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目的总结纯型乳腺黏液腺癌(PMBC)的临床病理学特点,并分析其预后及其影响因素。方法回顾性分析四川大学华西医院1996年11月至2011年10月期间收治的经病理学诊断为PMBC的94例患者的临床病理学资料,以及其长期随访结果。结果 1临床病理学特征:本组94例PMBC患者占四川大学华西医院同期乳腺癌的1.48%(94/6 330),均为女性,中位年龄为45岁(29~85岁),中位病程为90 d(5~2 920 d),有63.83%的患者(60/94)尚未绝经;98.94%的患者为单侧PMBC(93/94),1.06%的患者为同时双侧PMBC(1/94),共计95个病灶。有85.29%(58/68)的病灶T分期为T1+T2期,有82.80%(77/93)的病灶未出现淋巴结转移,1.05%(1/95)的病灶就诊时已出现远处转移,92.54%的病灶(62/67)处于Ⅰ+Ⅱ期,雌激素受体(ER)、孕激素受体(PR)及人类表皮生长因子受体-2基因(HER-2/neu)阳性的病灶分别占84.34%(70/83)、74.70%(62/83)和20.25%(16/79);保乳率为6.32%(6/95)。2术前诊断:单纯乳腺X片、单纯彩超检查及乳腺X线+彩超检查的恶性肿块检出率分别为60.87%(14/23)、83.33%(40/48)及100%(18/18),三者比较差异有统计学意义(P=0.006)。3预后及其影响因素:术后76例患者获访,随访率为80.85%,中位随访时间为60个月(19~188个月)。随访期间,有2例患者发生远处转移,其中1例患者死亡。获访患者的5年及10年总生存率均为98.50%,5年及10年无复发生存率均为95.80%。T1期患者均无淋巴结累及,随访中未曾出现复发、转移或者死亡。生存分析的单因素分析结果表明,病程、肿瘤T分期、TNM分期及HER-2/neu基因表达情况均是无复发生存的影响因素(P<0.050)。结论本组PMBC患者较欧美国家有发病年龄较小、绝经前患者居多、HER-2/neu表达阳性率更高、保乳率低及早期转移的趋势。PMBC具有良好的临床病理学特征及预后,病程、肿瘤T分期、TNM分期及HER-2/neu表达情况是其无复发生存的影响因素;乳腺X线联合超声检查可提高PMBC诊断的准确性;对于无保乳禁忌的患者可推荐行保乳手术。
Objective To summarize the clinicopathological features of pure breast mucinous adenocarcinoma (PMBC) and to analyze its prognosis and its influencing factors. Methods The clinical and pathological data of 94 patients with pathologically diagnosed PMBC admitted to West China Hospital of Sichuan University from November 1996 to October 2011 were retrospectively analyzed and the results of their long-term follow-up were retrospectively analyzed. The results of a clinicopathological features: 94 cases of PMBC patients in this group accounted for 1.48% (94/6 330) of breast cancer in West China Hospital of Sichuan University, all female, the median age of 45 years (29 to 85 years), the median The course of disease was 90 d (range 5-2 920 days), 63.83% (60/94) had not yet been menopause, 98.94% had unilateral PMBC (93/94), and 1.06% had bilateral bilateral PMBC (1 / 94), a total of 95 lesions. There were 85.29% (58/68) of the lesions T stage T1 + T2 period, 82.80% (77/93) of the lesions did not show lymph node metastasis, 1.05% (1/95) of the lesions have seen at the time of treatment of distant metastasis, 92.54% of the lesions (62/67) were in stage Ⅰ + Ⅱ, and the lesions of estrogen receptor (ER), progesterone receptor (PR) and human HER-2 gene (HER-2 / neu) Accounting for 84.34% (70/83), 74.70% (62/83) and 20.25% (16/79), respectively; and the rate of breast-conserving was 6.32% (6/95). 2 preoperative diagnosis: simple mammography, simple color Doppler ultrasound and mammography examination of malignant mass detection rates were 60.87% (14/23), 83.33% (40/48) and 100% (18/18 ), The difference between the three was statistically significant (P = 0.006). 3 Prognosis and its influencing factors: 76 patients were followed up, the follow-up rate was 80.85%, the median follow-up time was 60 months (19 to 188 months). During the follow-up period, 2 patients had distant metastases, of which 1 patient died. The 5-year and 10-year overall survival rates were 98.50%. The 5-year and 10-year recurrence-free survival rates were 95.80%. None of T1 patients had lymph node involvement, and no recurrence, metastasis or death occurred during follow-up. The results of univariate analysis of survival analysis showed that disease duration, tumor T stage, TNM stage and HER-2 / neu gene expression were all the factors of recurrence-free survival (P <0.050). Conclusions This group of patients with PMBC has a younger age of onset than those in Europe and the United States. Most patients with pre-menopausal patients have a higher positive rate of HER-2 / neu expression and a lower rate of breast-conserving and early-stage metastasis. PMBC has a good clinical and pathological features and prognosis, duration, tumor T stage, TNM stage and HER-2 / neu expression is the recurrence-free survival factors; mammography combined ultrasound can improve the diagnostic accuracy of PMBC; For breast-conserving contraindications patients may recommend breast-conserving surgery.