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目的乳腺导管内乳头状瘤是发生在乳头乳晕区的乳腺良性肿瘤,临床上较为常见。本研究探讨乳腺导管内乳头状瘤临床病理特征与复发的关系。方法回顾性分析2010-01-01-2015-07-01中国医学科学院肿瘤医院547例乳腺导管内乳头状瘤患者的临床病理资料。结果 547例患者中,348例不伴有非典型增生(63.6%),199例(36.4%)伴有非典型增生。中位随访37个月,导管内乳头状瘤组和导管内乳头状瘤伴非典型增生组3年无复发生存率分别为98.2%和95.0%;3年无肿瘤生存率分别为99.1%和98.5%。2组无复发生存曲线比较差异有统计学意义,P=0.009。Cox分析结果显示,非典型增生是影响术后复发的主要因素,RR=0.183,95%CI=0.045~0.675,P=0.011;Logistic回归分析结果显示,伴有乳房肿物(OR=0.448,95%CI=0.29~0.68,P<0.001)、外周型导管内乳头状瘤(OR=0.444,95%CI=0.45~0.72,P=0.001)术后病理更易出现非典型增生。结论非典型增生情况是乳腺导管内乳头状瘤术后复发重要预测指标。
Purpose Breast ductal papilloma is a benign breast tumor that occurs in the nipple areolar area, and is clinically common. This study was to investigate the relationship between clinicopathologic features and recurrence of intraductal papilloma in breast. Methods The clinical and pathological data of 547 patients with intraductal papilloma of the breast were retrospectively analyzed from January 2010 to January 2015 in the Tumor Hospital of Chinese Academy of Medical Sciences. Results Of the 547 patients, 348 were not associated with atypical hyperplasia (63.6%) and 199 (36.4%) were associated with atypical hyperplasia. At a median follow-up of 37 months, the 3-year recurrence-free survival rate was 98.2% and 95.0% for the intraductal papilloma group and the atypical hyperplasia group, respectively; the 3-year tumor-free survival rates were 99.1% and 98.5%, respectively %. There was significant difference between the two groups in recurrence-free survival curve, P = 0.009. Cox analysis showed that atypical hyperplasia was the main factor influencing postoperative recurrence, RR = 0.183, 95% CI = 0.045-0.675, P = 0.011; Logistic regression analysis showed that breast cancer with OR = 0.448,95 % CI = 0.29-0.68, P <0.001). Pathological changes of peripheral ductal papillomatosis (OR = 0.444, 95% CI = 0.45-0.72, P = 0.001) were more likely to cause atypical hyperplasia. Conclusions Atypical hyperplasia is an important predictor of postoperative recurrence of intraductal papilloma in the breast.