乳腺导管原位癌伴微小浸润腋窝前哨淋巴结转移的危险因素分析
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摘要
目的分析乳腺导管原位癌伴微小浸润(DCIS-MI)患者的临床病理特点及腋窝前哨淋巴结转移的危险因素。方法选取2004年1月至2016年6月新疆医科大学附属肿瘤医院乳腺外科收治并经病理确诊的女性乳腺DCIS-MI患者共79例,收集患者临床病理资料进行回顾性分析,采用Logistic回归方法分析DCIS-MI腋窝前哨淋巴结转移的危险因素。结果 79例患者均顺利完成腋窝前哨淋巴结活检,其中3例(3. 8%)患者出现腋窝前哨淋巴结转移,其中2例(2. 5%)为宏转移,1例(1. 3%)为微转移。淋巴结转移数目1例为2枚,其余2例均为1枚。3例前哨淋巴结出现转移的患者随后均行腋窝淋巴结清扫,非前哨淋巴结均未发现转移。单因素分析结果显示,年龄(P <0. 001)、肿瘤大小(P=0. 005)、组织学分级(P <0. 001)及Ki-67表达(P=0. 026)均与DCIS-MI患者腋窝前哨淋巴结转移相关。多因素Logistic回归分析结果显示,肿瘤大小> 3 cm(比值比=14. 645,95%置信区间:4. 485～47. 821,P <0. 001)、高组织学分级(比值比=10. 023,95%置信区间:4. 242～23. 668,P <0. 001)是预测DCIS-MI患者腋窝前哨淋巴结转移的独立危险因素。结论 DCIS-MI发生腋窝淋巴结转移的风险较低,肿瘤直径较大、组织学分级较差是DCIS-MI腋窝前哨淋巴结转移的独立危险因素。
Objective To analyze the clinicopathological characteristics of breast ductal carcinoma in situ with microinvasion( DCIS-MI) and the risk factors of axillary sentinel lymph node metastasis. Methods Clinical and pathological data of 79 DCIS-MI patients who underwent surgery from January 2004 to June 2016 in Tumor Hospital Affiliated to Xinjiang Medical University were retrospectively studied. Risk factors of axillary sentinel lymph node metastasis were analyzed. Results All patients underwent axillary sentinel lymph node biopsy;3 cases( 3. 8%) had lymphatic metastasis,including 2 cases( 2. 5%) of macrometastasis and 1 case( 1. 3%) of micrometastasis. There was 1 case of double node metastases and 2 cases of single node metastasis. The 3 cases had axillary lymph node dissection and no non-sentinel lymph node metastasis was found. Univariate analysis showed that age( P < 0. 001),tumor size( P = 0. 005),histological grade( P < 0. 001) and Ki-67 expression( P =0. 026) were related with axillary sentinel lymph node metastasis. Multivariate logistic regression showed that tumor size > 3 cm( odds ratio = 14. 645,95% confidence interval: 4. 485-47. 821,P < 0. 001) and high histological grade( odds ratio = 10. 023,95% confidence interval: 4. 242-23. 668,P < 0. 001) were independent risk factors of axillary sentinel lymph node metastasis. Conclusions Patients with DCIS-MI have low risk of axillary lymph node metastasis. Large tumor size and poor histological grade are independent risk factors of axillary sentinel lymph node metastasis in DCIS-MI patients.
Objective To analyze the clinicopathological characteristics of breast ductal carcinoma in situ with microinvasion( DCIS-MI) and the risk factors of axillary sentinel lymph node metastasis. Methods Clinical and pathological data of 79 DCIS-MI patients who underwent surgery from January 2004 to June 2016 in Tumor Hospital Affiliated to Xinjiang Medical University were retrospectively studied. Risk factors of axillary sentinel lymph node metastasis were analyzed. Results All patients underwent axillary sentinel lymph node biopsy;3 cases( 3. 8%) had lymphatic metastasis,including 2 cases( 2. 5%) of macrometastasis and 1 case( 1. 3%) of micrometastasis. There was 1 case of double node metastases and 2 cases of single node metastasis. The 3 cases had axillary lymph node dissection and no non-sentinel lymph node metastasis was found. Univariate analysis showed that age( P < 0. 001),tumor size( P = 0. 005),histological grade( P < 0. 001) and Ki-67 expression( P =0. 026) were related with axillary sentinel lymph node metastasis. Multivariate logistic regression showed that tumor size > 3 cm( odds ratio = 14. 645,95% confidence interval: 4. 485-47. 821,P < 0. 001) and high histological grade( odds ratio = 10. 023,95% confidence interval: 4. 242-23. 668,P < 0. 001) were independent risk factors of axillary sentinel lymph node metastasis. Conclusions Patients with DCIS-MI have low risk of axillary lymph node metastasis. Large tumor size and poor histological grade are independent risk factors of axillary sentinel lymph node metastasis in DCIS-MI patients.
引文
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[12]连臻强,张江宇,王颀,等.乳腺导管内癌及其微浸润癌病理和生物学指标表达差异的临床意义[J].中华乳腺病杂志:电子版,2011,5(4):419-425. DOI:10. 3969/j. issn. 1674-0807.2011. 04. 005.Lian ZQ,Zhang JY,Wang Q,et al. Differences of pathological indicators and biological markers between ductal carcinoma in situ(DCIS)and DCIS with microinvasion[J]. Chinese Journal of Breast Disease(Electronic Version),2011,5(4):419-425. DOI:10. 3969/j. issn. 1674-0807. 2011. 04. 005.
[13] Mori M,Tsugawa K,Yamauchi H,et al. Pathological assessment of microinvasive carcinoma of the breast[J]. Breast Cancer,2013,20(4):331-335. DOI:10. 1007/s12282-012-0339-0.
[14] Wang L,Zhang W,Lyu S,et al. Clinicopathologic characteristics and molecular subtypes of microinvasive carcinoma of the breast[J]. Tumour Biol,2015,36(4):2241-2248. DOI:10.1007/s13277-014-2652-z.
[15]王一澎,马沛卿,张丽华,等.乳腺微小浸润癌临床病理特点及其与腋窝淋巴结转移的相关性分析[J].中国医刊,2016,51(6):53-58. DOI:10. 3969/j. issn. 1008-1070. 2016. 06. 017.Wang YP,Ma PQ,Zhang LH,et al. Microinvasive breast cancer:clinicopathologic characteristics and their correlation with axillary lymph nodes invasion result of a large single-institution series[J].Chinese Journal of Medicine,2016,51(6):53-58. DOI:10.3969/j. issn. 1008-1070. 2016. 06. 017.
[16] Steinman S,Wang J,Bourne P,et al. Expression of cytokeratin markers,ER-alpha,PR,HER-2/neu,and EGFR in pure ductal carcinoma in situ(DCIS)and DCIS with co-existing invasive ductal carcinoma(IDC)of the breast[J]. Ann Clin Lab Sci,2007,37(2):127-134.
[17] Li Y, Zhang S, Wei X, et al. The clinical features and management of women with ductal carcinoma in situ with microinvasion:a retrospective Cohort study[J]. Int J Surg,2015,19:91-94. DOI:10. 1016/j. ijsu. 2015. 05. 013.
[18] Nishimura R,Osako T,Okumura Y,et al. Ki-67 as a prognostic marker according to breast cancer subtype and a predictor of recurrence time in primary breast cancer[J]. Exp Ther Med,2010,1(5):747-754. DOI:10. 3892/etm. 2010. 133.
[19] Orzalesi L,Casella D,Criscenti V,et al. Microinvasive breast cancer:pathological parameters,cancer subtypes distribution,and correlation with axillary lymph nodes invasion. Results of a large single-institution series[J]. Breast Cancer,2016,23(4):640-648. DOI:10. 1007/s12282-015-0616-9.
[2] Ko BS,Lim WS,Kim HJ,et al. Risk factor for axillary lymph node metastases in microinvasive breast cancer[J]. Ann Surg Oncol,2012,19(1):212-216. DOI:10. 1245/s10434-011-1812-2.
[3] Wehner P,Lagios MD,Silverstein MJ. DCIS treated with excision alone using the National Comprehensive Cancer Network(NCCN)guidelines[J]. Ann Surg Oncol,2013,20(10):3175-3179. DOI:10. 1245/s10434-013-3176-2.
[4] Gojon H,Fawunmi D,Valachis A. Sentinel lymph node biopsy in patients with microinvasive breast cancer:a systematic review and meta-analysis[J]. Eur J Surg Oncol,2014,40(1):5-11. DOI:10. 1016/j. ejso. 2013. 10. 020.
[5] Giuliano AE,Connolly JL,Edge SB,et al. Breast Cancer-Major changes in the American Joint Committee on Cancer eighth edition cancer staging manual[J]. CA Cancer J Clin,2017,67(4):290-303. DOI:10. 3322/caac. 21393.
[6] Okumura Y,Yamamoto Y,Zhang Z,et al. Identification of biomarkers in ductal carcinoma in situ of the breast with microinvasion[J]. BMC Cancer,2008,8:287. DOI:10. 1186/1471-2407-8-287.
[7] Ozkan-Gurdal S,Cabioglu N,Ozcinar B,et al. Factors predicting microinvasion in Ductal Carcinoma in situ[J]. Asian Pac J Cancer Prev,2014,15(1):55-60.
[8]刘思吟,张明帅,王晓文,等.乳腺导管原位癌伴微小浸润的临床分析[J].中华肿瘤防治杂志,2016,23(15):1000-1005.DOI:10. 16073/j. cnki. cjcpt. 2016. 15. 006.Liu SY,Zhang MS,Wang XW,et al. Clinicopathologic study of breast ductal carcinoma in situ with microinvasion[J]. Chinese Journal of Cancer Prevention and Treatment,2016,23(15):1000-1005. DOI:10. 16073/j. cnki. cjcpt. 2016. 15. 006.
[9] Padmore RF,Fowble B,Hoffman J,et al. Microinvasive breast carcinoma:clinicopathologic analysis of a single institution experience[J]. Cancer,2000,88(6):1403-1409.
[10]孙晓,王永胜,周正波,等.乳腺导管内癌前哨淋巴结活检术的临床意义[J].中华内分泌外科杂志,2010,4(1):28-31. DOI:10. 3760/cma. j. issn. 1674-6090. 2010. 01. 008.Sun X,Wang YS,Zhou ZB,et al. Sentinel lymph node biopsy for patients with breast ductal carcinoma in situ[J]. Chinese Journal of Endocrine Surgery,2010,4(1):28-31. DOI:10. 3760/cma. j.issn. 1674-6090. 2010. 01. 008.
[11]霍雷军,郜红艺,郭玉娟,等.乳腺导管原位癌及其微浸润的临床病理研究[J].中华乳腺病杂志:电子版,2013,7(6):427-432. DOI:10. 3877/cma. j. issn. 1674-0807. 2013. 06. 007.Huo LJ,Gao HY,Guo YJ,et al. Clinicopathologic study on breast ductal carcinoma in situ and microinvasion[J]. Chinese Journal of Breast Disease(Electronic Version),2013,7(6):427-432. DOI:10. 3877/cma. j. issn. 1674-0807. 2013. 06. 007.
[12]连臻强,张江宇,王颀,等.乳腺导管内癌及其微浸润癌病理和生物学指标表达差异的临床意义[J].中华乳腺病杂志:电子版,2011,5(4):419-425. DOI:10. 3969/j. issn. 1674-0807.2011. 04. 005.Lian ZQ,Zhang JY,Wang Q,et al. Differences of pathological indicators and biological markers between ductal carcinoma in situ(DCIS)and DCIS with microinvasion[J]. Chinese Journal of Breast Disease(Electronic Version),2011,5(4):419-425. DOI:10. 3969/j. issn. 1674-0807. 2011. 04. 005.
[13] Mori M,Tsugawa K,Yamauchi H,et al. Pathological assessment of microinvasive carcinoma of the breast[J]. Breast Cancer,2013,20(4):331-335. DOI:10. 1007/s12282-012-0339-0.
[14] Wang L,Zhang W,Lyu S,et al. Clinicopathologic characteristics and molecular subtypes of microinvasive carcinoma of the breast[J]. Tumour Biol,2015,36(4):2241-2248. DOI:10.1007/s13277-014-2652-z.
[15]王一澎,马沛卿,张丽华,等.乳腺微小浸润癌临床病理特点及其与腋窝淋巴结转移的相关性分析[J].中国医刊,2016,51(6):53-58. DOI:10. 3969/j. issn. 1008-1070. 2016. 06. 017.Wang YP,Ma PQ,Zhang LH,et al. Microinvasive breast cancer:clinicopathologic characteristics and their correlation with axillary lymph nodes invasion result of a large single-institution series[J].Chinese Journal of Medicine,2016,51(6):53-58. DOI:10.3969/j. issn. 1008-1070. 2016. 06. 017.
[16] Steinman S,Wang J,Bourne P,et al. Expression of cytokeratin markers,ER-alpha,PR,HER-2/neu,and EGFR in pure ductal carcinoma in situ(DCIS)and DCIS with co-existing invasive ductal carcinoma(IDC)of the breast[J]. Ann Clin Lab Sci,2007,37(2):127-134.
[17] Li Y, Zhang S, Wei X, et al. The clinical features and management of women with ductal carcinoma in situ with microinvasion:a retrospective Cohort study[J]. Int J Surg,2015,19:91-94. DOI:10. 1016/j. ijsu. 2015. 05. 013.
[18] Nishimura R,Osako T,Okumura Y,et al. Ki-67 as a prognostic marker according to breast cancer subtype and a predictor of recurrence time in primary breast cancer[J]. Exp Ther Med,2010,1(5):747-754. DOI:10. 3892/etm. 2010. 133.
[19] Orzalesi L,Casella D,Criscenti V,et al. Microinvasive breast cancer:pathological parameters,cancer subtypes distribution,and correlation with axillary lymph nodes invasion. Results of a large single-institution series[J]. Breast Cancer,2016,23(4):640-648. DOI:10. 1007/s12282-015-0616-9.