精准病理学诊断和个体化治疗改善乳腺浸润性微乳头状癌结局的中国患者十二年前瞻临...

纳兰烙烙

　

　乳腺浸润性微乳头状癌为乳腺癌组织学亚型之一，占所有乳腺癌的<2%至8%不等，与高发淋巴管浸润、淋巴结转移和预后不良相关。

　　2018年2月5日，美国和加拿大病理学会、英国《自然》qixia《现代病理学》在线发表中国天津医科大学肿瘤医院天津市肿瘤医院天津市肿瘤研究所付丽等学者、美国罗文大学库珀医学院库珀大学医院、普林斯顿大学医学中心、罗格斯大学、新泽西罗格斯癌症研究所、欧内斯**里奥药学院、纽约纪念医院斯隆凯特林癌症中心的中国患者十二年前瞻临床研究报告，调查了精准病理学诊断和个体化治疗对乳腺浸润性微乳头状癌结局的影响。

　　该前瞻研究将2004年1月～2015年12月天津医科大学肿瘤医院诊断浸润癌患者39714例，其中浸润性微乳头状癌患者2299例（6%）作为研究组，采用全标本连续切片三维成像法进行标本检查，对患者进行精准病理学诊断和个体化治疗。通过回顾分析1989年1月～2003年12月该院诊断浸润癌患者9056例，将其中接受常规病理学诊断（尚未采用全标本连续切片三维成像法进行标本检查）的浸润性微乳头状癌患者163例（2%）作为对照组。对两组患者的临床病理学特征、治疗和结局进行比较。

　　结果发现，研究组与对照组相比：

• 该乳腺癌发生率显著较高：6%比2%
• 五年无病生存率显著较高：83.8%比45.4%（P<0.05）
• 五年总的生存率显著较高：90.9%比57.4%（P<0.05）
  
  

　　根据多因素分析，无病生存率、总生存率的共同独立相关因素：

• 研究组：淋巴管浸润、雌激素受体状态、淋巴结转移
• 对照组：淋巴管浸润、雌激素受体状态
  
  

　　因此，虽然乳腺浸润性微乳头状癌与不良预后相关，但是精准病理学诊断和个体化治疗改善了浸润性微乳头状癌患者的无病生存和总生存。精准病理学诊断为个体化治疗和改善乳腺浸润性微乳头状癌患者结局的前提。

Mod Pathol. 2018 Feb 5. [Epub ahead of print]

Precise pathologic diagnosis and individualized treatment improve the outcomes of invasive micropapillary carcinoma of the breast: a 12-year prospective clinical study.

Weidong Li, Yunwei Han, Chijuan Wang, Xiaojing Guo, Beibei Shen, Fangfang Liu, Chengying Jiang, Yaqing Li, Yiling Yang, Ronggang Lang, Yu Fan, Feng Gu, Yun Niu, Xinmin Zhang, Lanjing Zhang, Hannah Y Wen, Li Fu.

Tianjin Medical University Cancer Institute and Hospital, Tianjin, China; Cooper University Hospital, Cooper Medical School of Rowan University, One Cooper Plaza, Camden, NJ, USA; University Medical Center of Princeton, Plainsboro, NJ, USA; Rutgers University, Newark, NJ, USA; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA; Ernest Mario School of Pharmacy Rutgers University, Piscataway, NJ, USA; Memorial Sloan Kettering Cancer Center, New York, NY, USA.

Invasive micropapillary carcinoma of the breast is a histologic subtype of breast cancer and associated with high incidence of lymphovascular invasion, lymph node metastasis and poor prognosis. The aim of this prospective study was to investigate the impact of precise pathologic diagnosis and individualized treatment on the outcomes of invasive micropapillary carcinoma of the breast. The study group included 2299 women with invasive micropapillary carcinoma diagnosed at Tianjin Medical University Cancer Institute and Hospital between January 2004 and December 2015. In the study group, specimens were examined with the method of whole-specimen orientation and serial sectioning, and patients received precise pathological diagnosis and individualized treatment. The control group of invasive micropapillary carcinoma consisted of 163 cases, identified through a retrospectively review of 9056 invasive carcinomas diagnosed at our institution between January 1989 and December 2003 using the standard pathology-evaluation method (i.e., not using the whole-specimen orientation and serial-sectioning method). The clinicopathological features, treatments and outcomes were compared between the two groups. The incidence of invasive micropapillary carcinoma in the study group was 6% (2299/39,714 cases), significantly higher than that of the control group (2%; 163/9056 cases). The 5-year disease-free survival in the study group was significantly higher than that in the control group (83.8 vs.45.4%; p<0.05). The 5-year overall survival was significantly increased from 57.4% in the control group to 90.9% in the study group (p<0.05). In the multivariate analysis, lymphovascular invasion, estrogen receptor status and lymph node metastasis were independent prognostic factors. Although invasive micropapillary carcinoma of the breast is associated with poor prognosis, precise pathologic diagnosis and individualized treatment improved the disease-free survival and overall survival of invasive micropapillary carcinoma patients. Precise pathological diagnosis is the premises for individualized treatments and for improving the outcomes of patients with invasive micropapillary carcinoma of the breast.

DOI: 10.1038/s41379-018-0024-8

来源：现代病理学