乳腺浸润性微乳头状癌与导管癌的预后比较—基于倾向性评分匹配的分析

doi:10.16139/j.1007-9610.2021.04.014

摘要/Abstract

摘要：

目的：采用倾向性评分匹配（propensity score matching, PSM）分析乳腺浸润性微乳头状癌（invasive micropapillary carcinoma, IMPC）与浸润性导管癌（invasive ductal carcinoma, IDC）的预后差异及其影响因素。方法：回顾性分析2011年1月至2017年12月上海交通大学乳腺癌数据库内IMPC与IDC病人的临床病理、治疗方案及随访资料。采用PSM均衡组间混杂因素,比较匹配后两组预后差异,分析预后影响因素。结果：共有111例IMPC及2 865例IDC病人。IMPC组雌激素受体阳性、孕激素受体阳性、人类表皮生长因子受体2阳性、淋巴结转移、乳房切除及内分泌治疗比例明显高于IDC组（均P<0.05）。IMPC组无乳腺癌生存（breast cancer-free interval, BCFI）率显著低于IDC组（P=0.022）。两组的总生存（overall survival, OS）率差异无统计学意义（P=0.268）。经PSM匹配109对病人,匹配后两组临床病理特征及治疗方案间差异无统计学意义（均P>0.05）。两组BCFI率及OS率差异无统计学意义（均P>0.05）。多因素分析显示淋巴结转移>3枚是BCFI的独立危险因素。结论：条件匹配情况下,IMPC和IDC组预后相似,转移淋巴结>3枚是预后的独立危险因素。

关键词: 乳腺癌, 浸润性微乳头状癌, 浸润性导管癌, 倾向性评分匹配法, 预后

Abstract:

Objective To investigate the difference in prognosis between invasive micropapillary carcinoma (IMPC) and invasive ductal carcinoma(IDC) of the breast and the factors influencing the prognosis of breast carcinoma using propensity score matching (PSM). Methods The retrospective study was performed enrolling the patients with IMPC or IDC in Shanghai Jiao Tong University Breast Cancer Database and the data of clinicopathological characteristics and treatments and follow-up from January 2011 to December 2017. The differences in clinicopathological characteristics and treatments between IMPC and IDC were analyzed. PSM was conducted to balance the confounding factors between IMPC group and IDC group. The difference in prognosis and the factors influencing prognosis of breast carcinoma between two groups after PSM were analyzed. Results A total of 111 cases in IMPC group and 2 865 cases in IDC group were studied. There were more cases in IMPC group who had the expression including estrogen receptor, progesterone receptor and human epidermal growth factor receptor 2, and lymph node metastasis, mastectomy and endocrine therapy when compared those with the cases in IDC group (P<0.05). The rate of breast cancer-free interval (BCFI) in IMPC group was significantly lower than that in IDC group (P=0.022). No significant difference was present in rate of overall survival (OS) between two groups (P=0.268). There were 109 pairs of patients after PSM. The significant difference was not found in clinicopathological characteristics and treatments (P>0.05), and in the rate of BCFI or the rate of OS (P>0.05) between IMPC group and IDC group. It was shown in multivariate analysis of clinicopathological characteristics and treatments that the index of more than 3 positive lymph nodes was an independent risk factor associated with BCFI. Conclusions The prognosis was similar between IMPC and IDC after PSM and the index of more than 3 positive lymph nodes could be an independent risk factor of prognosis.

Key words: Breast carcinoma, Invasive micropapillary carcinoma, Invasive ductal carcinoma, Propensity score matching, Prognosis

中图分类号:

R737.9

陈园园, 叶欣, 汤永喆, 王杰, 何奇. 乳腺浸润性微乳头状癌与导管癌的预后比较—基于倾向性评分匹配的分析[J]. 外科理论与实践, 2021, 26(04): 353-360.

CHEN Yuanyuan, YE Xin, TANG Yongzhe, WANG Jie, HE Qi. Prognosis of invasive micropapillary carcinoma versus invasive ductal carcinoma of the breast: a comparative analysis after propensity score matching[J]. Journal of Surgery Concepts & Practice, 2021, 26(04): 353-360.

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变量	匹配前（n=2 976）			匹配后（n=218）
变量	IDC(n=2 865)	IMPC(n=111)	P值	IDC(n=109)	IMPC(n=109)	P值
年龄（岁）			0.517			0.467
<50	936(32.7)	33(29.7)		37(33.9)	32(29.4)
≥50	1 929(67.3)	78(70.3)		72(66.1)	77(70.6)
肿瘤直径（cm）			0.662			0.782
≤2	1 662(58.0)	67(60.4)		64(58.7)	66(60.6)
2（不包括2）~5	1 203(42.0)	44(39.6)		45(41.3）	43(39.4)
组织学分级			0.224			0.343
Ⅰ~Ⅱ级	1 536(53.6)	53(47.7)		59(54.1)	52(47.7)
Ⅲ级	1 329(46.4)	58(52.3)		50(45.9)	57(54.1)
Ki67表达			0.102			0.781
低	875(30.5)	42(37.8)		43(39.4）	41(37.6）
高	1 990(69.5)	69(62.2)		66(60.6)	68(62.4)
淋巴结转移数（枚）			<0.001^a)			0.565
N₀(0)	1 793(62.6)	46(41.4)		50(45.9)	46(42.2)
N₁(1~3)	693(24.2)	30(27.1)		30(27.5)	30(27.5)
N₂(4~9)	236(8.2)	19(17.1)		12(11.0)	19(17.4)
N₃(≥10)	143(5.0)	16(14.4)		17(15.6)	14(12.9)
ER			0.020^a)			0.862
阴性	806(28.1)	20(18.0)		21(19.3)	20(18.3)
阳性	2 059(71.9)	91(82.0)		88(80.7)	89(81.7)
PR			0.031^a)			0.660
阴性	1 144(39.9)	33(29.7)		35(32.1)	32(29.4)
阳性	1 721(60.1)	78(70.3)		74(67.9)	77(70.7)
HER2			0.043^a)			0.880
阴性	2 268(79.2)	79(71.7)		78(71.6)	79(72.5)
阳性	597(20.8)	32(28.8)		31(28.4)	30(27.5)
TNM分期			<0.001^a)			0.566
Ⅰ	1 184(40.1)	33(27.6)		40(36.7)	33(30.3)
Ⅱ	1 215(44.1)	43(40.8)		37(33.9)	43(39.4)
Ⅲ	430(15.7)	35(31.6)		32(29.4)	33(30.3)
分子分型			0.006^a)			0.353
Luminal A	501(17.5)	21(18.9)		21(19.2)	21(19.2)
Luminal B	1 585(55.3)	74(66.7)		67(61.5)	72(66.1)
HER2过表达	300(10.5)	11(9.9)		9(8.3)	11(10.1)
三阴性	479(16.7)	5(4.5)		12(11.0)	5(4.6)

变量	PSM前（n=2 976）			PSM后（n=218）
变量	IDC(n=2 865)	IMPC(n=111)	P值	IDC(n=109)	IMPC(n=109)	P值
手术方式			<0.001^a)			1
保乳	1 037(36.2)	20(18.0)		20(18.3)	20(18.3)
乳房切除	1 828(63.8)	91(82.0)		89(81.7)	89(81.7)
化疗			0.250			0.865
是	2 188(76.4)	90(81.1)		87(58.7)	88(60.6)
否	677(23.6)	21(18.9)		22(41.3）	21(39.4)
放疗			0.174			0.777
是	1 594(55.6)	69(62.2)		71(65.1)	69(63.3)
否	1271(44.4)	42(37.8)		38(34.9)	40(36.7)
内分泌治疗			0.010^a)			1
是	1 996(69.7)	90(81.1)		88(80.7）	88(80.7）
否	869(30.3)	21(18.9)		21(19.3)	21(19.3)
靶向治疗			0.081			0.869
是	466(16.3)	25(22.5)		24(22.0)	23(21.1)
否	2 399(83.7)	86(77.5)		85(78.0)	86(78.9)

项目临床病理特征		联合组P值	IMPC组P值	IDC组P值
年龄（岁）	（<50,≥50）	0.126	0.013^a)	0.609
病理类型	（IMPC,IDC）	0.190	—	—
ER	（阳性,阴性）	<0.001^a)	0.082	0.006^a)
PR	（阳性,阴性）	0.156	0.241	0.310
HER2	（阴性,阳性）	0.040^a)	0.045^a)	0.246
Ki67	（低,高）	0.142	0.596	0.09
分子分型	（Luminal A,B,HER2过表达,三阴性）	0.006^a)	0.163	0.019^a)
组织学分级	（Ⅰ~Ⅱ,Ⅲ）	0.013^a)	0.056	0.126
肿瘤直径（cm）	（≤2.0,>2.0）	0.084	0.837	0.018^a)
淋巴结转移数（枚）	（≤3,>3）	<0.001^a)	0.016^a)	0.001^a)
TNM分期	（Ⅰ,Ⅱ,Ⅲ期）	0.003^a)	0.318	0.006^a)
手术方式	（乳房保留,切除）	0.529	0.941	0.184
化疗	（是,否）	0.071	0.245	0.220
放疗	（是,否）	0.005^a)	0.171	0.021^a)
内分泌治疗	（是,否）	0.001^a)	0.088	0.006^a)
靶向治疗	（是,否）	0.360	0.292	0.725

临床病理特征		联合组			IMPC组			IDC组
临床病理特征		HR	95%CI	P值	HR	95%CI	P值	HR	95%CI	P值
ER	（阳性,阴性）	2.960	1.286~6.811	0.011^a)	—	—	—	5.487	1.646~18.286	0.006^a)
淋巴结转移数（枚）	（≤3,>3）	4.742	2.111~10.651	<0.001^a)	4.029	1.443~11.254	0.008^a)	7.734	2.039~29.335	0.003^a)
年龄（岁）	（<50,≥50）	—	—	—	0.276	0.091~0.838	0.023^a)	—	—	—