CAJ | 학술논문

目的：探讨乳腺浸润性小叶癌( invasive lobular carcinoma, ILC)的临床病理特征及其预后因素。方法回顾性分析98例ILC和530例乳腺非特殊型浸润性癌患者的临床病理资料,观察ILC的临床病理特征及其预后因素。结果 ILC和非特殊型浸润性癌的中位随访时间分别为68．5、67个月。与非特殊型浸润性癌相比,ILC患者就诊时年龄较大,肿瘤较大,组织学分级多为2级,ER、PR阳性率高,HER-2多为阴性,Ki-67增殖指数较低,分子分型多为管腔A型(P<0．001)。 ILC中,经典型ILC肿瘤较小,组织学分级较低,Ki-67增殖指数较低,分子分型中管腔A型较多；非经典型ILC中管腔B型、三阴型和HER-2过表达型较多(P=0．035)。单因素分析显示经典型与非经典型ILC的无病生存率和总生存率差异均有统计学意义(P=0．043,P=0．048)；ILC与非特殊型浸润性癌的无病生存率和总生存率差异无统计学意义(P=0．537,P=0．397)；多因素分析显示,ILC中管腔A型患者的总生存率明显高于三阴型和HER-2过表达型(P=0．016,P=0．015)。结论 ILC的预后和组织学分型与分子分型有关,应为预后较差的患者探寻新的治疗策略。
목적：탐토유선침윤성소협암( invasive lobular carcinoma, ILC)적림상병리특정급기예후인소。방법회고성분석98례ILC화530례유선비특수형침윤성암환자적림상병리자료,관찰ILC적림상병리특정급기예후인소。결과 ILC화비특수형침윤성암적중위수방시간분별위68．5、67개월。여비특수형침윤성암상비,ILC환자취진시년령교대,종류교대,조직학분급다위2급,ER、PR양성솔고,HER-2다위음성,Ki-67증식지수교저,분자분형다위관강A형(P<0．001)。 ILC중,경전형ILC종류교소,조직학분급교저,Ki-67증식지수교저,분자분형중관강A형교다；비경전형ILC중관강B형、삼음형화HER-2과표체형교다(P=0．035)。단인소분석현시경전형여비경전형ILC적무병생존솔화총생존솔차이균유통계학의의(P=0．043,P=0．048)；ILC여비특수형침윤성암적무병생존솔화총생존솔차이무통계학의의(P=0．537,P=0．397)；다인소분석현시,ILC중관강A형환자적총생존솔명현고우삼음형화HER-2과표체형(P=0．016,P=0．015)。결론 ILC적예후화조직학분형여분자분형유관,응위예후교차적환자탐심신적치료책략。
Purpose To investigate the clinicopathological characteristics and the survival outcomes of invasive lobular carcinoma. Methods A retrospective analysis of 98 patients with invasive lobular carcinoma and 530 invasive carcinoma of no special type was performed in order to observe the histological features and the clinical outcomes of invasive lobular carcinoma. Results Median follow-up was 68. 5 months for invasive lobular carcinoma and 67 months for invasive carcinoma of no special type. Invasive lobular carcinoma presented with a larger tumor size, more histopathological grade 2 tumors, increased rate of hormonal receptor positivity, human epider-mal growth factor 2 (HER-2) negativity, and had a lower proliferative index as compared to invasive carcinoma of no special type, more frequently presented with the luminal A subtype (P<0. 001). The classical invasive lobular carcinoma presented with a smaller tumor size, to have a lower histological grade and proliferative index compared to the non-classic type, and more frequently presented with the luminal A subtype, whereas the non-classic invasive lobular carcinoma patients more frequently presented with the luminal B, HER-2 overexpression, or triple negative subtype (P=0. 035). A statistically significant difference in the outcome was observed at un-ivariate analysis for patients with non-classic for disease-free survival (P=0. 043) and for overall survival (P=0. 048), as compared with patients with classical invasive lobular carcinoma. The disease-free survival difference between the invasive lobular carcinoma and the invasive carcinoma of no special type was not significant (P=0. 537), and the overall survival rates were not statistically different between the two groups (P=0. 397). A statistically significant difference of overall survival was observed at multivariate analysis for patients with HER-2 positive and triple negative subtypes versus patients with luminal A invasive lobular carcinoma (P=0. 015, P=0. 016) . Conclusions The outcome of invasive lobular carcinoma is significantly correlated with histological and immunohistochemi-cally defined molecular subtypes. New tailored strategies should be explored in these subgroups of patients with poor outcome.