乳腺浸润性微乳头状癌的临床病理特征及预后影响因素

doi:10.3969/j.issn.1009-976X.2026.04.001

摘要/Abstract

摘要： 目的探讨乳腺浸润性微乳头状癌（IMPC）的临床病理特征及生存情况,比较单纯型与混合型IMPC患者的临床病理特征及无瘤生存（DFS）和总生存（OS）,并以IMPC占比75%为界进一步分析IMPC比例对预后的影响。方法回顾性分析2005年1月至2025年10月中山大学孙逸仙纪念医院收治的230例乳腺IMPC患者的临床病理及随访资料。微乳头状成分占浸润性癌成分100%者为单纯型IMPC（104例）,混有其他浸润性癌成分为混合型IMPC（126例）;同时以IMPC占比75%为界,分为IMPC≤75%组（96例）和IMPC>75%组（134例）。比较各组患者的临床病理特征及DFS和OS的影响因素。结果单纯型IMPC与混合型IMPC在ER阳性率上差异有统计学意义。总人群5年DFS率为76.2%,10年OS率为67.8%。单纯型与混合型IMPC的5年DFS率分别为67.1%和82.5%（P=0.066）,10年OS率分别为61.4%和73.8%（P=0.352）。IMPC≤75%组与IMPC>75%组的5年DFS率（82.4% vs. 70.7%）及10年OS率（79.1% vs. 63.0%）差异均无统计学意义。多因素分析显示,TNM分期（HR=7.320,95%CI：3.473~15.428,P<0.001）和内分泌治疗（HR=0.391,95%CI：0.166~0.919,P=0.031）是DFS的影响因素;TNM分期是OS的独立影响因素（HR=6.628,95%CI：2.407~18.251,P<0.001）。结论单纯型IMPC患者的5年DFS率及10年OS率在数值上均低于混合型IMPC患者,但两组DFS、OS的差异均无统计学意义。临床实践中应重视TNM分期评估,并对激素受体阳性患者积极考虑内分泌治疗以改善DFS。

关键词: 浸润性微乳头状癌, 乳腺癌, 临床病理特征, 预后, 影响因素

Abstract: Objective To investigate the clinicopathological features and survival of invasive micropapillary carcinoma （IMPC） of the breast. We compared pure-type IMPC with mixed-type IMPC in clinicopathological characteristics, disease-free survival （DFS）, and overall survival （OS）, and further assessed the prognostic impact of a 75% IMPC proportion threshold. Methods We retrospectively reviewed the clinicopathological and follow-up data of 230 patients with breast IMPC treated at Sun Yat-sen Memorial Hospital, Sun Yat-sen University, from January 2005 to October 2025. Pure-type IMPC was defined as a micropapillary component accounting for 100% of the invasive carcinoma （n=104）; mixed-type IMPC was defined as IMPC admixed with other invasive carcinoma components （n=126）. Patients were also stratified by a 75% threshold into an IMPC ≤75% group （n=96） and an IMPC >75% group （n=134）. Clinicopathological features and factors influencing DFS and OS were compared between the groups. Results The ER positivity rate differed significantly between pure-type and mixed-type IMPC. The overall 5-year DFS rate was 76.2%, and the 10-year OS rate was 67.8%. The 5-year DFS rates were 67.1% and 82.5% for pure-type and mixed-type IMPC, respectively （P=0.066）; the 10-year OS rates were 61.4% and 73.8% （P=0.352）. The 5-year DFS rates （82.4% vs. 70.7%） and 10-year OS rates （79.1% vs. 63.0%） did not differ significantly between the IMPC ≤75% and IMPC >75% groups. Multivariable analysis showed that TNM stage（HR=7.320,95%CI：3.473~15.428,P<0.001） and endocrine therapy （HR=0.391,95%CI：0.166~0.919,P=0.031） were independent factors for DFS, and TNM stage（HR=6.628,95%CI：2.407~18.251,P<0.001） was an independent factor for OS. Conclusion Although the 5-year DFS and 10-year OS rates were numerically lower in pure-type than in mixed-type IMPC, neither difference was statistically significant. In clinical practice, TNM stage assessment should be emphasized, and endocrine therapy should be actively considered for hormone receptor-positive patients to improve DFS.

Key words: invasive micropapillary carcinoma, breast cancer, clinicopathological characteristics, prognosis, influencing factors

中图分类号:

柴洁, 丁林潇潇, 王丽丽, 陈韬, 王君妍, 蔡阳阳. 乳腺浸润性微乳头状癌的临床病理特征及预后影响因素[J]. 岭南现代临床外科, 2026, 25(04): 207-214.

CHAI Jie, DING Linxiaoxiao, WANG Lili, CHEN Tao, WANG Junyan, CAI Yangyang. Clinicopathological features and prognostic factors of breast invasive micropapillary carcinoma[J]. Lingnan Modern Clinics In Surgery, 2026, 25(04): 207-214.

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