| BackgroundBreast cancer is one of the most common cancer in women, and its morbidity and mortality has been among the top of the female cancer in our country. With the launch of national breast cancer screening; people growing importance of their own health; development of the digital molybdenum target drone, high-resolution color Doppler ultrasound, breast MRI and other imaging technologies; early breast cancer detection rate was increasing year by year. In the early stage of breast cancer, ductal carcinoma in situ(DCIS) has an important position. About 400 thousand female die of the disease all over the world every year.In the United States, the statistics of DCIS was approximately 20%-30% of the newly diagnosed breast cancer cases; that figure was 7.8%- 7.8% in China. The detection rate of Ductal carcinoma in situ with microinvasive(DCIS-MI) in DCIS was 7.8%-12.8%. At present, there are few studies on the DCIS-MI. Foreign research has focused on the pathological classification, whether breast cancer breast conserving surgery and sentinel lymph node biopsy, etc. Domestic research on DCIS-MI is primarily clinical pathology analysis, immunohistochemical features, case reports and imaging characteristics. At present, there are few studies on the difference of clinical features between DCIS-MI,DCIS and invasive ductal carcinoma(IDC). Compared with IDC, DCIS-MI and DCIS have better prognosis and lower mortality. Study the differences in clinical and prognostic between DCIS-MI and IDC, has a clinical value.Our study based on the patient’s medical record data and the return visit information to carry on the retrospective analysis in our hospital. There were 90 cases of DCIS, 86 cases of DCIS-MI and 125 cases of early IDC. To explore the clinical and Prognostic differences between DCIS-MI,DCIS and IDC.In order to provide evidence for clinical diagnosis and treatment.Objective1. Analysis of DCIS, DCIS-MI and IDC clinical medical records. Compare the clinical characteristics and differences of the three types of breast cancer, to provide the corresponding help for the diagnosis and treatment of breast cancer.2. Collect the DCIS-MI pathological data and return visit information, analyze the related factors influencing the prognosis and to provide evidence for clinical treatment.Materials and methods1. Collection of breast cancer patients admitted to the Third Affiliated Hospital of Zhengzhou University from January 2008 to December 2013. There were 90 cases of DCIS, 86 cases of DCIS-MI and 125 cases of early IDC. Its main project: the patient’s age, menopause, tumor size, ER, PR, HER-2, Ki-67,whether recurrence, etc..Compare the clinical characteristics and differences of the three types of breast cancer2. Collect the DCIS-MI patient’s age, the menopause, tumor size, ER, PR, HER-2,Ki-67,surgical,chemotherapy,endocrine therapy,relapse,recurrence, recurrence site, etc. Analysis of factors affecting prognosis.3. Statistical analysis using SPSS18.0 statistical software analysis system. Chi square test was used to examine the clinical pathological characteristics; Comparison of Fisher exact probability method. Statistically significant(? =0.05, P < 0.05). The clinical and pathological features are statistically significant data using the chi-square test pairwise comparison. Statistically significant( ? =0.0167, P < 0.016).The survival and prognosis of DCIS-MI were analyzed by Kaplan-Meier method, Log-rank test was used for univariate analysis, Cox proportional hazard model was used for multivariate analysis. Statistically significant( P < 0.05).Result1. DCIS, DCIS-MI and IDC patients in the ER, PR and HER-2, Ki-67 positive distribution were significantly different, there is statistical significance( P < 0.05). There were no differences in age, menopausal status and tumor size distribution,no statistical significance( P >0.05). In ER positive distribution, DCIS and DCIS-MI, IDC were differences( P <0.016);DCIS-MI and IDC no difference( P >0.016). PR-positive distribution, There were differences between DCIS and IDC( P <0.016); there were no difference between DCIS-MI and DCIS, IDC( P >0.016). HER-2 positive distribution, although DCIS and DCIS-MI were different( P <0.016), but DCIS and IDC; DCI-MI and IDC no significant difference( P >0.016). Ki-67 high expression profiles were significantly different( P <0.016). There was no significant difference in recurrence and metastasis rate between the groups( P >0.05).2. DCIS-MI 3-year disease-free survival rate was 96.5%,5-year disease-free survival rate was 92.2%. Univariate analysis showed that Ki-67, lymph node metastasis and endocrine therapy for hormone receptor positive patients were associated with the prognosis of DCIS-MI( P <0.05). The age, menopause or not, ER, PR, HER-2, surgical treatment, chemotherapy, had no effect on the prognosis,and no statistical significance. Multivariate analysis showed that lymph node metastasis and endocrine were related to the prognosis of the patients( P <0.05).Conclusion1. DCIS, DCIS-MI and IDC there are differences in the clinical and pathological features; the difference is mainly reflected in the ER, PR, HER-2 and Ki-67. In our study are more likely to be seen as DCIS-MI to develop invasive ductal carcinoma in situ carcinoma of the intermediate state.2. DCIS-MI prognosis was better. Its main prognostic factors Ki-67, lymph node metastasis and hormone receptor-positive patients whether endocrine therapy.The lymph node metastasis and endocrine therapy is particularly important.3.Surgical approach to DCIS-MI patient selection may choose breast-conserving surgery plus priority sentinel lymph node biopsy or breast surgery alone; for hormone receptor- positive patients should undergo endocrine therapy; whether DCIS-MI need chemotherapy still needs more clinical studies have confirmed. |
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