微乳头状浸润癌与导管浸润癌比较

　　微乳头状浸润癌是一种特殊类型的乳腺浸润癌，临床特征通常不良。不过，微乳头状浸润癌与导管浸润癌相比，生存结局是否更差尚存争议。

　　2019年1月22日，英国《自然》旗下《科学报告》在线发表复旦大学附属肿瘤医院郝爽、赵源源、任飞、杨文涛、余科达、邵志敏等学者的研究报告，比较了微乳头状浸润癌与导管浸润癌的生存结局。

　　该研究对2008～2012年复旦大学附属肿瘤医院收治的327例微乳头状浸润癌患者和4979例导管浸润癌患者进行回顾分析。通过倾向评分匹配法，将两组患者根据年龄、肿瘤大小、淋巴结状态、激素受体状态、HER2状态按1∶1进行匹配。通过生存曲线分析和多因素比例风险回归模型分析，对生存结局进行比较。

　　结果，共匹配了324对患者。生存曲线分析表明，浸润微乳头癌患者与导管浸润癌患者相比：

• 总体生存相似（风险比：0.905，95%置信区间：0.487～1.683，P=0.752）

• 无病生存相似（风险比：0.901，95%置信区间：0.601～1.352，P=0.616）

　　多因素比例风险回归模型分析表明，无论其他影响因素如何，浸润微乳头癌患者与导管浸润癌患者相比：

• 无病生存相似（风险比：0.944，95%置信区间：0.601～1.481，P=0.802）

• 总体生存相似（风险比：0.727，95%可信区间：0.358～1.478，P=0.379）

　　因此，该研究结果表明，微乳头状浸润癌与导管浸润癌相比，生存结局并无统计学显著差异，并不需要过度或根治性临床治疗。

Sci Rep. 2019 Jan 22. [Epub ahead of print]

Invasive micropapillary carcinoma of the breast had no difference in prognosis compared with invasive ductal carcinoma: a propensity-matched analysis.

Hao S, Zhao YY, Peng JJ, Ren F, Yang WT, Yu KD, Shao ZM.

Cancer Center and Cancer Institute, Shanghai Medical College, Fudan University, Shanghai, China; Shanghai Medical College, Fudan University, Shanghai, China; Fourth People's Hospital of Zhenjiang, Jiangsu, China; Institute of Biomedical Science, Fudan University, Shanghai, China.

Invasive micropapillary carcinoma (IMPC) is a rare histopathological variant of breast carcinoma that is usually associated with poor clinical characteristics. Whether IMPC has worse prognosis than invasive ductal carcinoma (IDC) is controversial. This retrospective study examined the prognostic difference between IMPC and IDC. We analysed 327 cases of IMPC patients and 4979 IDC cases who underwent primary resection in our institution between 2008 and 2012. Using propensity score matching, the two groups were matched at 1:1 by age, tumour size, nodal status, hormone status, and HER2 status. Differences in prognosis were assessed by Kaplan-Meier estimates and Cox regression analysis. We established the IMPC group and identified 324 IDC patients by propensity score matching. The survival analysis indicated that IMPC patients had no significant reduced overall survival (p = 0.752) or disease-free survival (p = 0.578) compared with IDC patients. Multivariate Cox regression analysis revealed that IMPC was not an independent prognostic factor for disease-free survival (hazard ratio [HR] = 0.944; 95% confidential interval [CI], 0.601-1.481) or overall survival (HR = 0.727; 95% CI, 0.358-1.478). Survival analysis demonstrated no statistically significant difference between IMPC and IDC, indicating that proactive or radical clinical therapy is unnecessary.

PMID: 30670771

DOI: 10.1038/s41598-018-36362-8