三阴性特殊类型乳腺癌患者的临床病理特征及预后
|
摘要
目的:探讨三阴性特殊类型乳腺癌(special types of breast cancer,SBC)患者的临床病理特征及预后情况。方法:收集2011年1月—2014年12月于天津医科大学肿瘤医院诊治的240例三阴性SBC患者的临床资料,回顾性分析患者的临床病理特征及生存情况,并应用log-rank检验对影响患者生存的因素进行单因素分析,应用COX比例风险回归模型对影响患者生存的因素进行多因素分析。结果:全组240例患者,其中髓样癌38例,化生性癌84例,腺样囊性癌19例,浸润性小叶癌31例,大汗腺癌30例,混合型小叶导管癌38例。不同组织学类型的三阴性SBC患者在组织学分级、肿瘤T分期、淋巴结转移、Ki-67表达、化疗与否及化疗方案方面差异均有统计学意义(P值均<0.05)。混合型小叶导管癌、化生性癌和浸润性小叶癌患者的5年无病生存(diseasefree survival,DFS)率和5年总生存(overall survival,OS)率均低于腺样囊性癌、髓样癌和大汗腺癌患者(P值均<0.01)。组织学分级、肿瘤T分期、淋巴结转移、化疗和组织学类型影响三阴性SBC患者的5年DFS率和OS率(P值均<0.05)。肿瘤T分期、淋巴结转移、化疗及组织学类型是三阴性SBC患者5年DFS率和OS率的独立影响因素(P值均<0.05)。含铂类化疗方案在化生性癌(P=0.044)及蒽环联合紫杉类化疗方案在混合型小叶导管癌患者(P=0.008)中的DFS较长。结论:不同组织学类型三阴性SBC患者的临床病理特征和预后不同,腺样囊性癌、髓样癌和大汗腺癌患者的预后较好,化生性癌、浸润性小叶癌和混合型小叶导管癌患者的预后较差。铂类化疗药物可用于三阴性化生性癌患者的治疗。
Objective: To examine the clinicopathological features and prognosis of triple-negative special types of breast cancer(SBC).Methods: The clinical data of 240 patients with triple-negative SBC who were treated in Tianjin Medical University Cancer Institute and Hospital from January 2011 to December 2014 were collected. The clinicopathological features and survival time of patients were retrospectively analyzed. The univariate analysis of survival factors was performed by log-rank test, and the multivariate analysis of survival factors was performed by COX proportional hazard model.Results: Among the 240 patients, there were 38 cases of medullary carcinoma, 84 cases of metaplastic carcinoma, 19 cases of adenoid cystic carcinoma, 31 cases of invasive lobular carcinoma,30 cases of apocrine carcinoma, and 38 cases of mixed lobular-ductal carcinoma. The histological grade, tumor T stage, lymph node metastasis, Ki-67 expression, chemotherapy or not and chemotherapy regimens had statistically significant differences among the different histological types of triple-negative SBC patients(all P < 0.05). The 5-year disease-free survival(DFS) and5-year overall survival(OS) rates in patients with mixed lobular-ductal carcinoma, metaplastic carcinoma or invasive lobular carcinoma were lower than those in patients with adenoid cystic carcinoma, medullary carcinoma or apocrine carcinoma(all P < 0.01). The 5-year DFS and OS rates of patients with triple-negative SBC were correlated with histological grade, tumor T stage, lymph node metastasis, chemotherapy and histological type(all P < 0.05). Tumor T stage, lymph node metastasis,chemotherapy and histological type were independent prognostic factors on the 5-year DFS and OS in the triple-negative SBC patients(all P < 0.05). The metaplastic carcinoma patients after platinumbased chemotherapy(P = 0.044) and the mixed lobular-ductal carcinoma patients after anthracycline combined with taxane-based chemotherapy(P = 0.008) obtained longer DFS time.Conclusion: Triple-negative SBC patients with different histological types have different clinicopathological features and prognosis. The patients with adenoid cystic carcinoma, medullary carcinoma and apocrine carcinoma have a better prognosis, while the patients with metaplastic carcinoma, invasive lobular carcinoma and mixed lobular-ductal carcinoma have a poor prognosis. Platinum-based chemotherapy can be used in the treatment of patients with triple-negative metaplastic carcinoma.
Objective: To examine the clinicopathological features and prognosis of triple-negative special types of breast cancer(SBC).Methods: The clinical data of 240 patients with triple-negative SBC who were treated in Tianjin Medical University Cancer Institute and Hospital from January 2011 to December 2014 were collected. The clinicopathological features and survival time of patients were retrospectively analyzed. The univariate analysis of survival factors was performed by log-rank test, and the multivariate analysis of survival factors was performed by COX proportional hazard model.Results: Among the 240 patients, there were 38 cases of medullary carcinoma, 84 cases of metaplastic carcinoma, 19 cases of adenoid cystic carcinoma, 31 cases of invasive lobular carcinoma,30 cases of apocrine carcinoma, and 38 cases of mixed lobular-ductal carcinoma. The histological grade, tumor T stage, lymph node metastasis, Ki-67 expression, chemotherapy or not and chemotherapy regimens had statistically significant differences among the different histological types of triple-negative SBC patients(all P < 0.05). The 5-year disease-free survival(DFS) and5-year overall survival(OS) rates in patients with mixed lobular-ductal carcinoma, metaplastic carcinoma or invasive lobular carcinoma were lower than those in patients with adenoid cystic carcinoma, medullary carcinoma or apocrine carcinoma(all P < 0.01). The 5-year DFS and OS rates of patients with triple-negative SBC were correlated with histological grade, tumor T stage, lymph node metastasis, chemotherapy and histological type(all P < 0.05). Tumor T stage, lymph node metastasis,chemotherapy and histological type were independent prognostic factors on the 5-year DFS and OS in the triple-negative SBC patients(all P < 0.05). The metaplastic carcinoma patients after platinumbased chemotherapy(P = 0.044) and the mixed lobular-ductal carcinoma patients after anthracycline combined with taxane-based chemotherapy(P = 0.008) obtained longer DFS time.Conclusion: Triple-negative SBC patients with different histological types have different clinicopathological features and prognosis. The patients with adenoid cystic carcinoma, medullary carcinoma and apocrine carcinoma have a better prognosis, while the patients with metaplastic carcinoma, invasive lobular carcinoma and mixed lobular-ductal carcinoma have a poor prognosis. Platinum-based chemotherapy can be used in the treatment of patients with triple-negative metaplastic carcinoma.
引文
[1]张继博,史业辉,贾勇圣,等.三阴性乳腺癌治疗进展[J].肿瘤,2017,37(7):788-794.
[2]CRISCITIELLO C,AZIM HA Jr,SCHOUTEN PC,et al.Understanding the biology of triple-negative breast cancer[J].Ann Oncol,2012,23(6):13-18.
[3]BROUCKAERT O,WILDIERS H,FLORIS G,et al.Update on triplenegative breast cancer:prognosis and management strategies[J].Int JWomens Health,2012,4:511-520.
[4]YAMAMOTO Y,IWASE H.Clinicopathological features and treatment strategy for triple-negative breast cancer[J].Int J Clin Oncol,2010,15(4):341-351.
[5]ZHAO S,MA D,XIAO Y,et al.Clinicopathologic features and prognoses of different histologic types of triple-negative breast cancer:Alarge population-based analysis[J].Eur J Surg Oncol,2018,44(4):420-428.
[6]LIAO HY,ZHANG WW,SUN JY,et al.The clinicopathological features and survival outcomes of different histological subtypes in triplenegative breast cancer[J].J Cancer,2018,9(2):296-303.
[7]EL ZEIN D,HUGHES M,KUMAR S,et al.Metaplastic carcinoma of the breast is more aggressive than triplenegative breast cancer:A study from a single institution and review of literature[J].Clin Breast Cancer,2017,17(5):382-391.
[8]LIN NU,VANDERPLAS A,HUGHES ME,et al.Clinicopathologic features,patterns of recurrence,and survival among women with triple-negative breast cancer in the National Comprehensive Cancer Network[J].Cancer,2012,118(22):5463-5472.
[9]PEZZI CM,PATEL-PAREKH L,COLE K,et al.Characteristics and treatment of metaplastic breast cancer:analysis of892 cases from the National Cancer Data Base[J].Ann Surg Oncol,2007,14(1):166-173.
[10]LAI HW,TSENG LM,CHANG TW,et al.The prognostic significance of metaplastic carcinoma of the breast(MCB)-a case controlled comparison study with infiltrating ductal carcinoma[J].Breast,2013,22(5):968-973.
[11]LAKHANI SR,ELLIS IO,SCHNITT SJ,et al.WHO classification of tumors[M].4th ed.Lyon:IARC Press,2012:40-42.
[12]McCART REED AE,KUTASOVIC JR,LAKHANI SR,et al.Invasive lobular carcinoma of the breast:morphology,biomarkers and'omics[J].Breast Cancer Res,2015,17(1):12-33.
[13]LUINI A,AGUILAR M,GATTI G,et al.Metaplastic carcinoma of the breast,an unusual disease with worse prognosis:the experience of the European Institute of Oncology and review of the literature[J].Breast Cancer Res Treat,2007,101(3):349-353.
[14]MONTAGNA E,MAISONNEUVE P,ROTMENSZ N,et al.Heterogeneity of triple-negative breast cancer:histologic subtyping to inform the outcome[J].Clin Breast Cancer,2013,13(1):31-39.
[15]PARK I,KIM J,KIM M,et al.Comparison of the characteristics of medullary breast carcinoma and invasive ductal carcinoma[J].J Breast Cancer,2013,16(4):417-425.
[16]CAO AY,HE M,HUANG L,et al.Clinicopathologic characteristics at diagnosis and the survival of patients with medullary breast carcinoma in China:a comparison with infiltrating ductal carcinoma-not otherwise specified[J].World J Surg Oncol,2013,11:91.
[17]TSUTSUMI Y.Apocrine carcinoma as triple-negative breast cancer:novel definition of apocrine-type carcinoma as estrogen/progesterone receptornegative and androgen receptorpositive invasive ductal carcinoma[J].Jpn J Clin Oncol,2012,42(5):375-386.
[18]PENG Y.Potential prognostic tumor biomakers in triple-negative carcinoma[J].Beijing Da Xue Xue Bao Yi Xue Ban,2012,44(5):666-672.
[19]GERRATANA L,FANOTTO V,PELIZZARI G,et al.Do platinum salts fit all triple negative breast cancers?[J].Cancer Treat Rev,2016,48:34-41.
[20]TELLI ML,JENSEN KC,VINAYAK S,et al.PhaseⅡstudy of gemcitabine,carboplatin,and iniparib as neoadjuvant therapy for triple-negative and BRCA 1/2 mutationassociated breast cancer with assessment of a tumor-based measure of genomic instability:PrECOG 0105[J].J Clin Oncol,2015,33(17):1895-1901.
[21]BYRSKI T,HUZARSKI T,DENT R,et al.Pathologic complete response to neoadjuvant cisplatin in BRCA1-positive breast cancer patients[J].Breast Cancer Res Treat,2014,147(2):401-405.
[2]CRISCITIELLO C,AZIM HA Jr,SCHOUTEN PC,et al.Understanding the biology of triple-negative breast cancer[J].Ann Oncol,2012,23(6):13-18.
[3]BROUCKAERT O,WILDIERS H,FLORIS G,et al.Update on triplenegative breast cancer:prognosis and management strategies[J].Int JWomens Health,2012,4:511-520.
[4]YAMAMOTO Y,IWASE H.Clinicopathological features and treatment strategy for triple-negative breast cancer[J].Int J Clin Oncol,2010,15(4):341-351.
[5]ZHAO S,MA D,XIAO Y,et al.Clinicopathologic features and prognoses of different histologic types of triple-negative breast cancer:Alarge population-based analysis[J].Eur J Surg Oncol,2018,44(4):420-428.
[6]LIAO HY,ZHANG WW,SUN JY,et al.The clinicopathological features and survival outcomes of different histological subtypes in triplenegative breast cancer[J].J Cancer,2018,9(2):296-303.
[7]EL ZEIN D,HUGHES M,KUMAR S,et al.Metaplastic carcinoma of the breast is more aggressive than triplenegative breast cancer:A study from a single institution and review of literature[J].Clin Breast Cancer,2017,17(5):382-391.
[8]LIN NU,VANDERPLAS A,HUGHES ME,et al.Clinicopathologic features,patterns of recurrence,and survival among women with triple-negative breast cancer in the National Comprehensive Cancer Network[J].Cancer,2012,118(22):5463-5472.
[9]PEZZI CM,PATEL-PAREKH L,COLE K,et al.Characteristics and treatment of metaplastic breast cancer:analysis of892 cases from the National Cancer Data Base[J].Ann Surg Oncol,2007,14(1):166-173.
[10]LAI HW,TSENG LM,CHANG TW,et al.The prognostic significance of metaplastic carcinoma of the breast(MCB)-a case controlled comparison study with infiltrating ductal carcinoma[J].Breast,2013,22(5):968-973.
[11]LAKHANI SR,ELLIS IO,SCHNITT SJ,et al.WHO classification of tumors[M].4th ed.Lyon:IARC Press,2012:40-42.
[12]McCART REED AE,KUTASOVIC JR,LAKHANI SR,et al.Invasive lobular carcinoma of the breast:morphology,biomarkers and'omics[J].Breast Cancer Res,2015,17(1):12-33.
[13]LUINI A,AGUILAR M,GATTI G,et al.Metaplastic carcinoma of the breast,an unusual disease with worse prognosis:the experience of the European Institute of Oncology and review of the literature[J].Breast Cancer Res Treat,2007,101(3):349-353.
[14]MONTAGNA E,MAISONNEUVE P,ROTMENSZ N,et al.Heterogeneity of triple-negative breast cancer:histologic subtyping to inform the outcome[J].Clin Breast Cancer,2013,13(1):31-39.
[15]PARK I,KIM J,KIM M,et al.Comparison of the characteristics of medullary breast carcinoma and invasive ductal carcinoma[J].J Breast Cancer,2013,16(4):417-425.
[16]CAO AY,HE M,HUANG L,et al.Clinicopathologic characteristics at diagnosis and the survival of patients with medullary breast carcinoma in China:a comparison with infiltrating ductal carcinoma-not otherwise specified[J].World J Surg Oncol,2013,11:91.
[17]TSUTSUMI Y.Apocrine carcinoma as triple-negative breast cancer:novel definition of apocrine-type carcinoma as estrogen/progesterone receptornegative and androgen receptorpositive invasive ductal carcinoma[J].Jpn J Clin Oncol,2012,42(5):375-386.
[18]PENG Y.Potential prognostic tumor biomakers in triple-negative carcinoma[J].Beijing Da Xue Xue Bao Yi Xue Ban,2012,44(5):666-672.
[19]GERRATANA L,FANOTTO V,PELIZZARI G,et al.Do platinum salts fit all triple negative breast cancers?[J].Cancer Treat Rev,2016,48:34-41.
[20]TELLI ML,JENSEN KC,VINAYAK S,et al.PhaseⅡstudy of gemcitabine,carboplatin,and iniparib as neoadjuvant therapy for triple-negative and BRCA 1/2 mutationassociated breast cancer with assessment of a tumor-based measure of genomic instability:PrECOG 0105[J].J Clin Oncol,2015,33(17):1895-1901.
[21]BYRSKI T,HUZARSKI T,DENT R,et al.Pathologic complete response to neoadjuvant cisplatin in BRCA1-positive breast cancer patients[J].Breast Cancer Res Treat,2014,147(2):401-405.