目的：探讨含微乳头成分的乳腺浸润性黏液癌（invasive micropapillary mucinous carcinoma, IMpMC）与纯黏液癌（pure mucinous carcinoma, PMC）临床病理特征以及预后的差异。方法：回顾性分析2008年9月至2017年12月上海交通大学乳腺癌数据库中有完整临床病理与随访资料的IMpMC与PMC病人。比较这两类乳腺癌临床病理特征以及预后的差异,分析微乳头成分对黏液癌病人预后的影响。结果：共239例乳腺癌病人入组,其中IMpMC病人27例（11.3%）,PMC病人212例（88.7%）。临床病理特征的多因素分析显示,与PMC相比,IMpMC有较高的淋巴结阳性率（OR=4.84,P=0.014）、较多的脉管浸润（OR=13.38,P=0.001）以及较多的Ki67高表达（OR=4.07,P=0.044）。治疗方面的多因素分析显示,IMpMC比PMC病人较多行乳腺癌根治术（OR=10.00,P=0.003）、辅助化疗（OR=7.11,P<0.001）与放疗（OR=5.33,P=0.006）。PMC病人的5年无病生存率（disease free survival, DFS）和总生存率分别为92.5%和98.6%,高于IMpMC病人的79.2%（P=0.011）和93.8%（P=0.022）。多因素生存分析显示,病理类型和肿瘤直径是影响病人DFS的独立因素。IMpMC较PMC病人有较差的DFS（HR=10.39,P=0.014）。结论：与PMC相比,IMpMC的肿瘤侵袭性较高。IMpMC病人的预后较PMC差。
Objective To investigate differences in clinicopathological features and prognosis between invasive micropapillary mucinous carcinoma (IMpMC) and pure mucinous carcinoma (PMC) of breast. Methods The patients of IMpMC and those of PMC were enrolled in this study retrospectively with clinicopathological and follow-up data from Shanghai Jiao Tong University Breast Cancer Database (SJTU-BCDB) between September 2008 and December 2017. Differences in clinicopathology and prognosis between IMpMC and PMC were analyzed. Results A total of 239 patients were enrolled including 27 (11.3%) cases with IMpMC and 212 (88.7%) cases with PMC. Multivariate analysis on clinicopathological feature showed that there were more cases with IMpMC with lymph node metastasis (OR=4.84, P=0.014), lymphovascular invasion (OR=13.38, P=0.001) and higher expression of Ki67 (OR=4.07, P=0.044) when compared the patients with PMC. Multivariate analysis on treatment showed that radical mastectomy for breast cancer (OR=10.00, P=0.003), adjuvant chemotherapy (OR=7.11, P<0.001) and radiotherapy (OR=5.33, P=0.006) were performed for more cases with IMpMC than for cases with PMC. PMC patients had higher disease free survival (DFS) 92.5% and overall survival (OS) 98.6%, compared to IMpMC patients (DFS 79.2%, P=0.011, OS 93.8%, P=0.022). Pathological type and tumor size were independent factors associated with DFS shown in multivariate analysis. IMpMC patients had lower DFS than PMC patients (HR=10.39, P=0.014). Conclusions IMpMC was associated with aggressive behavior and worse prognosis when compare to PMC.
[1] Barkley CR, Ligibel JA, Wong JS, et al.Mucinous breast carcinoma: a large contemporary series[J]. Am J Surg,2008,196(4):549-551.
[2] Di Saverio S, Gutierrez J, Avisar E.A retrospective review with long term follow up of 11,400 cases of pure mucinous breast carcinoma[J]. Breast Cancer Res Treat,2008,111(3):541-547.
[3] Yu JI, Choi DH, Park W, et al.Differences in prognostic factors and patterns of failure between invasive micropapillary carcinoma and invasive ductal carcinoma of the breast: matched case-control study[J]. Breast,2010, 19(3):231-237.
[4] Nassar H, Wallis T, Andea A, et al.Clinicopathologic analysis of invasive micropapillary differentiation in breast carcinoma[J]. Mod Pathol,2001,14(9):836-841.
[5] Barbashina V, Corben AD, Akram M, et al.Mucinous micropapillary carcinoma of the breast: an aggressive counterpart to conventional pure mucinous tumors[J]. Hum Pathol,2013,44(8):1577-1585.
[6] Ng WK.Fine-needle aspiration cytology findings of an uncommon micropapillary variant of pure mucinous carcinoma of the breast: review of patients over an 8-year period[J]. Cancer,2002,96(5):280-288.
[7] Madur B, Shet T, Chinoy R.Cytologic findings in infiltrating micropapillary carcinoma and mucinous carcinomas with micropapillary pattern[J]. Acta Cytol,2007,51(1):25-32.
[8] Kim HJ, Park K, Kim JY, et al.Prognostic significance of a micropapillary pattern in pure mucinous carcinoma of the breast: comparative analysis with micropapillary carcinoma[J]. J Pathol Transl Med,2017,51(4):403-409.
[9] Liu F, Yang M, Li Z, et al.Invasive micropapillary mucinous carcinoma of the breast is associated with poor prognosis[J]. Breast Cancer Res Treat,2015,151(2):443-451.
[10] Yang YL, Liu BB, Zhang X, et al.Invasive micropapillary carcinoma of the breast: an update[J]. Arch Pathol Lab Med,2016,140(8):799-805.
[11] Amin MB, Edge SB, Greene FL, et al.AJCC Cancer Staging Manual[M]. 8th ed. New York:Springer,2016:621-624.
[12] Goldhirsch A, Winer EP, Coates AS, et al.Personalizing the treatment of women with early breast cancer: highlights of the St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2013[J]. Ann Oncol,2013,24(9):2206-2223.
[13] Lacroix-Triki M, Suarez PH, MacKay A, et al. Mucinous carcinoma of the breast is genomically distinct from invasive ductal carcinomas of no special type[J]. J Pathol,2010,222(3):282-298.
[14] Ranade A, Batra R, Sandhu G, et al.Clinicopathological evaluation of 100 cases of mucinous carcinoma of breast with emphasis on axillary staging and special reference to a micropapillary pattern[J]. J Clin Pathol,2010,63(12):1043-1047.
[15] Shet T, Chinoy R.Presence of a micropapillary pattern in mucinous carcinomas of the breast and its impact on the clinical behavior[J]. Breast J,2008,14(5):412-420.
[16] 刘芳芳, 付丽. 具有微乳头状结构的乳腺黏液癌的临床病理学特征及研究现状[J]. 临床与试验病理学杂志,2013,29(8):896-898.
[17] Gradishar WJ, Anderson BO, Abraham J, et al. NCCN clinical practice guidelines in oncology: Breast Cancer Version 3.2018[EB/OL].[2018-10-25].http://www.nccn.org.
[18] 吴佳毅, 靳疆, 陈伟国, 等. 乳腺黏液癌21基因复发风险评分与临床病理关系[J]. 外科理论与实践,2017,22(5):397-400.
