摘要目的 探讨非特殊型浸润性乳腺癌(invasive breast carcinoma of no specific type, IBC-NST)中大范围癌周间隙(>20%的肿瘤区域内出现癌周间隙)的出现对患者预后的影响.方法 收集河北医科大学第四医院2006年1月至2008年12月经病理确诊的2184例IBC-NST患者的病理资料,按照2012版WHO乳腺肿瘤病理学和遗传学分类标准复核诊断,剔除因组织固定问题导致的固缩,筛选出具有癌周间隙特征的病例483例,对其大范围癌周间隙、淋巴管侵犯、淋巴结转移、组织学分级、预后等临床病理资料进行回顾性分析.结果 483例患者中肿瘤最大径0.8~4.8 cm,平均2.0 cm.组织学分级1级97例(20.1%),2级232例(48.0%),3级154例(31.9%);Ⅰ~Ⅱ期患者382例(79.1%);177例(36.7%)出现了淋巴管侵犯,202例(41.8%)出现了淋巴结转移;237例(49.1%)出现了大范围癌周间隙.407例患者有完整的随访资料,359例存活,生存时间37~103个月.多因素分析结果显示:肿瘤大小、组织学分级、淋巴结转移是 IBC-NST 患者生存的危险因素(P<0.05);淋巴管侵犯、淋巴结转移是IBC-NST患者出现大范围癌周间隙的危险因素(P<0.05).出现大范围癌周间隙而没有淋巴管侵犯时,淋巴结转移的几率较高,差异具有统计学意义(P<0.05).结论 淋巴管侵犯、淋巴结转移均是IBC-NST患者出现大范围癌周间隙的危险因素,出现大范围癌周间隙与IBC-NST患者预后差相关,且具有淋巴结转移的IBC-NST患者更常见大范围癌周间隙.

abstractsObjective To investigate the effect of extensive retraction clefts(RC,>20% of tumor volume)on prognosis in invasive breast carcinoma of no specific type(IBC-NST).Methods A total of 2 184 cases of IBC-NST diagnosed at the Fourth Hospital of Hebei Medical University from January 2006 to December 2008 were collected. All the cases were diagnosed according to the latest guideline and standard. After excluding cases of shrinkage due to tissue fixation,483 cases with RC were identified,and the clinical and pathological features were retrospectively analyzed. Results Among the 483 cases,the mean tumor size was 2.0 cm(range 0.8 to 4.8 cm). Two hundred and thirty-two cases were moderately differentiated (48.0%),97 were well differentiated(20.1%),154 were poorly differentiated(31.9%);382(79.1%) cases were of stages Ⅰ and Ⅱ. A total of 177 cases(36.7%)had lymphatic invasion; nodal metastasis were found in 202 cases(41.8%). Extensive RC was found in 237 of 483 cases(49.1%). Follow-up information was available in 407 patients, and 46 died of breast cancer with survival time from 37 to 103 months. Multivariate analysis of extensive RC showed that tumor size,histological grade and nodal metastasis were risk factors of patients with IBC-NST(P<0.05).Lymphatic invasion and nodal metastasis were risk factors for extensive RCs in patients with IBC-NST(P<0.05).There was a high probability of lymph node metastasis in patients of extensive RC without lymphatic invasion, and the difference was statistically significant(P<0.05). Conclusions Both lymphatic invasion and nodal metastasis are risk factors of extensive RC. The presence of extensive RC in IBC-NST patients is correlated with poor outcome. Tumors with lymphatic invasion are more likely to show extensive RC.