乳腺黏液腺癌的临床病理特征及预后分析

doi:10.3969/j.issn.1009-976X.2026.03.001

摘要/Abstract

摘要： 目的比较单纯型乳腺黏液腺癌（PMuBC）与混合型乳腺黏液腺癌（MMuBC）的临床病理特征及长期预后差异,分析预后影响因素,为个体化治疗提供依据。方法回顾性收集2000年1月至2025年4月于中山大学孙逸仙纪念医院收治的334例乳腺黏液腺癌（MuBC）患者的临床及病理资料,其中PMuBC 238例（71.3%）,MMuBC 96例（28.7%）。比较两组患者的临床病理特征。采用Cox比例风险回归模型确定MuBC的预后因素,Kaplan-Meier法和log-rank检验用于生存分析。结果与PMuBC相比,MMuBC患者HER-2阳性率（11.46% vs. 3.36%,P=0.004）、淋巴结阳性比例（26.04% vs. 9.66%,P<0.001）、临床Ⅲ期比例（12.50% vs. 4.62%,P=0.004）、接受化疗（60.42% vs. 39.50%,P<0.001）以及保乳手术（53.13% vs. 34.03%,P=0.001）的比例更高,前哨淋巴结活检率更低（71.88% vs. 84.03%,P=0.011）。两组患者5年无病生存率（DFS）差异无统计学意义（97.5% vs. 94.8%,P=0.061）,但PMuBC组10年总生存率（OS）显著优于MMuBC组（96.6% vs. 88.5%,P<0.001）。多因素Cox回归分析显示,病理类型及年龄是OS的独立影响因素,MMuBC患者的死亡风险是PMuBC患者的近5倍（HR=4.722,95%CI：2.019~11.043,P<0.001）。结论 PMuBC与MMuBC是两种临床病理特征及预后存在显著差异的疾病实体。MMuBC具有更强的生物学侵袭性,其长期生存预后明显劣于PMuBC,MMuBC患者应被视为需要更积极治疗和密切随访的高危人群。病理类型的精确区分对于预后判断和治疗决策至关重要。

关键词: 单纯型乳腺黏液腺癌, 混合型乳腺黏液腺癌, 临床特征, 病理特征, 预后

Abstract: Objective To compare the clinicopathological features and long-term prognosis of pure mucinous breast carcinoma （PMuBC） versus mixed mucinous breast carcinoma （MMuBC）, to identify prognostic factors, and to inform individualized treatment strategies. Methods We retrospectively collected clinical and pathological data from 334 patients with mucinous breast carcinoma （MuBC） treated at Sun Yat-sen Memorial Hospital, Sun Yat-sen University, between January 2000 and April 2025. The cohort comprised 238 patients with PMuBC （71.3%） and 96 with MMuBC （28.7%）. Clinicopathological characteristics were compared between the two groups. A Cox proportional hazards regression model was used to identify independent prognostic factors, and survival outcomes were assessed using the Kaplan-Meier method with log-rank tests. Results Compared with patients with PMuBC, those with MMuBC had significantly higher rates of HER-2 positivity （11.46% vs. 3.36%, P=0.004）, lymph node involvement （26.04% vs. 9.66%, P<0.001）, clinical stage Ⅲ disease （12.50% vs. 4.62%, P=0.004）, chemotherapy receipt （60.42% vs. 39.50%, P<0.001）, and breast-conserving surgery （53.13% vs. 34.03%, P=0.001）, and a significantly lower rate of sentinel lymph node biopsy （71.88% vs. 84.03%, P=0.011）. The 5-year disease-free survival （DFS） rate did not differ significantly between the two groups （97.5% vs. 94.8%, P=0.061）. However, the 10-year overall survival （OS） rate was significantly higher in the PMuBC group than in the MMuBC group （96.6% vs. 88.5%, P<0.001）. Multivariate Cox regression analysis identified pathological subtype and age as independent prognostic factors for OS; patients with MMuBC had a hazard of death nearly five times that of those with PMuBC （HR=4.722,95%CI：2.019~11.043, P<0.001）. Conclusion PMuBC and MMuBC represent two distinct disease entities with significantly different clinicopathological features and prognoses. MMuBC exhibits greater biological aggressiveness and substantially worse long-term survival, and should be regarded as a high-risk subtype warranting more intensive treatment and closer surveillance. Accurate histological subtyping is essential for prognostic assessment and treatment decision-making in patients with mucinous breast carcinoma.

Key words: pure mucinous breast carcinoma, mixed mucinous breast carcinoma, clinical characteristics, pathological characteristics, prognosis

中图分类号:

柴洁, 王丽丽, 丁林潇潇, 陈韬, 王君妍, 蔡阳阳. 乳腺黏液腺癌的临床病理特征及预后分析[J]. 岭南现代临床外科, 2026, 26(03): 139-146.

CHAI Jie, WANG Lili, DING Linxiaoxiao, CHEN Tao, WANG Junyan, CAI Yangyang. Clinicopathological features and prognosis of mucinous breast carcinoma[J]. Lingnan Modern Clinics In Surgery, 2026, 26(03): 139-146.

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