杨后圃王伟琦王殊谢菲郭嘉嘉曹迎明佟富中刘鹏刘媛媛



1 190例乳腺癌患者乳头浸润相关因素分析

杨后圃①王伟琦②王殊①谢菲①郭嘉嘉①曹迎明①佟富中①刘鹏①刘媛媛②

摘要目的：探讨早期乳腺癌侵犯乳头的概率和相关危险因素。方法：收集北京大学人民医院2008年10月至2014年3月行乳腺癌标准乳房切除术病例1 190例，比较临床乳头异常组（54例）与无明显异常组（1 136例）乳头浸润率差异，分析相关临床病理因素与隐匿性乳头浸润的相关性。将单因素分析具有统计学意义的指标纳入二元Logistic回归模型行多因素分析，筛选独立预测因子。结果：所有标本乳头浸润率为6.0%（71/1 190），其中临床乳头异常组为40.7%（22/54）显著高于无明显异常组的4.3%（49/1 136）（χ2=121.9，P<0.001）。单因素分析显示病变位置（中央象限、外周象限）、肿瘤至乳头距离（≤2 cm、>2 cm）、脉管癌栓、肿瘤（包括原位癌）长径（≤3.5 cm、>3.5 cm）、T分期、N分期和TNM分期与隐匿性乳头浸润有关。多因素分析显示病变位置、肿瘤至乳头距离、T分期和N分期是乳头浸润的独立预测因子。结论：临床乳头无明显异常者乳头浸润概率较低。肿瘤位于外周、至乳头距离>2 cm、T1～T2、N0～N1的病例保留乳头风险更低。

关键词乳腺肿瘤乳房切除术乳头浸润预测因子

Nipple involvement in early breast cancer: retrospective analysis of 1,190 consecutive mastectomy specimens

Houpu YANG1, Weiqi WANG2, Shu WANG1, Fei XIE1, Jiajia GUO1, Yingming CAO1, Fuzhong TONG1, Peng LIU1, Yuanyuan LIU3
Correspondence to: Shu WANG; E-mail: shuwang@pkuph.edu.cn
1Breast Center, Peking University People's Hospital, Beijing 100044, China;2Department of General Surgery, Aerospace Center Hospital, Beijing 100039, China;3Department of Breast Surgery, Maternal and Child Health Institute of Changping District, Beijing 102200, China

Abstract Objective: To evaluate the frequency and predictive factors of nipple involvement in a large contemporary cohort of patients and to improve patient selection for the preservation of the nipple-areolar complex.Methods: This retrospective study reviewed the medical charts of 1,190 patients who underwent traditional mastectomy in Peking University People's Hospital between October 2008 and March 2014.Nipple involvement incidence was compared between the cases of clinically abnormal and clinically normal breasts.Other clinicopathological features and nipple status were analyzed to evaluate the association between these factors and occult nipple involvement.Univariate and multivariate analyses were conducted to identify predictive factors.Results: Nipple involvement was detected in 6.0% of the mastectomy specimens.Meanwhile, incidence was 40.7%（22 out of 54）in clinically abnormal nipple cases and 4.3%（49 out of 1,136）in clinically normal nipple cases（χ2=121.9, P<0.001）.Univariate analysis revealed that tumor location, tumor to nipple distance（≤2 and >2 cm）, lymphovascular invasion, diameter（including carcinoma in situ;≤3.5 and >3.5 cm）, T stage, N stage, and TNM stage were associated with occult nipple involvement.By logistic regression analysis, tumor location, tumor to nipple distance, T stage, and N stage were determined to be the independent predictors of nipple involvement.Conclusion: Clinical abnormalities of the nipples are reliable and potent predictors of nipple pathology.The cases with peripheral tumor, T1-T2stage, and N0-N1stage have lower probability of occult nipple involvement.

Key words:breast neoplasm, mastectomy, nipple involvement, predictive factor

在确保肿瘤获得良好控制的基础上提高手术的美容效果是现代乳腺外科的目标。尽管保乳手术在一部分患者中实现了这个目标，但仍有一定比例（20%～70%）的患者不适合保乳而不得不接受乳房切除手术［1］。保留乳头乳晕的乳房切除术联合乳房重建可以极大改善重建乳房的美观性，近年来成为乳腺外科的研究热点［2］。乳头乳晕区的癌残留和复发是该术式应用的最大顾虑，其肿瘤学安全性及适应证目前尚存在争议。本研究……