Clinicopathological Features And Prognostic Factors Of Invasive Micropapillary Carcinoma Of The Breast

Objective: To investigate the pathological and clinical features and prognostic factors of breast invasive micropapillary carcinoma(IMPC),construct a prognosis prediction model,and predict the prognosis of IMPC patients。Methods: A retrospective analysis was conducted of 177 breast IMPC patients who were admitted,diagnosed and treated in the Breast Surgery Department of the First Affiliated Hospital of Dalian Medical University from March 2012 to September 2022.Collect their general clinical data,pathological data and prognosis.The pathological and clinical features were analyzed,and the selected the pathological and clinical features were analyzed by univariate and multivariate Cox proportional hazards regression models,and forest plots were drawn to analyze the factors affecting the prognosis of IMPC patients.Kaplan Meier method was used for survival analysis and survival curves were drawn.The nomogram model was constructed with the screened IMPC prognostic factors to predict the disease-free survival(DFS)of the patients.Results: A general analysis of the collected clinical and pathological data found that breast IMPC patients were more likely to occur in patients older than 50 years(120/177,67.8%)and postmenopausal patients(117/177,66.1%),and tumors were more likely to occur on the outer surface in the quadrant,the rate of lymph node metastasis was high(108/177,61.02%).The number of lymph node metastases is 1-3,and most of the molecular types were Luminal B(121/177,68.36%).The pathological and clinical features selected for analysis were the largest tumor diameter,Ki-67,histological grade,vascular invasion,soft tissue invasion,ER,PR,HER-2,molecular typing,T stage,N stage,and clinical stage.The prognostic endpoint was disease-free survival.Univariate Cox proportional hazards regression analysis was performed on the selected the pathological and clinical features,and the differences in the DFS of the largest tumor diameter,histological grade,ER,and clinical stage were statistically significant(P=0.047,<0.001,0.025 and 0.033).HR(95%CI)were 1.1769(1.002-1.381),9.248(3.276-26.108),0.411(0.190-0.893)and 1.255(1.018-1.546)respectively.Then,multi-factor Cox proportional hazards regression analysis was performed on the selected the pathological and clinical features,among which the differences in the largest tumor diameter,histological grade,ER,molecular type,T stage,and clinical stage were statistically significant(P<0.05),and they were IMPC independent prognostic factors for patients.HR(95%CI)were 1.639(1.187-2.264),1.762(1.471-1.959),0.111(0.022-0.56),0.39(0.167-0.910),2.061(1.007-4.217),respectively.The forest plot of multivariate analysis show that the largest tumor diameter,histological grade,and clinical stage are risk factors for the prognosis of IMPC patients.ER,T stage,and molecular type are protective factors for the prognosis of IMPC patients.However,ER has the lowest hazard ratio and the highest hazard ratio in histological analysis,suggesting that compared with other the pathological and clinical features of IMPC included,ER positivity is more likely to be a protective factor for better prognosis,and the higher histological grade indicates the worse prognosis.prognosis.For ER,PR,HER-2,histological grade,T stage,and Ki-67,the Kaplan Meier method was used for survival analysis and the survival curve was drawn.There was no difference in the survival curve between HER-2 expression and non-expression.The 5-year and 10-year survival rates of ER and PR positive patients were higher than those of negative patients.The level of Ki-67 expression has a significant difference in the 5-year survival rate,but there is no significant difference in the 10-year survival rate.The analyzed independent prognostic factors were incorporated into the nomogram model of DFS prediction in IMPC patients.Conclusion: 1.Breast IMPC has a high recurrence rate and high lymph node metastasis rate.2.The largest tumor diameter,histological grade,ER,molecular type,T stage,and clinical stage are independent prognostic factors for breast IMPC patients.3.The survival rate of ER and PR positive patients is better than that of negative patients,which suggests that even if the lymphatic metastasis rate of breast IMPC patients is high and the prognosis is poor,endocrine therapy can still improve the prognosis.4.The nomogram can predict the prognosis of patients and provide the basis for individualized treatment of IMPC patients.