Objective: To analyze the differences of clinicopathological characters and prognostic factors between invasive micropapillary carcinoma of the breast (IMPC) and invasive ductal carcinoma (IDC) not otherwise specified of the breast. Methods: Patients who were treated from June 2008 to April 2016 in Breast Center of Beijing Hospital were retrospectively analyzed to evaluate the differences between IMPC (n=59) and IDC (n=1 080). Follow-up was done every 3 to 6 months postoperatively with a deadline of July 31, 2016. The curves of disease free survival (DFS) and overall survival (OS) were drawn by Kaplan-Meier method, and survival rates were compared by means of the Log-rank test. Potential prognostic variables which were identified on univariate analysis were analyzed with Cox's proportional hazards regression model for multivariate analysis. Results: More lymph nodes were involved in IMPC group (χ(2)=12.168, P=0.007) which led to more later stage in this group (χ(2)=8.950, P=0.011). IMPC group displayed a significantly increased rate of lymphovascular invasion (LVI) compared to IDC group (χ(2)=13.511, P = 0.001). The expression rate of estrogen receptor (ER) and progesterone receptor (PR) was higher in IMPC group than that in IDC group (89.8% vs. 76.3% and 88.1% vs. 70.7%, respectively, χ(2)=5.786, 8.332, all P<0.05). In multivariate analysis performed with the variables found significant in univariate analysis, the only variable found significantly affecting DFS of IMPC group was the T stage (T1-2 and T3-4, OR=5.217, 95%CI: 1.401 to 19.430, P=0.014), while in IDC group, pathological stage (stage Ⅰ to Ⅱ and stage Ⅲ to Ⅳ, OR=1.870, 95% CI: 1.262 to 2.771, P=0.002), lymph node positive ratio (LNR) (OR=2.222, 95%CI: 1.561 to 3.162, P=0.000), PR (OR=1.856, 95%CI: 1.118 to 3.082, P=0.017), and age (<50 years old and ≥50 years old, OR=0.695, 95%CI: 0.488 to 0.989, P=0.043) were prognostic factors. There were two variables found significantly affecting OS of IMPC group, which were T stage (OR=3.713, 95%CI: 1.539 to 8.959, P=0.004) and LNR (OR=2.850, 95%CI: 1.033 to 7.862, P=0.043). While in IDC group, LNR was the only variable found significantly affecting OS (OR=2.129, 95%CI: 1.324 to 3.425, P=0.002). Compared with IDC, the patients with IMPC were more likely to have local or regional recurrence (P=0.006). Although the median DFS interval was longer in IDC group (χ(2)=9.739, P=0.002), the median OS interval was comparable between the two groups (χ(2)=0.787, P=0.375). Conclusion: Although IMPC has lymphotropic feature, tendency of LVI and local or regional recurrence, it has an OS which is comparable with IDC.
目的： 探讨乳腺浸润性微乳头状癌(IMPC)和非特殊类型浸润性导管癌(IDC)临床病理学特点及预后因素的差异。 方法： 本研究为单中心回顾性对比研究，收集2008年6月至2016年4月北京医院乳腺中心治疗的所有IMPC患者(59例)和IDC患者(1 080例)的临床病理学资料。所有患者接受手术治疗，术后每3～6个月随访一次，直至患者出现疾病进展、死亡或2016年7月31日随访截止。单因素分析采用U检验、χ(2)检验或Fisher精确检验，多因素分析采用Cox比例风险模型，Kaplan－Meier法绘制生存曲线并行Log－rank检验。 结果： IMPC组淋巴结阳性比例更高(χ(2)＝12.168，P＝0.007)，TNM分期更晚(χ(2)＝8.950，P＝0.011); IMPC组23.7%(14/45)的患者病理学检查发现脉管内癌栓，高于IDC组的9.1%(98/982)(χ(2)＝13.551，P＝0.000)。IMPC组雌激素受体、孕激素受体的阳性率高于IDC组(89.8%比76.3%，88.1%比70.7%，χ(2)为5.786、8.332，P值均<0.05)。多因素分析结果显示，对于IMPC组患者，T分期(T1－2和T3－4，OR＝5.217，95%CI：1.401～19.430，P＝0.014)是无病生存时间的独立预后因素，T分期(OR＝3.713，95%CI：1.539～8.959，P＝0.004)和淋巴结阳性比例(<50%和≥50%，OR＝2.850，95%CI：1.033～7.862，P＝0.043)是总体生存时间的独立预后因素。对于IDC组患者，病理分期(Ⅰ～Ⅱ期和Ⅲ～Ⅳ期，OR＝1.870，95%CI：1.262～2.771，P＝0.002)、淋巴结阳性比例(OR＝2.222，95%CI：1.561～3.162，P＝0.000)、孕激素受体(OR＝1.856，95%CI：1.118～3.082，P＝0.017)及年龄(<50岁和≥50岁，OR＝0.695，95%CI：0.488～0.989，P＝0.043)是无病生存时间的独立预后因素，淋巴结阳性比例(OR＝2.129，95%CI：1.324～3.425，P＝0.002)是总体生存时间的独立预后因素。与IDC组患者相比，IMPC组患者更易出现局部(区域性)复发(P＝0.006)；尽管IDC组无病生存的中位时间较IMPC组延长(χ(2)＝9.739，P＝0.002)，但是两组总体生存时间相近(χ(2)＝0.787，P＝0.375)。 结论： 尽管IMPC与IDC相比具有侵犯淋巴结和脉管的倾向性，局部(区域性)复发风险较高，但两者的总体生存时间相近。.
Keywords: Breast neoplasms; Carcinoma, papillary; Prognosis.