CAJ | 학술논문

目的探讨乳腺癌肉瘤的临床特征、诊治要点和预后.方法回顾性分析1976年1月至2008年1月收治的25例乳腺癌肉瘤患者的临床和病理资料,并对患者年龄、肿瘤大小、腋淋巴结转移情况和治疗方式等因素与预后的关系进行统计学分析.Kaplan-Meicr法计算生存率,Log rank法进行预后单因素分析,Cox比例风险回归模型进行预后多因素分析.结果 25例乳腺癌肉瘤患者均为女性,中位年龄56岁.肿瘤平均直径为5.1 cm.术前钼靶、超声和空心针吸病理检查误诊率高,主要诊断依据为术后病理组织检查.雌激素受体和孕激素受体、人表皮生长因子受体2的阳性表达率分别为8.3％和7.7％.25例乳腺癌肉瘤中,癌成分以浸润性导管癌为主,占92.3％；肉瘤成分以纤维肉瘤为主,占 46.2％.25例患者的5年生存率为57.9％,中位生存时间为86个月.单因素分析结果显示,肿瘤大小(P=0.012)和治疗方式(P=0.028)是影响预后的因素,而患者年龄和腋淋巴结转移情况与预后无关.多因素分析显示,治疗方式是影响预后的独立因素(P =0.047).结论乳腺癌肉瘤发病率低,临床特征缺乏特异性,确诊主要依据术后病理.肿瘤大小和治疗方式是影响患者预后的因素,以根治性手术为主的综合治疗是乳腺癌肉瘤的最佳治疗方式.乳腺癌肉瘤的ER和PR及HER-2阳性率低,探索新的治疗靶点是今后的研究方向之一.
목적 탐토유선암육류적림상특정、진치요점화예후.방법 회고성분석1976년1월지2008년1월수치적25례유선암육류환자적림상화병리자료,병대환자년령、종류대소、액림파결전이정황화치료방식등인소여예후적관계진행통계학분석.Kaplan-Meicr법계산생존솔,Log rank법진행예후단인소분석,Cox비례풍험회귀모형진행예후다인소분석.결과 25례유선암육류환자균위녀성,중위년령56세.종류평균직경위5.1 cm.술전목파、초성화공심침흡병리검사오진솔고,주요진단의거위술후병리조직검사.자격소수체화잉격소수체、인표피생장인자수체2적양성표체솔분별위8.3％화7.7％.25례유선암육류중,암성분이침윤성도관암위주,점92.3％；육류성분이섬유육류위주,점 46.2％.25례환자적5년생존솔위57.9％,중위생존시간위86개월.단인소분석결과현시,종류대소(P=0.012)화치료방식(P=0.028)시영향예후적인소,이환자년령화액림파결전이정황여예후무관.다인소분석현시,치료방식시영향예후적독립인소(P =0.047).결론 유선암육류발병솔저,림상특정결핍특이성,학진주요의거술후병리.종류대소화치료방식시영향환자예후적인소,이근치성수술위주적종합치료시유선암육류적최가치료방식.유선암육류적ER화PR급HER-2양성솔저,탐색신적치료파점시금후적연구방향지일.
Objective To improve the recognition,appropriate diagnosis and treatment of breast carcinosarcoma through analysis of their clinical features,diagnosis,management and prognosis.Methods The clinicopathological data from 25 patients with breast carcinosarcoma treated in our hospital between January 1976 and January 2008 were retrospectively reviewed.The correlation between prognosis and age,tumor size,axillary node status,and treatment modality was analyzed using the statistical software SPSS 13.0.The survival rate was calculated by Kaplan-Meier analysis and compared using log-rank test.Univariate and multivariate factors for survival were analyzed using Cox proportional hazards regression model.Results All patients were female and their median age was 56-years.The median tumor diameter was 5.1 cm.The misdiagnosis rate was high by mammography,B-ultrasound and pathological examination of needle aspiration biopsy before operation. So that the diagnosis primarily depended on postoperative histopathologic examination.The ER/PR and HER-2 positive rate of the breast carcinosarcomas was 8.3％ and 7.7％,respectively.Invasive ductal carcinoma was the main malignant component accounting for 92.3％,while the sarcoma element was constitutive of fibrosarcoma with a proportion of 46.2％.The overall 5-year survival rate was 57.9％ with a median survival time of 86 months after a median follow-up of 52 months.Univariate factor analysis showed that the tumor size ( P =0.012 ) and treatment methods ( P =0.028 ) were impact factors,while age and axillary lymph node status were not significantly related with prognosis. Cox multivariate analysis validated that the therapy modality was an independent prognostic factor for breast carcinosarcoma (P =0.047 ).Conclusions Breast carcinosarcoma is rare and its clinical features are not specific,so that its final diagnosis is mainly based on the postoperative pathology.Tumor size and treatment modality are independent prognostic factors,so the comprehensive therapy mainly based on radical resection is the best treatment modality.The positive expression of ER/PR and HER-2 in breast carcinosarcoma is low,while exploring new target is one of future research directions.