乳腺派杰氏病45例临床分析

目的:研究分析乳腺派杰氏病的临床特点及影响其预后的因素.方法:对我院收治的45例经病理诊断的乳腺派杰氏病例资料进行回顾性分析.结果:45例中有乳头和/或乳晕区糜烂、出血等湿疹样表现者40例(其中伴乳头下方肿块11例);单纯表现为乳头下肿块5例;伴同侧腋窝淋巴结肿大13例.本组25例作根治术,20例作改良根治术.派杰氏病不伴深部肿块者的5年和10年生存率分别为95.5%和78.6%,而伴有深部肿块者的5年和10年生存率分别为53.8%和36.4%,两者的5年和10年的生存率比较均有统计学意义(其P值分别为＜0.01和＜0.05);无乳头下方浸润者的5年和10年生存率分别为100%和88.9%,而有乳头下方浸润者的5年和10年生存率分别为69.6%和43.8%,前者亦优于后者(P＜0.05);腋窝淋巴结阴性者的5年和10年生存率分别为92.0%和76.5%,而阳性者则分别为50.0%和25.0%,前者同样优于后者(P＜0.05).结论:乳腺派杰氏病多数有典型的临床表现,凡有湿疹样表现者均要考虑本病的可能性;本病预后的关键在于早期治疗.不伴深部肿块、没有深部浸润和腋淋巴结阴性者的手术治疗有很好效果,伴有肿块、有深部浸润和腋淋巴结阳性者的预后差,且均有统计学意义.

Paget's Disease of the Breast:Clinical Analysis of 45 Patients

Objective: Paget's disease is an uncommon breast malignancy and often misdiagnosed. If the patient is treated in early stage, the prognosis is satisfied. Our study analyzed the clinical characteristic of the disease and the factors influencing the prognosis. Methods: 45 patients with Paget's disease who were admitted our hospital were analyzed retrospectively. Results: The most common symptoms of the disease were erosion and bleeding like eczematoid change at nipple/areola. Of the 40 patients with eczematoid change, 11 patients had verified paget's disease with a palpable mass on physical examination, and 29 patients had verified paget's disease with nonpalpable mass. Five patients only manifested a mass with no eczematoid change. Thirteen patients had lateral axillary lymphadenopathy. In this study, 25 cases were treated by radical mastectomy and 20 cases were treated by modified radical mastectomy. Five and ten-year survival rates for the patients with nonpalpable mass and for those with palpable mass were 95.5%, 78.6%, and 53.8%, 36.4% respectively. The former were significantly better than latter P value <0.01 and <0.05 respectively). Five and ten-year survival rates for the patients without underlying carcinoma (DCIS/IDC) and for the patients with underlying carcinoma were 100%, 88.9% and 69.6%, 43.8% respectively. The former were significantly better than latter (P value <0.05). Five and ten-year survival rates for the patients with lymph nodes negative and for the patients with lymph nodes positive were 92.0%, 76.5% and 50.0%, 25.0% respectively. The former were also significantly better than latter (P value <0.05). Conclusion: The treatment in early stage is very important and influences the prognosis directly for Paget's disease of breast. The survival of the patients with nonpalbable mass, without underlying carcinoma and without lymphadenopathy were significantly better than the patients with palpable mass, with underlying carcinoma and with lymphadenopathy respectively. There was significant statistic difference between each two groups.