| Paget's病伴浸润性导管癌的临床病理特征及预后因素分析:基于SEER的回顾性研究 |
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| 引用本文： | 魏 路,姚 峰.Paget's病伴浸润性导管癌的临床病理特征及预后因素分析:基于SEER的回顾性研究[J].现代肿瘤医学,2019,0(15):2679-2684. |
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| 作者姓名： | 魏 路 姚 峰 |
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| 作者单位： | 武汉大学人民医院乳腺甲状腺外科，湖北 武汉 430060 |
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| 基金项目： | 湖北省计生委基金项目（编号:JS-2011019) |
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| 摘 要： | 目的:分析佩吉特氏病伴浸润性导管癌（Paget's disease with invasive ductal carcinoma，PD-IDC）患者的临床病理特征、治疗和预后情况。方法:通过美国 SEER*Stat 软件搜集2010至2014年病理明确诊断为PD-IDC及浸润性乳腺癌（invasive ductal carcinoma，IDC）并接受手术治疗的患者分别550例和207 221例。用SPSS 21.0进行统计学分析和绘制生存曲线。结果:与IDC相比，PD-IDC患者男性乳腺癌比例更大，可能有更大的体积、更多的淋巴结受累、更高级别以及更晚期的肿瘤（P均<0.05）；且更可能是激素受体（HR）阴性［ER阴性（37.3% vs 18.5%）、PR阴性（52.0% vs 28.5%）］和Her-2阳性（53.3% vs 15.4%）；在治疗方案中更有可能接受乳房切除术（85.8% vs 43.9%）和腋窝淋巴结清扫术（45.1% vs 29.5%）（P均<0.05）；但预后更差，死亡率更高，且乳腺癌相关死亡率（BCSM）更高。此外，Cox回归分析显示肿瘤分级和Her-2状态与PD-IDC患者的总生存时间（OS）显著相关（P<0.05），而患者性别和肿瘤分级与PD-IDC患者的BCSM相关（P<0.05），且Her-2阳性者相较于阴性者（OS:HR=0.019，P=0.009；BCSM:HR=0.000，P=0.623）与PD-IDC患者的OS显著相关，淋巴结手术方式也与PD-IDC患者的OS有一定的相关性。结论:与IDC相比，PD-IDC患者更可能是HR阴性和Her-2阳性且预后较差。同时，淋巴结的处理在PD-IDC的治疗中有一定的必要性。
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| 关 键 词： | Paget's病伴浸润性导管癌 浸润性导管癌 预后 Her-2 |
Clinicopathological features and prognostic factors of Paget's disease with invasive ductal carcinoma:A retrospective study based on SEER |
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| Wei Lu,Yao Feng.Clinicopathological features and prognostic factors of Paget's disease with invasive ductal carcinoma:A retrospective study based on SEER[J].Journal of Modern Oncology,2019,0(15):2679-2684. |
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| Authors: | Wei Lu Yao Feng |
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| Affiliation: | Department of Breast and Thyroid Surgery，Renmin Hospital of Wuhan University，Hubei Wuhan 430060，China. |
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| Abstract: | Objective:To analyze the clinicopathological features，treatment and prognosis of patients suffered from Paget's disease with invasive ductal carcinoma（PD-IDC).Methods:Using data obtained by the Surveillance，Epidemiology，and End Results（SEER) program from 2010 to 2014，550 patients with pathologically diagnosed Paget's disease with invasive ductal carcinoma（PD-IDC) and 207 221 cases with invasive ductal carcinoma（IDC) who underwent surgery were collected.Statistical analysis was performed with SPSS 21.0 and survival curves were plotted.Results:Compared with IDC，PD-IDC patients have a higher proportion of male breast cancer，and are more likely to have larger volume，more lymph node involvement，higher grade and more advanced tumors（all above P<0.05).More likely HR negative（ER negative 37.3% vs 18.5%)，PR negative（52.0% vs 28.5%) and Her-2 positive（53.3% vs 15.4%).More likely to undergo mastectomy in the treatment regimen（85.8% vs 43.9%) and axillary lymph node dissection（45.1% vs 29.5%)（all P<0.05).However，the prognosis was worse，mortality was higher，and breast cancer-related mortality was higher.In addition，Cox regression analysis showed that tumor grade and Her-2 status were significantly associated with OS in PD-IDC patients（P<0.05)，while patient's gender and tumor grade were associated with BCSM in PD-IDC patients（P<0.05)，and Her-2 positive patients were significantly associated with OS in patients with PD-IDC compared with those negative（OS:HR=0.019，P=0.009，BCSM:HR=0.000，P=0.623)，lymph node surgery was also associated with OS in PD-IDC patients.OS has a certain correlation as well.Conclusion:Compared with IDC，PD-IDC patients are more likely to be HR negative and Her-2 positive with a poor prognosis.At the same time，the treatment of lymph nodes is necessary in the treatment of PD-IDC. |
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| Keywords: | Paget's disease with invasive ductal carcinoma invasive ductal carcinoma prognosis Her-2 |
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