The Clinical Research About Clinical,pathological And Prognosis Features Of Invasive Ductal Micropapillary Carcinoma And Invasive Mucinous Micropapillary Carcinoma

ObjectiveThis study was to investigate the clinical,pathological,and prognostic features between IDMPC and MUMPC and explore the factors which influence recurrence-free survival.MethodsAll the cases in this study were from the 1780 cases of breast cancer patients(from2013-12-01 to 2017-06-01)in the Breast Malignant Tumor Database of this hospital.All the 58 mixed IMPCs(including 38 cases of IDMPC and 20 cases of MUMPC)and 32 cases of pure mucinous carcinoma(pMC)were selected,and 60 cases of IDC-NOS were randomly selected.We collected,summarized and organized pathological data and follow-up information of the above patients.For the comparison of two pairs,three subgroups were compared and the chi-square test was used to analyze the clinical and pathological features of each subgroup.The follow-up period was from the date of surgery to 2019-02-01.Kaplan-Meier method was used to analyze recurrence free survival(RFS),Log-Rank was used to test survival curve differences and single factor analysis.Cox regression test was used to explore independent risk factors of recurrence-free survival.Results38 cases of IDMPC,60 cases of IDC-NOS,20 cases of MUMPC and 32 cases of pMC were included in the study.There was no significant difference in the age,size of the tumor,histological grade and HER2 amplification.Regarding lymph node metastasis rate,multifocal cancer incidence,vascular invasion rate,and low progesterone receptorexpression rate,IDMPC was significantly higher than IDC-NOS(p=0.014,0.001,0.039,0.029,<0.05),and MMUPC was significantly higher than pMC(p=0.006,0.029,0.020,0.016,<0.05),pMC was not significantly different from IDMPC(p=0.406,0.852,0.852,0.465).Regarding estrogen receptor positive rate,IDMPC was significantly higher than IDC-NOS(p=0.030,<0.05).Regarding the high expression rate of Ki67,IDMPC was significantly higher than IDC-NOS(p=0.003,< 0.05)and pMC(p=0.007,<0.05).Regarding molecular typing,the Luminal B type ratio of IDMPC was significantly higher than IDC-NOS(p=0.001,<0.05),the Luminal B type ratio of MUMPC was slightly higher than pMC,but not statistically significant(p=0.066),Luminal B type ratio of MMUPC and IDMPC has no significant difference(p=0.304).Regarding clinical stage,the rate of phase III in IDMPC was significantly higher than that in IDC-NOS(p=0.021,<0.05),and the stage III incidence rate of MUMPC was slightly higher than that of pMC,but not statistically significant(p=0.123),there was no significant difference between MUMPC and IDMPC(p=0.363).Regarding recurrence-free survival,during follow-up,9 of 38 IDMPC patients had recurrence or metastasis,with an average RFS of 56.196±0.888 months;9 of 60 IDC-NOS patients had recurrence or metastasis,with an average RFS of 52.534±2.620 months;4cases of MMUPC patients had recurrence or metastasis,the average RFS was50.953±2.037 months;2 cases of 38 cases of pMC recurred,the average RFS was58.306±1.150 months,with significant differences(p=0.048,<0.05).Univariate analysis with Kaplan-Meier method showed multifocal carcinoma(p<0.001),high histological grade(p=0.016,<0.05),HER2 amplification(p=0.025,<0.05),presence of micropapillary carcinoma(p=0.014,<0.05)are risk factors affecting recurrence-free survival.Cox multivariate analysis showed that only multifocal cancer was an independent risk factor for recurrence-free survival.Logistic regression analysis showed that the presence of micropapillary carcinoma may be a risk factor for multifocal cancer.ConclusionsMixed invasive micropapillary carcinoma(IMPC)include IDMPC and MUMPC have no significant differences in high multifocal tumor incidence,high vascular invasion rate,high lymph node metastasis rate,and high PR low-no expression rate.IDMPC and MUMPC have more aggressive potential than IDC-NOS and MMUPC.However,there are no significant difference in certain characteristics of MUMPC and pMC such as ER positive rate and Ki67 expression rate.The prognosis of IDMPC and MUMPC is relatively poor.Multifocality is an independent factor of recurrence-free survival.The presence of micropapillary carcinoma may be a multi-focal risk factor,so the presence of micropapillary cancer components synergistically reduces the recurrence-free survival of mixed IMPC(IDMPC and MUMPC).