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目的:分析乳腺癌不同组织学类型的发病率,并进行预后相关性研究。方法:应用2003年版世界卫生组织(WHO)乳腺癌分类,对1998～2001年经治疗并有完整随访资料的565例原发乳腺癌重新进行组织学分析,并利用NPI值进行预后相关因素分析。结果:565例乳腺癌患者平均年龄52.86岁,79.3%的患者年龄位于40～69岁,小于40岁占11.3%。临床分期0、Ⅰ、Ⅱ、Ⅲ、Ⅳ期分别占5.3%、27.1%、55.0%、11.3%、1.2%。导管原位癌30例(5.3%),浸润癌535例(94.7%)。其中浸润性导管癌(非特殊类型)432例,占76.5%,位居首位。混合型癌31例(5.5%),黏液癌23例(4.1%),浸润性小叶癌22例(3.9%),浸润性筛状癌13例(2.3%),其他14例(2.5%)。浸润性乳腺癌患者,淋巴结转移率为42.4%。10年总生存率及无瘤生存率分别为90.76%和84.10%。经单因素分析显示,肿瘤的大小及临床分期与10年总生存率及无瘤生存率呈负相关(P均<0.01)。经Cox多因素分析显示,NPI值与10年总生存率呈负相关(P<0.001),组织学分级(P=0.0271)和淋巴结分期(P<0.001)与无瘤生存率负相关。结论:该院经治乳腺癌年轻患者所占比例高于欧美,浸润性小叶癌的发生率低于欧美国家,与亚洲其他国家接近。肿瘤组织学分级、淋巴结分期、肿瘤大小、临床分期,尤其是NPI值可以作为判断预后的指标。严格鉴别特殊类型的乳腺癌对判断预后有一定的指导意义。
Objective: To analyze the incidence of different histological types of breast cancer and to study the prognosis. Methods: According to the World Health Organization (WHO) classification of breast cancer in 2003, 565 cases of primary breast cancer treated and with complete follow-up data from 1998 to 2001 were re-histologically analyzed and the prognostic factors were analyzed using NPI. Results: The average age of 565 breast cancer patients was 52.86 years. The age of 79.3% patients was 40-69 years old and less than 40 years old, accounting for 11.3%. Clinical stage 0, Ⅰ, Ⅱ, Ⅲ and Ⅳ accounted for 5.3%, 27.1%, 55.0%, 11.3% and 1.2% respectively. There were 30 cases of ductal carcinoma in situ (5.3%) and 535 cases of invasive carcinoma (94.7%). Including invasive ductal carcinoma (non-special type) 432 cases, accounting for 76.5%, ranking first. There were 31 cases of mixed carcinoma (5.5%), 23 cases of mucinous carcinoma (4.1%), 22 cases of invasive lobular carcinoma (3.9%), 13 cases of invasive carcinoma of reticular carcinoma (2.3%) and the other 14 cases (2.5%). Invasive breast cancer patients, lymph node metastasis rate was 42.4%. 10-year overall survival and tumor-free survival rates were 90.76% and 84.10%. Univariate analysis showed that tumor size and clinical stage were negatively correlated with 10-year overall survival and tumor-free survival (P <0.01). Cox multivariate analysis showed that NPI was negatively correlated with 10-year overall survival (P <0.001), histological grade (P = 0.0271) and lymph node staging (P <0.001) were negatively correlated with disease-free survival. Conclusion: The proportion of young patients with breast cancer in the hospital is higher than that in Europe and America. The incidence of invasive lobular carcinoma is lower than that in Europe and the United States, which is close to that in other Asian countries. Tumor histological grade, lymph node staging, tumor size, clinical stage, especially the NPI value can be used as an indicator of prognosis. Strict identification of special types of breast cancer to determine the prognosis of a certain degree of guiding significance.