and surgery for low rectal cancer evaluated by multiple correspondence analysis:ten years as minimum follow-up[J].Clin Colorectal Cancer,2018,17(1):e13-e19.
[10]Nutter EL,Weiss JE,Marotti JD,et al.Personal history of proliferative breast disease with atypia and risk of multifocal breast Cancer[J].Cancer,2017,124(7):1350-1357.
[11]Fushimi A,Yoshida A,Yagata H,et al.Prognostic impact of multifocal and multicentric breast Cancer versus unifocal breast Cancer[J].Surg Today,2019,49(3):224-230.
[12]Karakas Y,Dizdar O,Aksoy S,et al.The effect of total size of lesions in multifocal/multicentric breast cancer on survival[J].Clin Breast Cancer,2018,18(4):320-327.
[13]Grimm LJ,Johnson KS,Marcom PK,et al.Can breast cancer molecular subtype help to select patients for preoperative Mr imaging[J].Radiology,2015,274(2):352-358.
[14]Rabasco P,Caivano R,Dinardo G,et al.Magnetic resonance imaging in the pre-surgical staging of breast cancer:our experience[J].Cancer Invest,2017,35(1):43-50.
[15]Yin J,Yang J,Lu H,et al.Quantitative discrimination between invasive ductal carcinomas and benign lesions based on semi-automatic analysis of time intensity curves from breast dynamic contrast enhanced MRI[J].J Exp Clin Cancer Res,2015,34(24):1-10.
[16]Fragomeni SM,Sciallis A,Jeruss JS.Molecular subtypes and local-regional control of breast cancer[J].Surg Oncol Clin N Am,2018,27(1):95-120.
[17]李智勇,白雪.三阴性乳腺癌分子分型的研究进展[J].新医学,2018,49(2):77-81.Li ZY,Bai X.Research progress on molecular typing of triple-negative breast Cancer[J].N Med,2018,49(2):77-81.