乳腺导管原位癌伴微浸润的临床病理特点及远期预后

Clinicopathological Features and Long-Term Prognosis of Breast Ductal Carcinoma in Situ with Microinvasion

摘要: 目的：为进一步了解乳腺导管原位癌伴微浸润的生物学特点，比较乳腺导管原位癌(DCIS)、导管原位癌伴微浸润(DCIS-MI)及导管原位癌伴T1a乳腺癌(DCIS-T1a)的临床病理特点及远期预后。方法：回顾性分析了青岛大学附属医院乳腺病诊疗中心确诊的乳腺癌患者资料，病例收集时间为2008年2月~2017年5月，共554例，其中导管原位癌(DCIS)组患者237例，导管原位癌伴微浸润(DCIS-MI)患者104例和DCIS伴T1a浸润性乳腺癌(DCIS-T1a)患者213例，比较不同亚组间的临床病理特征。结果：DCIS、DCIS-MI和DCIS-T1a在临床病理特点存在差异。DCIS和DCIS-MI组患者较DCIS-T1a组年轻(P = 0.042)。雌激素受体(ER)状态、孕激素受体(PR)状态及Ki-67指数，均呈现显著组间差异(P < 0.001)；三组患者的分子分型分布也同样呈现显著统计学差异(P < 0.001)。在手术方式选择、化疗及内分泌治疗方面，三组患者间存在统计学差异(P < 0.001)。远期预后方面，5年DFS分别为94.4%、94%、95.8%；十年DFS分别为89.9%、91.5%、91.3%，三组患者的远期预后差异无统计学意义(P = 0.952)。结论：DCIS-MI代表一个独立的实体，这表明当发现DCIS具有激素受体阴性、HER-2阳性和Ki67高表达等特征时，应检查是否伴随微浸润。但与导管原位癌及导管原位癌伴T1a乳腺癌的预后差异并不明显，本结论有待后续更大样本量的研究进行验证。

Abstract: Objective: To further understand the biological characteristics of breast ductal carcinoma in situ with microinvasion, the clinicopathological features and long-term prognosis of ductal carcinoma in situ (DCIS), ductal carcinoma in situ with microinvasion (DCIS-MI) and ductal carcinoma in situ with T1a breast cancer (DCIS-T1a) were compared. Methods: The data of breast cancer patients diagnosed by the Diagnosis and Treatment Centre of Breast Diseases of the Affiliated Hospital of Qingdao University were analyzed retrospectively. The cases were collected from February 2008 to May 2017, with a total of 554 cases, including 237 patients with DCIS, 104 patients with DCIS-MI and 213 patients with DCIS-T1a. The clinicopathological features of different subgroups were compared. Results: There are differences among DCIS, DCIS-MI and DCIS-T1a in clinicopathological features. The patients in the DCIS and DCIS-MI groups were younger than those in the DCIS-T1a group (P = 0.042). There were significant differences in estrogen receptor (ER) status, progesterone receptor (PR) status and Ki-67 index among the three groups (P < 0.001); the molecular typing distribution of the three groups also showed significant statistical differences (P < 0.001). There were significant differences in the choice of operation, chemotherapy and endocrine therapy among the three groups (P < 0.001). In terms of long-term prognosis, the DFS (within 5 years) was 94.4%, 94% and 95.8% respectively, and the DFS (within 10 years) was 89.9%, 91.5% and 91.3%, respectively. There was no significant difference in long-term prognosis among the three groups (P = 0.952). Conclusion: DCIS-MI represents an independent entity, which indicates that when DCIS is found to possess features including hormone receptor negativity, HER-2 positivity and high Ki67 expression, it should be checked for coexisting microinvasion. However, the difference of prognosis between DCIS, DCIS-MI and DCIS-T1a is not obvious. Further studies with larger sample size are needed to replicate our observations.