Clinicalpathological Features And Prognosis For Invasive Micropapillary Carcinoma Of The Breast

Objective : Objective to summarize the diagnostic rate of invasive micropapillary carcinoma(IMPC)of the breast from January 1,2015 to December 31,2019 in general hospital of Ningxia Medical University,analyze the clinical and pathological characteristics of IMPC,and explore the factors influencing the prognosis of IMPC,Objective to provide help for clinicians to evaluate whether IMPC needs more active follow-up and adjuvant treatment.Methods:A total of 104 patients with IMPC confirmed by pathology after operation in general hospital of Ningxia Medical University from January 1,2015 to December 31,2019 were collected.230 cases of non-specific invasive breast cancer(NSIBC)were selected by matching method for retrospective analysis.Follow up was conducted by outpatient follow-up,telephone,wechat and other means.Spss25.0 and graphpad prism 8.0.1 were used to analyze and process the data,and chi square test was used to compare the constituent ratio and rate between groups;Kaplan Meier method was used to draw survival curve,and log rank test was used to test the single factor;Cox regression analysis was used to analyze the prognostic factors of IMPC;The difference was statistically significant(P(27)0.05).Results: 1.Diagnosis rate of IMPC patients: from January 1,2015 to December 31,2019,the General Hospital of Ningxia Medical University treated 4532 cases of breast cancer patients,227 cases of IMPC patients(5.01%).The diagnostic rates of IMPC from 2015 to2019 were 1.12%(9/807),4.28%(36/841),5.61%(50/891),6.21%(61/983)and 7.03%(71/1010),respectively.2.Clinicopathological characteristics of 104 IMPC patients eligible for enrollment2.1 The clinical characteristics of 104 patients with IMPC: median age 51 years(28～87years),premenopausal patients 57.69%(60/104),modified radical mastectomy 80.77%(84/104),breast conserving surgery 19.23%(20/104),postoperative radiotherapy 53.85%(56/104),endocrine therapy 79.81%(83/104),targeted therapy 90.91%(30/33).2.2 The pathological characteristics of 104 patients with IMPC were as follows: 2.88%(3/104)in homozygous IMPC,97.12%(101/104)in mixed IMPC,88.46%(92/104)in T1-2 and11.54%(12/104)in T3-4,71.15%(74/104)in n0-1 and 28.85%(30/104)in N2-3,and 7.69%(8/104)and 92.31%(96/104)in Grade 1 and 2-3 respectively,Lymphatic invasion was 21.15%(22/104),vascular invasion was 6.73%(7/104),drug resistance gene was positive GST-(47)、31%(44/104),TNM stage I-II and III were 71.15%(74/104)and 28.85%(30 / 104),respectively.2.3 The characteristics of immunohistochemical indexes of 104 IMPC cases were as follows: 83 cases(79.81%)were ER positive,68 cases(65.38%)were pr positive,33 cases(31.73%)were HER2 positive,and 75 cases(72.12%)had high Ki-67 expression.2.4 Among 104 cases of IMPC,luminal type and non luminal type were 80.77%(84/104)and 19.23%(20/104)respectively.2.5 Clinicopathological characteristics of IMPC and NSIBC the clinicopathological characteristics of the 104 IMPC patients were compared with those of the 230 NSIBC patients who had been matched after matching,and the following data were available: there were significant differences in the proportion of endocrine therapy,lymphatic invasion,expression of resistance genes,er positivity and molecular classification(P<0.05);age,menstrual status,tumor location,surgical procedure There were no significant differences in the formula,radiotherapy,targeted therapy,T stage,N stage,histological grade,vascular invasion,TNM stage,PR positive rate,Ki-67 expression,and HER2 positive rate between the two groups(P>0.05).3.The 5-year local recurrence free survival(LRRFS)rates were 85.5% for IMPC patients and 90.4% for NSIBC patients(P=0.044),and the 5-year disease-free survival rates were81.5% for IMPC patients and 78.0% for NSIBC patients(P= 0.385);The 5-year distant metastasis free survival(DMFS)rate was 94.8% for IMPC patients and 85.5% for NSIBC patients,with no significant difference(P = 0.568).4.Univariate analysis of the clinical features,pathologic features,and molecular classification of 104 IMPC patients revealed that T stage,N stage,lymphatic invasion,vascular invasion,ER negativity,and PR negativity were risk factors for a poor outcome in IMPC patients(P<0.05),and multivariate analysis by incorporating the above factors into the Cox regression model showed that lymphatic invasion、T stage,N stage was a risk factor for IMPC patients Independent prognostic factors for survival(P <0.05).Conclusions 1.The diagnosis rate of IMPC patients increased year by year(1.12%-7.03%)in 2015～2019 at the Ningxia Medical University General Hospital.2.IMPC compared with NSIBC patients,IMPC patients had higher ER positive rate and the proportion of patients with luminal type,suggesting that endocrine therapy is available;IMPC patients had lower positive rate of resistance genes,which may be highly sensitive to chemotherapy and have better chemotherapy effect,and further research is needed.3.There was no significant difference in 5-year DFS and DMFS between IMPC and NSIBC patients,but 5-year LRRFS was poor,suggesting that IMPC has a high local recurrence rate and requires postoperative intensive local therapy and follow-up.4.Univariate analysis suggested that T stage,N stage,lymphatic invasion,vascular invasion,er negativity,and PR negativity were risk factors for the poor prognosis of IMPC patients,and Cox regression analysis showed that lymphatic invasion,T stage and N stage were independent risk factors for prognosis of IMPC patients.