摘要
目的:分析乳腺癌肉瘤的临床病理特征及预后情况,了解患者生存状态并探讨其最佳诊疗方案。方法:收集郑州大学第一附属医院1995年1月-2012年1月收治的94例可手术乳腺癌肉瘤患者的临床资料,回顾性分析其临床病理特征和治疗方法,并以同期448例一般乳腺癌患者作为对照组探讨其预后情况。结果:97.9%的癌肉瘤患者以乳房肿物为首发症状,术前钼靶和B超检查误诊率高,确诊主要依据术后病理。本组淋巴结转移者28例(29.8%),均未见有肉瘤细胞成分。癌组织中细胞角蛋白(cytokeratins,CK)、上皮膜抗原(epithelial membrane antigen,EMA)、雌激素受体(estrogen receptor,ER)和孕激素受体(progesterone receptor,PR)的阳性率显著高于肉瘤组织(P<0.05),而Vimentin和S100在肉瘤组织中表达水平高于癌组织(P<0.05)。癌与肉瘤区域间有组织学过渡带,该带的瘤细胞常呈上皮与间叶细胞双重表型。术后予以辅助治疗的癌肉瘤患者5年总生存率较单纯手术者高;癌肉瘤患者的复发转移率高于同期乳腺癌患者,5年总生存率低于同期乳腺癌各亚型患者(P<0.05)。结论:乳腺癌肉瘤确诊主要依据术后病理,其免疫表型差异较大;它较一般乳腺癌更易复发和转移,预后较一般乳腺癌各亚型差,术后辅以综合治疗可提高其5年总生存率。
Objective： To analyze the clinicopathological features and prognosis of patients with breast carcinosarcoma and determine their survival status, so as to explore the best choice for breast carcinosarcoma treatment. Methods： The clinical data from 94 patients with breast carcinosarcoma, who received surgical operation at the First Affiliated Hospital of Zhengzhou University between January 1995 and January 2012, were collected and reviewed. The clinicopathological features, therapeutic methods and prognosis were retrospectively analyzed. Four hundred and forty-eight patients with synchronous other types of breast cancer expect carcinosarcoma were serving as the controls for prognosis analysis. Results： Breast mass as an initial symptom was seen in 97.9% patients with breast carcinosarcoma. The rate of misdiagnosis by using mammography or B-scan ultrasonography was very high, and thus the diagnosis of breast carcinosarcoma mainly depended on the result from postoperative histopathological examination. Metastases of axillary lymph nodes were found in 28 patients （29.8%）, and no evidence of sarcoma was found in these patients. The result of immunohistochemistry showed that the positive rates of CK （cytokeratin）, EMA （epithelial membrane antigen）, ER （estrogen receptor） and PR （progesterone receptor） in breast carcinoma tissues were significantly higher than those in sarcoma tissues （P 〈 0.05）, while the positive rates of Vimentin and $100 in sarcoma tissues were higher than those in carcinoma tissues （P 〈 0.05）. There was a histologically transitional zone between carcinoma and sarcoma regions, where the tumor cells often presented epithelial and mesenchymal cell phenotypes. The five-year OS （overall survival） rate of patients with breast carcinosarcoma who received adjuvant treatment after surgical operation was higher than those only received surgical operation （P 〈 0.05）. The rates of relapseand metastasis of patients with breast carcinosarcoma were both higher than those of the patients with synchronous breast cancer, while the 5-year OS rate was lower （P 〈 0.05）. Conclusion： The diagnosis of breast carcinosarcoma mainly depends on postoperative pathology. The immunohistochemical phenotypes of breast carcinosarcoma vary significantly. Breast carcinosarcoma is more likely to have recurrence and metastasis and its prognosis is poorer as compared with other types of breast cancer. Adjuvant treatment after surgical operation may improve the 5-year OS of patients with breast carcinosarcoma.
出处
《肿瘤》
CAS
CSCD
北大核心
2013年第1期63-69,共7页
Tumor
关键词
癌肉瘤
乳腺肿瘤
回顾性研究
免疫组织化学
治疗
预后
Carcinosarcoma
Breast neoplasms
Retrospective studies
Immunohistochemistry
Treatment
Prognosis
