协和医学杂志

2021, v.12(01) 122-128

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乳腺原发性神经内分泌癌与浸润性癌(非特殊型)临床病理特点和淋巴结转移相关因素的病例对照研究
Clinicopathological Features and Lymph Node Metastasis-related Factors of Primary Neuroendocrine Breast Cancer and Invasive Breast Cancer of Nonspecial Type:A Case-control Study

彭理;赵佳琳;赵大春;张震;茅枫;孙强;
PENG Li;ZHAO Jia-lin;ZHAO Da-chun;ZHANG Zhen;MAO Feng;SUN Qiang;Department of Breast Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;Department of Pathology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;

摘要(Abstract):

目的探讨原发性乳腺神经内分泌癌(primary neuroendocrine breast carcinoma, pNEBC)的临床病理特点以及淋巴结转移相关影响因素,为pNEBC的治疗及预后评价提供依据。方法回顾性选取2004年11月至2016年10月于北京协和医院乳腺外科手术治疗并诊断为pNEBC的患者为研究组(pNEBC组),1∶4配对同期手术并诊断为乳腺浸润性癌(非特殊型)(invasive carcinoma of no special type,NST)的患者为对照组(NST组),比较两组患者的临床病理特点及淋巴结转移相关影响因素。结果共50例符合纳入和排除标准的pNEBC患者入选本研究,按照1∶4配对原则入选同期NST患者200例。两组患者年龄、瘤体直径、组织学分级、淋巴结清扫数目及TNM分期均无统计学差异(P均>0.05)。pNEBC组淋巴结转移15例(30.0%,15/50);雌激素受体(estrogen receptor,ER)阳性表达率为96.0%(48/50),孕激素受体(progesterone receptor,PR)阳性表达率为84.0%(42/50),人表皮生长因子受体2(human epidermal growth factor receptor-2,Her-2)阳性表达率为10.4%(5/48),嗜铬素A阳性表达率为58.0%(29/50),突触素阳性表达率为97.9%(47/48)。对于影响淋巴结转移的相关因素,组织学分级、ER表达、PR表达、Her-2表达、Ki-67指数、分子分型差异在两组中均无统计学意义(P均>0.05),T分期在NST组患者中存在显著差异(P=0.006),在pNEBC组中无显著差异(P=0.872)。结论 pNEBC患者ER、PR阳性表达率高,Her-2阳性表达率低,突触素阳性表达率较嗜铬素A高,其生物学行为尚需进一步研究,联合检测上述免疫组化指标并结合淋巴结状况,可能有助于pNEBC的预后评估。
Objective This study aimed to approach the clinicopathological characteristics of primary neuroendocrine breast carcinoma(pNEBC) and to identify related factors of lymph node metastasis. MethodsWe retrospectively collected the clinical data of patients in Department of Breast Surgery, Peking Union MedicalCollege Hospital from November 2004 to October 2016.The patients who were diagnosed as pNEBC were selected as the study group(pNEBC group). Meanwhile, the patients who were operated at the same time and diagnosed as invasive carcinoma of no special type(NST) were selected as the control group(NST group). The clinico-pathological characteristics and lymph node metastasis-related factors of the two groups were compared. ResultsFollowing the inclusion and exclusion criteria, a tolal of 50 patients diagnosed as pNEBC and 200 patients diagnosed as NST were included in this study.There was no significant difference in age, tumor diameter, histological grade, number of lymph nodes dissected, and TNM stage between the two groups(all P>0.05). The baseline level of the two groups was similar. Fifteen pNEBC patients(30.0%,15/50) had lymph node metastasis. The expressions of estrogen receptor(ER), progesterone receptor(PR), and human epidermal growth factor receptor-2(Her-2) status were 96.0%, 84.0%, and 10.4%, respectively. The expressions of chromogranin A(CgA) and synaptophysin(Syn) were 58.0% and 97.9%,respectively. In the analysis of related factors affecting the lymph node metastasis, there was no significant difference in the histological grade, immunohistochemical index, and molecular typing between the two groups(all P>0.05). There existed significant differences in the T stage in the control group(P=0.006),while no difference found in the study group(P=0.872). Conclusions pNECB is often positive for hormone receptors, but almost negative for Her-2. The positive expression rate of Syn is higher than that of CgA. Although interfering factors on the prognosis of pNEBC are still controversial, its biological behavior needs further study and more attention should be paid to joint detection of the above immunohistochemical indicators and lymph node status.

关键词(KeyWords): 乳腺神经内分泌癌;雌激素受体;孕激素受体;人类表皮生长因子受体2;嗜铬素A;突触素;淋巴结转移
neuroendocrine breast carcinoma;estrogen receptor;progesterone receptor;human epidermal growth factor receptor-2;chromogranin A;synaptophysin;lymph node metastasis

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作者(Author): 彭理;赵佳琳;赵大春;张震;茅枫;孙强;
PENG Li;ZHAO Jia-lin;ZHAO Da-chun;ZHANG Zhen;MAO Feng;SUN Qiang;Department of Breast Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;Department of Pathology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;

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