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目的随着乳腺X射线摄影技术的进步及普及,使得乳腺导管原位癌伴微小浸润(ductal carcinoma in situ with microinvasion,DCIS-MI)在乳腺癌中比例增高,但所占比例<1.0%。由于DCIS-MI术前确诊困难,病理和预后不同,同时缺乏大规模的循证医学证据指导治疗方案的选择,并存在着诸多争议,现已成为临床医师及病理医师普遍关注的热点。本研究总结和分析DCIS-MI的临床病理特征,加深对DCIS-MI的认识并探讨其合理的治疗方式。方法回顾性分析2004-01-01-2014-12-31新疆医科大学附属肿瘤医院收治的318例患者的临床病理资料,其中乳腺导管原位癌(ductal carcinoma in situ,DCIS)患者239例,DCIS-MI患者79例。结果DCIS与DCIS-MI在核分级(χ~2=29.699,P<0.001)、粉刺型(χ~2=26.242,P<0.001)、ER(χ~2=11.807,P=0.001)、PR(χ~2=7.623,P=0.006)、Ki-67阳性表达率(χ~2=5.185,P=0.023)、分子分型(χ~2=16.570,P<0.001)和手术方式(χ~2=29.713,P<0.001)方面均不同,差异均有统计学意义。在年龄(χ~2=4.563,P=0.102)、民族(χ~2=2.102,P=0.147)、月经情况(χ~2=0.455,P=0.500)、肿块位置(χ~2=0.267,P=0.605)、临床表现〔包括乳房肿块(χ~2=1.393,P=0.238)、乳头改变(χ~2=1.345,P=0.246)、无症状(χ~2=3.077,P=0.079)〕、钙化(χ~2=0.010,P=0.920)、肿块的大小(χ~2=3.370,P=0.066)和HER-2阳性表达率(χ~2=0.317,P=0.574)方面差异均无统计学意义。中位随访时间为66个月,共有4例患者复发,其中DCIS组有2例胸壁复发,复发率为0.8%(2/239);DCIS-MI组有2例胸壁复发,复发率为2.5%(2/79)。DCIS组和DCIS-MI组复发率(χ~2=1.373,P=0.241)和总生存率(χ~2=1.397,P=0.237)相比,差异无统计学意义。DCIS与DCIS-MI的复发与手术方式、核分级、微浸润和腋窝淋巴结清除差异均无统计学意义,P>0.05。结论 DCIS-MI预后较好,是一种少见的乳腺癌亚型。DCIS-MI与DCIS的腋窝淋巴结转移率和预后无差别,提示对DCIS-MI的处理应该按照DCIS的治疗方式进行处理。
Objective With the progress and popularization of mammography, the proportion of breast ductal carcinoma in situ with microinvasion (DCIS-MI) increased in breast cancer, but the proportion was less than 1.0%. Because DCIS-MI preoperative diagnosis difficulties, pathology and prognosis are different, while the lack of large-scale evidence-based medical evidence to guide the choice of treatment options, and there are many controversies, clinicians and pathologists have now become the hot spot of general concern. This study summarizes and analyzes the clinicopathological features of DCIS-MI, deepens its understanding of DCIS-MI and discusses its reasonable treatment. Methods The clinical and pathological data of 318 patients admitted to the Tumor Hospital Affiliated to Xinjiang Medical University from January 2004 to January 2014 were analyzed retrospectively. Among them 239 patients with ductal carcinoma in situ (DCIS), DCIS -MI patients in 79 cases. Results DCIS and DCIS-MI showed significant differences in nuclear grade (χ ~ 2 = 29.699, P <0.001), acne type (χ ~ 2 = 26.242, P <0.001) The positive rates of Ki-67 (χ ~ 2 = 5.185, P = 0.023), molecular typing (χ ~ 2 = 7.623, P = 0.006) = 29.713, P <0.001), the differences were statistically significant. There were significant differences in age (χ ~ 2 = 4.563, P = 0.102), nationality (χ ~ 2 = 2.102, P = 0.147), menstrual status (χ ~ 2 = 0.455, P = 0.500) (Χ ~ 2 = 1.345, P = 0.246), asymptomatic (χ ~ 2 = 3.077, P = 0.079) (Χ ~ 2 = 0.010, P = 0.920), tumor size (χ ~ 2 = 3.370, P = 0.066) and HER-2 positive rate No statistical significance. The median follow-up time was 66 months. A total of 4 patients relapsed, including 2 cases of DCIS recurrence of chest wall, the recurrence rate was 0.8% (2/239); DCIS-MI group 2 cases of chest wall recurrence, the recurrence rate was 2.5% (2/79). The recurrence rate (χ ~ 2 = 1.373, P = 0.241) and the overall survival rate (χ ~ 2 = 1.397, P = 0.237) in DCIS group and DCIS-MI group were not significantly different. There was no significant difference between DCIS and DCIS-MI in the recurrence, operation mode, nuclear grade, microinvasion and axillary lymph node clearance (P> 0.05). Conclusions DCIS-MI has a good prognosis and is a rare subtype of breast cancer. There was no difference in axillary lymph node metastasis and prognosis between DCIS-MI and DCIS, suggesting that the treatment of DCIS-MI should be treated according to the DCIS treatment.