Clinical Characteristics And Survival Analysis Of Three Pathological Types Of Paget's Disease

BackgroundBreast cancer,one of the biggest threats to women's health,is increasing year by year,according to a report released by the World Health Organization in 2015.As part of its branch,.the incidence of the disease(Mammary Paget's disease,MPD)is low and the clinical characteristics are unique.However,due to the extremely low incidence of the disease,there are few case analyses in a wide range and no single diagnosis and treatment standard.Therefore,more and more comprehensive analyses are needed to summarize the changed clinical characteristics.At present,the pathological classification of MPD mainly includes simple MPD,MPD with intraductal carcinoma and MPD with invasive carcinoma.ObjectiveBased on the analysis of three types MPD patients admitted in our hospital in recent years,which conclude the diagnosis,auxiliary examination,surgical methods,pathological types and prognosis of the disease,to summarize and describe the characteristicsMethodThe key words of"Paget's disease of mammary gland"and"Paget"were searched in the discharge diagnosis and HIS outpatient system of jiahe medical record system.Retrospective analysis was performed on the clinical data of 126 female patients who were admitted to the first affiliated hospital of zhengzhou university from December 2010 to December 2016 and were pathologically diagnosed with MPD according to the inclusion criteria.Auxiliary examination includes color ultrasound and molybdenum target.Immuno-histochemical analysis mainly included ER,PgR,Her-2 qualitative analysis and Ki67 quantitative analysis.X~2 test was used for counting data,and P<0.05 was considered statistically significant.X~2 test and Kappa test were used for the difference and consistency of the effective rate of ultrasound,molybdenum target and pathological results,and K>0.4 was considered highly consistent.Kaplan-meier method was used for survival analysis of the data.Research Results1.The minimum age of onset was 26 years old,the maximum age was 86 years,and the mean age was 52.93±10.801 years,which was more than that of postmenopausal patients.The skin lesions in the nipple areola were the most common cause and were easy to be misdiagnosed,and the second common cause was the lumps in the breast,which found that there were fewer cases of delayed treatment.Skin lesions can also occur in nearby breasts and armpits where no nipple areola is involved.2.Total mastectomy is still the main surgical method for surgical treatment of MPD.2.The mass occupying rate was the highest in ultrasound examination,about54%(68/126),the highest in mammography,about 56.3%(71/126),and in mammography examination,calcification was found in 56.3%(71/126).The OR value between mammography and ultrasound was 1.012(80/79),and the two methods were of the same value.The difference between the two imaging examinations in the diagnosis of mpd was statistically significant(P<0.05),and the consistency was poor,K<0.4.3.The rates of modified radical surgery,simple adenectomy combined with sentinel lymph node biopsy and breast-conserving were 50.8%(64/126),44.5%(56/126)and 0.8%(1/126),respectively.4.Most MPD patients were associated with invasive carcinoma,followed by MPD with intraductal carcinoma,and the simple MPD were the least,respectively58.0%(73/126),27.0%(34/126)and 12.7%(16/126).All patients with positive axillary lymph nodes were found in PD-IDC patients,and accounted for nearly 1/3(21/73)of patients with invasive cancer.There were statistically significant differences between the three pathological types in the detection of tumor and the expression of Ki67 in ultrasound examination,P<0.05.There was no significant difference in the incidence profile,molybdenum target on calcification and the expression of ER,PgR and Her-2,respectively,P>0.05.5.The proportions of MPD immuno-histochemical indexes were ER(-)85.7%(108/126),PgR(-)90.5%(114/126)and Her-2(+)93.7%(118/126)respectively.The low expression group of Ki67 was 6.3%(81/126),the medium expression group was 17.5%(22/126),and the high expression group was 69.0%(87/126).6.82 patients(65.1%)received comprehensive treatment after surgery,and 36patients received regular review.7.By the end of follow-up,a total of 11 patients had distant metastasis,and 1patient died of brain metastasis.8.The 2-year and 5-year DFS of MPD and MPD combined with intraductal carcinoma were 100%,while the 2-year and 5-year DFS of PD-IDC were 99.1%and95.6%,respectively.9.In the short term,the survival probability of each immuno-histochemical index showed no statistical significance.However,in the long term,the prognosis of patients with ER(+)was worse than that of patients with ER(-),PgR(+)was worse than that of patients with PgR(-),and Her-2(+)was worse than that of patients with Her-2(-).Conclusion1.Among the most common reasons for MPD patients to see the doctor,eczema-like changes in the skin in the area of the nipple and areola were the most common,followed by internal breast lumps.2.The immuno-histochemical results were mainly ER(-),PgR(-)and Her-2(+),and had no statistically significant difference among the three groups of MPD patients.Ki67 was the highest in the high expression group,and the distribution difference among the three groups was statistically significant.3.Ultrasonography and mammography examination have similar diagnostic value for MPD.4.The 2-year and 5-year DFS of MPD and MPD combined with intraductal carcinoma were 100%,and the 2-year and 5-year DFS of PD-IDC were 99.1%and95.6%,respectively.Overall,the prognosis is good.5.In the long term,patients with high expression of ER(+),PgR(+),Her-2(+)and Ki67 had poor prognosis.