Prognosis of invasive micropapillary carcinoma versus invasive ductal carcinoma of the breast: a comparative analysis after propensity score matching

doi:10.16139/j.1007-9610.2021.04.014

Abstract

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

CLC Number:

R737.9

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.

Figures/Tables 7

References 31

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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)	—	—	—