乳腺导管／小叶混合型癌的临床病理分析

目的 比较分析乳腺导管/小叶混合型癌（mixed ductal/lobular carcinoma）与乳腺浸润性导管癌（invasive ductal carcinoma,IDC）的临床病理特征.方法 回顾性分析2009年7月至2012年12月沈阳军区总医院普外科收治的35例乳腺导管/小叶混合型癌及86例IDC的临床病理资料,比较二者的临床病理特征.计数资料采用χ2检验及Fisher确切概率法,等级资料采用非参数检验,多因素分析采用二分类非条件Logistic回归分析.结果 单因素分析显示ER、PR阳性表达率及E-cadherin阴性表达率混合型癌组显著高于IDC组（χ2=4.169、8.860、12.392;P=0.041、0.003、0.000）,多因素回归分析提示PR和E-cadherin是混合型癌与IDC的独立危险因素[Exp（B）=2.957,95%CI=1.250～6.991,P=0.014;Exp（B）=0.255,95%CI=0.104～0.623;P=0.003].但发病年龄、月经情况、腋窝淋巴结转移、HER-2与Ki67阳性表达、TNM分期两组差异均无统计学意义（χ2=1.442、0.979、0.455、0.010、2.364,P=0.230、0.323、0.500、0.920、0.124;Z=-0.197,P=0.844）.结论 乳腺导管/小叶混合型癌是兼有IDC与浸润性小叶癌临床病理特征但却独立的一种类型.

Clinicopathologic analysis of mixed ductal/lobular carcinoma of breast

Objective To analyze and compare the clinicpathological characteristics between mixed ductal/lobular carcinoma and invasive ductal carcinoma （ IDC ） of the breast. Methods We retrospectively analyzed the data of patients treated in Department of General Surgery, General Hospital of Shenyang Military Region from July 2009 to December 2012, including 35 cases of mixed duetal/iobular carcinoma of the breast and 86 cases of IDC and compared clinicopathologie characteristics between the two groups. Chi-square test and Fisher＇ s exact propahility were used for enumeration data, non-parametric test for ranked dat. Multivariate analysis was performend using Logistic regression analysis. Results Univariate analysis showed that the positive rate of ER and PR and negative expression of E-cadherin in mixed carcinoma group were significantly higher than those in IDC group （ X2 = 4. 169, 8. 860, 12. 392; P = 0. 041,0. 003,0. 000 ）. Multivariate regression analysis showed that PR and E-cadherin were independent risk factors in mixed carcinoma and IDC [Exp（B）= 2.957, 95%CI=1.250-6.991,P=0.014;Exp（B）= 0.255,95%CI=0.104-0.623;P= O. 003 ]. But onset age, menstruation, axillary lymph node metastasis, HER-2 and Ki67 expression and TNM stage showed no statistically significant difference between the two groups （ X2 = 1. 442,0. 979,0. 455, O. 010, 2.364,P=0.230,0.323,0.500,0.920,0. 124;Z=-0. 197,P=0.844） Conclusion The mixed ductal/ lobular carcinoma is a distinctive clinicopathologic type incorporating some features of both invasive lobular carcinoma and IDC.