The Establishment Of Prognostic Evaluation System Of Paget's Disease Of The Breast In Women

[Objective]MPD was one special breast cancer which combined with pathological changes of nipple-areola complex,but There was different with others breast cancer in clinical manifestation, pathology types and method of diagnose and treatment,There exited considerable dispute in the selection of its treatments. The ways to work out focus on how the prognosis of these patients was estimated exactly and objectively. Only when the suitable strategy of therapy was applied in some patients the conservative treatment according to recurrence and metastasis of tumor. In this research,The related clinical and pathologic factors as well as tumor markers that may affect prognosis of the urothelium carcinoma were screened by univariate and multivariate analysis and. the tables of prognostic evaluation were formulated. Setting up a prognostic model which may stratify the patients into different risk groups as a tool for prognosis prediction to MPD.[Methods]During 1985 to 2005,there were 216 cases MPD patients in women affirmed pathologically after operation in the Second affliliated Hospital and Cancer Hospital of Tianjin Medical University. The general character, clinical data, ways of treatment and pathological data of all MPD patients were registered in sequence. The prognostic information about all 216 patients was investigated with different ways. Among these patients 216 cases of MPD,The final 177 cases were to be selected because of pero-cases and paraffin blockes of 39 cases were ignored. The expression of PR,ER, C-erbB-2,P53,VEGF, E-cadherin, Ki-67 and MVD of all patients'paraffins samples were detected using immunohistochemistry.28 prognostic risk factors were planed to estimate in our study such as age, the time from symptom emerging to visiting doctor, marriage, menarche. According the three different endpoints (recurrence, metastasis and death), the prognosis risk factors were preliminary screened respectively with Kaplan-Meier univariate analysis. And then the prognosis risk factors were determined finally with multivariate Cox proportional hazards regression model.Based on the coefficients of the variables in the multivariate model,a weight for each level of each variable was obtained and the prognostic evaluation score of MPD was calculated. [Results] 1.The clinical characteristics of Patient. In our study, the number of MPD patients in women occupied 1% of that of all the simultaneous breast cancer patients. The average age was 65±15.4 years (29～79 years) and the fastigium of morbidity was from 50 years to 60 years. The morbidity age of female was mostly in post-menopause,similiarly with age distribution of breast cancer,putted off 5～10 years later than invasion breast cancer. Based on a median follow-up of 144 months and a maximum follow up of 240 months,53cases of MPD recurred (29.9%),57 cases metastasised (32.2%) and 45 cases died (26.0%).2.The 2year,10 year, probability of tumor recurrence was 5%,21% respectively with life table method estimating the accumulation probability. The 2year, 10year, probability of disease metastasis was 3%,26% and the 2 year,10 year probability of death was 4%,16%, respectively.3.The risk factors of the tumor recurrence of MPD included in the multivariate model were coded as:the time from symptom emerging to visiting doctor, lymphaden intumesce, Postoperative combined therapy,P53,VEGF, E-cadherin, and MVD. The risk factors of the metastasis were coded as:the time from symptom emerging to visiting doctor, lymphaden intumesce,MPD with goiter, Postoperative combined therapy, clinical pathology, P53,VEGF, E-cadherin, and MVD.Only metastasis was the risk factor of death.4. The tables of prognostic evaluation of tumor recurrence and disease progression of MPD were presented.[Conclusion] In this study, the risk factor of tumor recurrence and metastasis of MPD were determined with statistics method by investing the prognosis of 177 cases. Based on this, the risk coefficient was translated into prognostic score and the tables of prognostic evaluation of MPD was founded initially, which shows the influence of each risk factor with intuitional scores. According to total risk scores,the recurrence and metastasis of tumor of 1 yea,5 year,10year and 20 year were predicted The model of prognostic evaluation of MPD could help the doctor to make a decision of the patients conveniently.