Prognosis Of Neoajuvant Chemotherapy In Invasive Micropapillary Carcinoma Of Breast And Clinical Significance Of Mimic IMPC

PART 1ObjectiveInvasive micropapillary carcinoma(IMPC)is a special type of breast cancer with high lymph node metastasis.The classical pathological morphology consists of small mass-like hollow or mulberry-like tumor cell clusters,sorounded by clear spaces or retraction clefts.The apical pole of the IMPC cell mass faces the stroma not the luminal surface and is in a state of inside-out.Neoadjuvant chemotherapy(NAC),also known as preoperative chemotherapy,is increasingly used in breast cancer patients because it can reduce tumor size and reduce tumor stage.To investigate whether IMPC patients would benefit after subject neoadjuvant chemotherapy,in this study we explore the efficacy and prognosis of IMPC patients by comparing the prognosis between IMPC patients undergoing neoadjuvant chemotherapy and IMPC patients without neoadjuvant chemotherapy.Methods1.To collect the clinical and pathological data of 251 patients with breast IMPC of Tianjin Medical University Cancer Institute& Hospital from January 2011 to March 2014.According to whether neoadjuvant chemotherapy subjected patients were divided into NAC group including 67 patients and non-NAC group with 184 patients.The clinicopathological features and the survival difference of no metastasis were analyzed.We also compare clinicopathological features and the survival difference between these two groups in pN0-pN2 subgroup and pN3 subgroup based on lymph node stage.And the prognostic factors were analyzed in patients who underwent neoadjuvant chemotherapy.Furthermore,we also explore the prognostic in IMPC patients who subject neoadjuvant.Results1.In total 251 IMPC patients,tumour size and T stage was significantly higher and in NAC group than non-NAC group whenever before neoadjuvant chemotherapy and after neoadjuvant chemotherapy.And tumors size was significantly reduced from 5.0cm to 4.3 cm(P=0.035),but there was no significant difference for the changes of T stage in patients subjected neoadjuvant chemotherapy(P=0.064).Although neoadjuvant chemotherapy was not independent predictor of distant metastasis-free survival(DMFS)in total 251 patients with IMPC,univarite survival analysis showed that the NAC group had a lower DMFS than non-NAC patients(P=0.020).2.In pN0-pN2 subgroup,tumor size and T stage were significantly reduced after NAC(Ps<0.005),the differences in the distant metastasis-free survival between NAC group and non-NAC group were insignificant(P=0.729).In pN3 subgroup,tumor size and T stage were not significantly changed(Ps>0.05),and the DMFS was significantly worse for NAC group than non-NAC group(P=0.033).3.pN stage,PR status and p53 status were independent predictor for DMFS rate in 67 IMPC patients who accepted neoadjuvant chemotherapy,and pN3 stage,PR negative and P53 positive would significantly correlation with poor DMFS.ConclusionIMPC is a special type of cancer with high lymph node metastasis and is not sensitive to chemotherapy.Whether patients with IMPC subjected neoadjuvant chemotherapy benefit is significantly related to the stage of pN.When pN stage is too high,the application of neoadjuvant chemotherapy will increase the risk of distant metastasis.Therefore,the diagnosis of breast cancer histology by core needle biopsy and accurate assessment of lymph node status before treatment are essential for predicting the efficacy and prognosis of neoadjuvant chemotherapy.PART 2ObjectiveRetraction clefts(RC)are one of thes of IMPC.In clinical practice,we usually find the retrcaction clefts present in invasive carcinoma of no special type(NST)of breast.It exsist like IMPC in NST that tumour cell clusters with retraction clefts are morphologically very similar to IMPC,but MUC1/EMA immunohistochemical staining has no typical polarity reversal characteristics like IMPC.This study mainly analyzed difference of clinicopathological features and prognosis such as recurrence and metastasis among IMPC group,the NST group with retrcaction clefts(RC group)and the NST group without retrcaction clefts(non-RC group),to analyse association of RC group asnd IMPC group,futher to explore the role in breast cancer.MethodsA total of 2021 cases of breast cancer admitted to Tianjin Medical University Cancer Institute& Hospital from January 2005 to December 2006 were collected and their clinical and pathological data were included.Including 198 cases of IMPC and 1823 cases of NST,and NST patients were divided into RC group with 902 patients and non-RC group with 921 patients according to whether retration clefts present.In this study we firstly compared the clinicopathological features and prognosis of the three groups in total cases.And then patients in the RC group were divided into two groups of high-low proportion retration clefts,and the clinicopathological features and prognosis differences between high and low proportion RC cases were analyzed.Results1.The clinicopathological features of 2021 patients showed that the parameters related to lymphatic dissemination such as lymph node positivity,p N3 stage,and pathological TNM ?-? stage and lymphovascular invasion(LVI)positivity were significantly higher in RC group than non-RC group,but lower than IMPC group.And the recurrence rate in RC group was also higher than non-RC group,but is lower than IMPC group(17.0%,9.9% and 4.9%,P<0.001).There was no significance for distant metastasis between RC(20.5%)group and non-RC group(18.0%),and they are both lower than IMPC group(29.3%)(P=0.006).2.univaraite analysis of RFS of 2021 patients showed that the RFS of the IMPC group and the RC group,high p T stage,high p N stage and LVI-positive were lower(P<0.05).Multivariate RFS showed that study grouping and p N staging were independent prognostic factors for the risk of recurrence in breast cancer patients.Univariate analysis of DMFS showed no significant difference in DMFS be tween RC and non-RC groups,although their DMFS rate were both lower than that in IMPC group(P<0.05).Multivariate DMFS analysis showed that the study grouping was not an independent prognostic factor.3.The clinicopathological features of the RC group showed that there was no statistical difference in the distribution of p T stage,p N stage,TNM stage,LVI between <15% RC group and ?15% RC group.4.Univariate RFS analysis of patients in the RC group showed high p N stage,LVI positive had lower RFS(Ps<0.05).Multivariate survival analysis showed LVI is an independent prognostic factor for patients' RFS.Univariate DMFS analysis showed that DMFS was lower in low percent RC,high p T stage,high p N stage,LVI positive,and fat-positive cases(P<0.05).Multivariate survival analysis showed that RC percent,p T stage,p N staging were independent prognostic factor for DMFS.ConclusionOur results suggest that the presence of RC is associated with lymphatic dissemination of breast cancer,regardless of the percentage of the RC.Not only the morphology of the NST with RC similar to IMPC,but also the clinicopathological feaures such as LVI,lymph node metastasis and risk of recurrence.But both they not reach to IMPC,maybe we could call this type the mimic IMPC.