CAJ | 학술논문

目的：探讨乳腺浸润性微乳头状癌（invasive micropapillary carcinoma， IMPC）和浸润性癌（非特殊型）（inva-sive carcinoma of no special type， NST）的临床病理特征差异及其与腋窝淋巴结转移的相关性。方法回顾性分析2010年8月至2013年8月北京协和医院92例IMPC手术患者的临床病理资料，随机选取368例同期手术的NST患者作为对照组。比较IMPC和NST的临床病理特征并分析其腋窝淋巴结转移的影响因素。结果 IMPC与NST在肿瘤大小[（2.9±1.9） cm比（2.1±1.4） cm， P＝0.001]、脉管浸润率（85.9％比6.0％， P ＜0.001）、腋窝淋巴结转移率（71.7％比47.3％， P ＜0.001）及转移个数（8.2±9.9比2.9±5.7， P＜0.001）、孕激素受体表达（P＝0.047）、人类表皮生长因子受体2（hu-man epidermal growth factor receptor-2， HER-2）表达（P＝0.009）、 Ki-67指数（P＜0.001）以及TNM分期（P＜0.001）、分子分型（ P＜0.001）方面的差异均具有统计学意义。肿瘤组织中 IMPC 成分≤24％、25％～49％、50％～75％以及≥76％者淋巴结转移率分别为73.9％、56.3％、72.2％和77.1％， IMPC的腋窝淋巴结转移率与其在肿瘤中所占比例无关（P＝0.347），与肿瘤T分期（P＝0.001）、 HER-2表达（P＝0.029）、分子分型（P＝0.003）、 P53表达（P＝0.003）以及Ki-67指数（P＝0.045）相关。 NST的腋窝淋巴结转移与肿瘤T分期（P＜0.001）、组织学分级（P＝0.001）、脉管浸润（P＜0.001）、雌激素受体α（P ＝0.007）、孕激素受体（P ＝0.031）、 HER-2表达（P ＝0.008）及分子分型（P ＜0.001）均相关。结论 IMPC是一种具有高脉管侵袭性、高腋窝淋巴结转移率的浸润性乳腺癌，具有与NST不同的病理特征。 IMPC成分的多少并不影响腋窝淋巴结转移的程度，其腋窝淋巴结转移的影响因素明显少于NST。
목적：탐토유선침윤성미유두상암（invasive micropapillary carcinoma， IMPC）화침윤성암（비특수형）（inva-sive carcinoma of no special type， NST）적림상병리특정차이급기여액와림파결전이적상관성。방법회고성분석2010년8월지2013년8월북경협화의원92례IMPC수술환자적림상병리자료，수궤선취368례동기수술적NST환자작위대조조。비교IMPC화NST적림상병리특정병분석기액와림파결전이적영향인소。결과 IMPC여NST재종류대소[（2.9±1.9） cm비（2.1±1.4） cm， P＝0.001]、맥관침윤솔（85.9％비6.0％， P ＜0.001）、액와림파결전이솔（71.7％비47.3％， P ＜0.001）급전이개수（8.2±9.9비2.9±5.7， P＜0.001）、잉격소수체표체（P＝0.047）、인류표피생장인자수체2（hu-man epidermal growth factor receptor-2， HER-2）표체（P＝0.009）、 Ki-67지수（P＜0.001）이급TNM분기（P＜0.001）、분자분형（ P＜0.001）방면적차이균구유통계학의의。종류조직중 IMPC 성분≤24％、25％～49％、50％～75％이급≥76％자림파결전이솔분별위73.9％、56.3％、72.2％화77.1％， IMPC적액와림파결전이솔여기재종류중소점비례무관（P＝0.347），여종류T분기（P＝0.001）、 HER-2표체（P＝0.029）、분자분형（P＝0.003）、 P53표체（P＝0.003）이급Ki-67지수（P＝0.045）상관。 NST적액와림파결전이여종류T분기（P＜0.001）、조직학분급（P＝0.001）、맥관침윤（P＜0.001）、자격소수체α（P ＝0.007）、잉격소수체（P ＝0.031）、 HER-2표체（P ＝0.008）급분자분형（P ＜0.001）균상관。결론 IMPC시일충구유고맥관침습성、고액와림파결전이솔적침윤성유선암，구유여NST불동적병리특정。 IMPC성분적다소병불영향액와림파결전이적정도，기액와림파결전이적영향인소명현소우NST。
Objective To explore the difference in clinicopathological characteristics between invasive mi -cropapillary carcinoma (IMPC) and invasive carcinoma of no special type (NST), and analyze its association with axillary lymph node metastasis .Methods The clinicopathological data of 92 IMPC cases treated within the period from August 2010 to August 2013 in Peking Union Medical College Hospital were retrospectively analyzed . From patients in the same period , 368 NST cases were randomly selected as control group .The difference in clin-icopathological characteristics between IMPC and NST were compared , and the factors associated with axillary lymph node metastasis were analyzed .Results There were significant differences in tumor size [ ( 2.9 ± 1.9) cm vs.(2.1 ±1.4) cm, P=0.001], lymph-vascular invasion rate (85.9% vs.6.0%, P<0.001), axillary lymph node metastatic rate (71.7%vs.47.3%, P<0.001), number of involved lymph node (8.2 ± 9.9 vs.2.9 ±5.7 , P<0.001 ) , progestogen receptor expression ( P=0.047 ) , human epidermal growth factor receptor-2 (HER-2) expression (P=0.009), Ki-67 index (P<0.001), TNM staging (P<0.001), and mo-lecular subtype ( P<0.001 ) between IMPC and NST .The axillary lymph node metastatic rates of tumor contai-ning ≤24%, 25%-49%, 50%-75% and ≥76% IMPC component were 73.9%, 56.3%, 72.2% and 77.1%, respectively .The axillary lymph node metastatic rate was not correlated with the percentage of IMPC component ( P=0.347 ) , but correlated with T-staging ( P=0.001 ) , HER-2 expression ( P=0.029 ) , molecu-lar subtype ( P=0.003 ) , P53 expression ( P=0.003 ) , and Ki-67 index ( P=0.045 ) .The axillary lymph node metastasis of NST was found correlated with T-staging ( P<0.001 ) , histological grade ( P =0.001 ) , lymph-vascular invasion ( P<0.001 ) , estrogen receptor αexpression ( P=0.007 ) , progestogen receptor expres-sion ( P=0.031 ) , HER-2 expression ( P=0.008 ) , and molecular subtype ( P<0.001 ) .Conclusions IMPC is a distinct variant of invasive breast carcinoma with a high propensity for lymph -vascular invasion and axillary lymph node involvement .IMPC and NST have different clinicopathological characteristics .The percentage of IMPC component does not correlate with axillary lymph node metastasis .Compared with NST , there are less clini-copathological determinants for axillary lymph node metastasis in IMPC .