乳腺导管原位癌伴微浸润与浸润癌患者的临床特征对比分析

目的:分析乳腺导管原位癌伴微浸润（ductal carcinoma in situ with microinvasion,DCIS-MI）与乳腺浸润性导管癌（invasive ductal carcinoma,IDC）患者的临床特征、治疗方式等。方法:回顾性分析55例乳腺导管原位癌伴微浸润及508例乳腺浸润性导管癌患者的临床资料，包括两组患者的年龄、月经情况、雌激素受体（estrogen receptor,ER）、孕激素受体（progestrone receptor，PR）、人表皮生长因子受体（human epidermal growth factor，HER-2）、肿瘤细胞增殖活性标志物（Ki67）的表达情况、分子分型、治疗方式及预后。结果:DCIS-MI组和IDC组患者在年龄上的差异不具有统计学意义（P＞0.05），DCIS-MI组在已绝经及淋巴结转移阳性比例均低于IDC组（P＜0.05）；DCIS-MI组Ki67阳性表达率显著低于IDC组（P＜0.05），ER、PR及HER-2阳性表达率与IDC组比较差异无统计学意义（P＞0.05）。DCIS-MI组Luminal A型比例高于IDC组，而Luminal B(HER-2-)型比例低于IDC组，且差异均具有统计学意义（P＜0.05）。其余分子分型差异不具有统计学意义。DCIS-MI组患者单纯乳房切除术比例（10.9%）显著高于IDC组（0.8%）（P＜0.05）。DCIS-MI患者主要采用的手术方式为乳腺癌改良根治术和全乳切除+腋窝淋巴结清扫，其比例分别为60.0%、16.4%，与IDC组患者采用相同手术方式的比例（67.3%、19.9%）无显著差异。DCIS-MI组化疗比例、放疗比例均低于IDC组（P＜0.05），而两组患者在内分泌治疗、靶向治疗及中药治疗方面差异不具有统计学意义（P＞0.05）。DCIS-MI组和IDC组患者的5年无病生存（disease-free survival,DFS）率分别为97.0%和81.0%，差异具有统计学意义（Log-rank，χ2=4.962，P=0.026）。结论:与IDC患者相比，DCIS-MI组患者绝经前状态比例高、淋巴结转移阳性率及Ki67阳性率更低，Luminal A型比例更高而Luminal B(HER-2-)型比例更低；DCIS-MI组患者行单纯乳房切除术比例更高，放疗及化疗比例更低，其预后更好。

Clinical comparison between ductal carcinoma in situ with microinvasive carcinoma and invasive ductal carcinoma of breast

Objective:To analyze the differences in the clinical characteristics,treatment patterns and so on between breast ductal carcinoma in situ with microinvasion(DCIS-MI) and invasive ductal carcinoma(IDC).Methods:55 cases of ductal carcinoma in situ with microinvasion and the clinical data of 508 patients with breast invasive ductal carcinoma were retrospectively analysed,including two groups of patient's age,menstrual,estrogen receptor(ER),progesterone receptor(PR),human epidermal growth factor receptor(HER-2),Ki67 expression,molecular typing and treatment and prognosis.Results:There was no statistically significant difference in age between the DCIS-MI group and the IDC group(P＞0.05).The positive rates of menopause and lymph node metastasis in the DCIS-MI group were lower than those in the IDC group(P＜0.05).The positive expression rate of Ki67 in the DCIS-MI group was significantly lower than that in the IDC group(P＜0.05).The positive expression rates of ER,PR and HER-2 were not statistically significant compared with that in the IDC group(P＞0.05).Luminal A of DCIS-MI group was higher than that of IDC group,while Luminal B(HER-2-) was lower than that of IDC group,with statistically significant difference(P＜0.05).The remaining molecular typing differences were not statistically significant.The proportion of patients with simple mastectomy in the DCIS-MI group(10.9%) was significantly higher than that in the IDC group(0.8%)(P＜0.05).Modified radical mastectomy and total mastectomy+ALND were the main surgical methods used in patients with DCIS-MI,and the proportions were 60.0% and 16.4%,respectively.There was no significant difference with the proportion of patients in the IDC group who adopted the same surgical method(67.3% and 19.9%).The proportion of chemotherapy and radiotherapy in the DCIS-MI group was lower than that in the IDC group(P＜0.05),while there was no statistically significant difference between the two groups in terms of endocrine therapy,targeted therapy and traditional Chinese medicine therapy(P＞0.05).The 5-year disease-free survival rate of the DCIS-MI group and the IDC group were 97.0% and 81.0%,respectively,with statistically significant differences(P=0.026).Conclusion:Compared with IDC patients,patients in the DCIS-MI group were more likely to premenopausal status,lower positive lymph node metastasis rate and Ki67 positive rate,higher luminal A ratio and lower luminal B(HER-2-) ratio.Patients in the DCIS-MI group have a higher proportion of simple mastectomy,lower proportion of radiotherapy and chemotherapy,and a better prognosis.