乳腺恶性肿瘤包括来源于上皮组织的乳腺癌、来源于结缔组织的乳腺肉瘤。乳腺肉瘤比较少见，其临床病理特征和生存结局尚不明确。
2019年12月5日，欧洲乳腺癌专科医师学会《乳腺》在线发表复旦大学附属肿瘤医院林叔陈、刘畅、陶中华、张剑、胡夕春等学者的大数据分析报告，对乳腺肉瘤与乳腺导管浸润癌的临床病理特征和临床结局进行了比较。
该研究对2010～2015年美国国家癌症研究所NCI监测流行病学最终结果SEER数据库进行检索，其中乳腺肉瘤患者仅63例、乳腺导管浸润癌患者达20万596例，随后对两组患者进行比较。由于两组患者数量悬殊，故通过倾向评分匹配，对基本临床病理因素差异的影响进行平衡。通过多因素比例风险回归模型，对可能影响乳腺肉瘤患者生存结局的因素进行分析。
结果，乳腺肉瘤与乳腺导管浸润癌相比，分级较高、分期较高、肿瘤较大、淋巴结转移比例较低、三阴性乳腺癌比例较高、总生存和乳腺癌相关生存结局显著较差。
通过倾向评分匹配，对分布不均的临床病理因素进行校正后，上述不同之处仍然显著。
亚组分析进一步表明，三阴性乳腺肉瘤与三阴性乳腺导管浸润癌相比，临床结局显著较差。
最终，通过多因素比例风险回归模型，确定了独立的生存结局影响因素：分期、肿瘤大小、远处转移，无论其他因素如何变化。
因此，该研究结果表明，乳腺肉瘤与常见的乳腺导管浸润癌相比，临床病理特征比较独特、三阴性比例较高、临床结局显著较差。
Breast. 2019 Dec 5;49:157-164. [Epub ahead of print]
Clinicopathological characteristics and survival outcomes in breast carcinosarcoma: A SEER population-based study.
Shuchen Lin, Chang Liu, Zhonghua Tao, Jian Zhang, Xichun Hu.
Fudan University Shanghai Cancer Center, Shanghai, China; Shanghai Medical College, Fudan University, Shanghai, China.
HIGHLIGHTS
Breast carcinosarcoma correlates with a higher proportion of triple negative breast cancer than invasive ductal carcinoma.
Triple negative breast carcinosarcoma correlates with worse prognosis than triple negative invasive ductal carcinoma.
Stage, tumor size, and distant metastasis were independent prognostic factors for breast carcinosarcoma.
OBJECTIVES: Carcinosarcoma of the breast is a rare disease. Its clinicopathological features and prognosis are not well defined. The aim of this study was to compare the clinicopathological features and clinical outcome between breast carcinosarcoma and breast invasive ductal carcinoma (IDC).
MATERIALS AND METHODS: Patients with breast carcinosarcoma and breast IDC were identified through the Surveillance, Epidemiology, and End Results (SEER) database from 2010 to 2015. Then a comparison was conducted between these two groups. Propensity score matching (PSM) was performed to balance the effects of baseline clinicopathological differences. The Cox proportional hazard model was used to identify potential prognostic factors of breast carcinosarcoma.
RESULTS: In total, we identified 63 patients with breast carcinosarcoma and 200,596 cases with breast IDC. Comparing with IDC, breast carcinosarcoma was significantly correlated with higher grading, higher staging, larger tumor size, lower lymph node involvement, and a higher proportion of triple negative breast cancer (TNBC), suggesting a significantly worse clinical outcome. After adjusting for the uneven clinicopathological variables with PSM, significant differences were still observed between these two histology types. Subgroup analysis further showed that carcinosarcoma-TNBC has an inferior clinical outcome compared with IDC-TNBC. Finally, we identified independent prognostic factors, namely, stage, tumor size, and distant metastasis.
CONCLUSION: It is concluded that breast carcinosarcoma has distinct clinicopathological features and a significantly worse clinical outcome than common IDC.
KEYWORDS: Carcinosarcoma; Invasive ductal carcinoma; SEER; Prognosis; Cancer-specific survival
DOI: 10.1016/j.breast.2019.11.008
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