Clinicopathological Features and Prognosis of Metaplastic Breast Carcinoma: Experience of a Major Chinese Cancer Center.
Clinicopathological Features and Prognosis of Metaplastic Breast Carcinoma: Experience of a Major Chinese Cancer Center.
复制标题
化生性乳腺癌的临床病理特征和预后：中国大型肿瘤中心的经验
DOI：
10.1371/journal.pone.0131409
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发表时间：
2015
期刊：
影响因子：
3.7
通讯作者：
Guo X
中科院分区：
文献类型：
--
作者：
Zhang Y;Lv F;Yang Y;Qian X;Lang R;Fan Y;Liu F;Li Y;Li S;Shen B;Pringle GA;Zhang X;Fu L;Guo X
化生性乳腺癌（MBC）是一种罕见的异质性组原发性乳腺恶性肿瘤，激素受体表达低，预后差。到目前为止，还没有这种肿瘤的预后标志物得到验证。本研究对天津医科大学附属肿瘤医院收治的乳腺癌患者的临床病理特征、对不同治疗方案的反应和预后进行了评价。从档案中检索2000年1月至2014年9月在我院诊断的90例MBC。总体而言，乳腺癌体积较大，淋巴结转移率较低，局部复发/远处转移率高于1，090例分期匹配的非特定类型浸润性癌（IDC-NST），与雌激素受体、孕激素受体和人表皮生长因子受体2表达状态无关。MBC的5年无病生存率（DFS）明显低于IDC-NST。单因素分析显示，淋巴结转移、诊断时临床分期高、Ki-67标记的高肿瘤增殖率和表皮生长因子受体（EGFR）过表达/基因扩增与DFS降低显著相关，而OS降低与淋巴结转移和EGFR过表达/基因扩增显著相关。多因素分析显示，淋巴结状态是DFS的独立预测因子，淋巴结状态和EGFR过表达/基因扩增是OS的独立预测因子，MBC的组织学亚型和分子亚群不是影响预后的重要因素。我们还发现MBC对新辅助化疗、常规化疗和放疗不敏感。本研究提示MBC是一种侵袭性乳腺癌，预后差，需要确定和优化有效的综合治疗方案。
Metaplastic breast carcinoma (MBC) is a rare heterogeneous group of primary breast malignancies, with low hormone receptor expression and poor outcomes. To date, no prognostic markers for this tumor have been validated. The current study was undertaken to evaluate the clinicopathologic characteristics, the response to various therapeutic regimens and the prognosis of MBCs in a large cohort of patients from Tianjin Medical University Cancer Hospital in China. Ninety cases of MBCs diagnosed in our hospital between January 2000 and September 2014 were retrieved from the archives. In general, MBCs presented with larger size, a lower rate of lymph node metastasis, and demonstrated more frequent local recurrence/distant metastasis than 1,090 stage-matched cases of invasive carcinoma of no specific type (IDC-NST), independent of the status of estrogen receptor, progesterone receptor and human epidermal growth factor receptor 2 expressions. The five-year disease-free survival (DFS) of MBC was significantly worse than IDC-NST. Using univariate analysis, lymph node metastasis, advanced clinical stage at diagnosis, high tumor proliferation rate assessed by Ki-67 labeling, and epidermal growth factor receptor (EGFR) overexpression/gene amplification were associated significantly with reduced DFS, while decreased OS was associated significantly with lymph node metastasis and EGFR overexpression/gene amplification. With multivariate analysis, lymph node status was an independent predictor for DFS, and lymph node status and EGFR overexpression/gene amplification were independent predictors for OS. Histologic subtyping and molecular subgrouping of MBCs were not significant factors in prognosis. We also found that MBCs were insensitive to neoadjuvant chemotherapy, routine chemotherapy, and radiation therapy. This study indicates that MBC is an aggressive type of breast cancer with poor prognosis, and that identification and optimization of an effective comprehensive therapeutic regimen is needed.