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  本文選題：乳腺腫瘤 + 浸潤性小葉癌�。� 參考：《腫瘤》2017年11期

【摘要】：目的 :比較晚期乳腺浸潤性小葉癌(invasive lobular carcinoma,ILC)與乳腺浸潤性導(dǎo)管癌(invasive ductal carcinoma,IDC)患者的臨床病理特征及預(yù)后因素。方法:采用回顧性病例對照研究方法,選擇2008年1月—2016年12月天津醫(yī)科大學(xué)腫瘤醫(yī)院收治的59例女性晚期乳腺ILC病例,另按照匹配條件確診年齡和手術(shù)時間(±2年),按1∶4的比例選取同期住院的236例女性晚期乳腺IDC病例。比較2組臨床病理特征和預(yù)后的差異以及預(yù)后相關(guān)因素。結(jié)果:晚期乳腺ILC患者與IDC患者初診時的腫瘤臨床分期、T分期、M分期、組織學(xué)分級、雌激素受體狀態(tài)、孕激素受體狀態(tài)、人表皮生長因子受體2狀態(tài)和分子分型的差異均有統(tǒng)計學(xué)意義(P值均0.05)。對晚期乳腺ILC患者與IDC患者的復(fù)發(fā)/轉(zhuǎn)移特征進(jìn)行比較,結(jié)果顯示ILC患者的中位復(fù)發(fā)年齡為50歲(范圍:28~73歲),IDC患者的中位復(fù)發(fā)年齡為51歲(范圍:27~69歲);2組首次轉(zhuǎn)移部位數(shù)目、淋巴結(jié)轉(zhuǎn)移、內(nèi)臟轉(zhuǎn)移、肺轉(zhuǎn)移和骨轉(zhuǎn)移的差異均有統(tǒng)計學(xué)意義(P值均0.05)。ILC患者的中位無進(jìn)展生存時間為14個月(范圍:2~62個月),IDC患者的中位無進(jìn)展生存時間為11個月(范圍:1~89個月),2組的差異無統(tǒng)計學(xué)意義(P=0.121)。ILC患者的轉(zhuǎn)移后中位生存時間為42個月(范圍:5~78個月),IDC患者的轉(zhuǎn)移后中位生存時間為44個月(范圍:1~110個月),2組的差異無統(tǒng)計學(xué)意義(P=0.392)。多因素分析結(jié)果顯示,孕激素受體狀態(tài)、復(fù)發(fā)/轉(zhuǎn)移年齡和骨轉(zhuǎn)移治療是晚期乳腺ILC患者預(yù)后的獨立影響因素(P值均0.05);分子分型、首次轉(zhuǎn)移部位數(shù)目和胸腔積液是晚期乳腺IDC患者預(yù)后的獨立影響因素(P值均0.05)。結(jié)論:女性晚期乳腺ILC與IDC相比,前者顯示出獨特的臨床病理、復(fù)發(fā)/轉(zhuǎn)移和預(yù)后特征,應(yīng)指導(dǎo)臨床開展個體化的精準(zhǔn)診療。
[Abstract]:Objective: to compare the clinicopathological features and prognostic factors of advanced invasive lobular carcinoma (ILC) and invasive ductal carcinoma (IDC). Methods: a retrospective case-control study was conducted in 59 female patients with advanced breast ILC who were admitted to Tianjin Medical University Oncology Hospital from January 2008 to December 2016. In addition, according to the age of diagnosis and the time of operation (鹵2 years), 236 female patients with advanced breast IDC were selected according to the ratio of 1:4. The differences of clinicopathological features and prognosis and prognostic factors were compared between the two groups. Results: in patients with advanced breast ILC and in patients with IDC, T staging, histological grading, estrogen receptor status, progesterone receptor status, and progesterone receptor status were observed. There were significant differences in the status and molecular typing of human epidermal growth factor receptor 2 (P < 0.05). The characteristics of recurrence / metastasis in patients with advanced breast ILC and those with IDC were compared. The results showed that the median age of recurrence in patients with ILC was 50 years old (range: 28 / 73). The median age of recurrence was 51 years (range: 2769 years). Lymph node metastasis, visceral metastasis, There were significant differences in lung metastasis and bone metastasis. The median progression-free survival time of patients with 0.05).ILC was 14 months (range: 2 ~ 62 months). Median progression free survival time of patients with 0.05).ILC was 11 months (range: 1 ~ 89 months). The median survival time after metastasis was 42 months (range: 5 ~ 78 months). The median survival time of IDC patients was 44 months (range: 1 ~ 110 months). There was no significant difference between the two groups. Multivariate analysis showed that progesterone receptor status, recurrence / metastasis age and bone metastasis were independent factors influencing the prognosis of advanced breast ILC patients (P = 0.05). The number of first metastatic sites and pleural effusion were independent factors influencing the prognosis of patients with advanced breast IDC (P = 0.05). Conclusion: compared with IDC, female advanced breast ILC shows unique clinicopathological features, recurrence / metastasis and prognosis, and should be guided by individualized and accurate diagnosis and treatment.
【作者單位】： 天津醫(yī)科大學(xué)腫瘤醫(yī)院乳腺腫瘤內(nèi)科 國家腫瘤臨床醫(yī)學(xué)研究中心 乳腺癌防治教育部重點實驗室 天津市惡性腫瘤臨床醫(yī)學(xué)研究中心 天津市腫瘤防治重點實驗室;
【基金】：國家科技支撐計劃課題(編號:2015BAI12B15) 天津市衛(wèi)生和計劃生育委員會攻關(guān)項目(編號:16KG128)~~
【分類號】：R737.9

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