| Purpose:To explore the clinical features,pathological features,treatment options and prognostic factors of Mammary Paget's disease(MPD),and to further understand the disease.Methods: Retrospective analysis of clinical pathological data and prognosis of45 patients with MPD diagnosed in the Department of Breast Surgery,the First Affiliated Hospital of Nanchang University from January 2007 to May 2017.SPSS22 software was used for statistical analysis.The chi-square test was used to compare the differences between various factors,kaplan-meier method was used for survival analysis,and log-rank test was used to test the significance of the differences.P <0.05 was considered statistically significant.Results:Forty-five patients were female,unilateral,accounting for 1.9% of breast cancer patients in the same period,the age of onset was 26-82 years old,the average age of onset was 48.9 years old,of which 40-60 years old(62.2%)was the peak incidence;25 patients(55.6%)were postmenopausal patients;The first symptoms were breast edema in 30 cases(66.7%),nipple hemorrhage in 3 cases(6.7%),and nipple changes in 12 cases(26.7%).Thirty patients(66.7%)had clinically palpable breast masses and 15 patients(33.3%)had clinically untouched masses.The difference between the two groups was statistically significant in lymph node status,invasive carcinoma,and TNM pathological grade.<0.05),the lymph node positive rate of the palpable mass was high,the possibility of invasive carcinoma was high,and the pathological grade was higher.Forty-three patients underwent breast ultrasound before surgery,and the results were positive in 29 patients(67.4%).Forty-one patients underwent mammography before surgery,and the results were positive in 33 patients(80.5%).No abnormalities were found in mammography and mammography in 6 patients(13.3%).The pathological types were simple MPD in 5cases(11.1%),MPD with breast in situ carcinoma in 6 cases(13.3%),and MPD with breast invasive carcinoma in 34 cases(75.6%).Comparing the three groups ofclinicopathological data,the difference of lymph node metastasis and Her-2 status between the three clinical pathological types was statistically significant(P<0.05).The two-to-two comparison showed that the lymph node metastasis rate of Paget's disease with breast invasive group was high(P<0.05);Forty-five patients underwent immunohistochemical examination,ER-positive in 15 patients(33.3%),PR-positive in 14 patients(31.1%),Her-2-positive in 38 patients(84.4%);Molecular typing of 34 patients with potentially invasive cancer: 20 patients with positive Her-2(58.8%),12 patients with Luminal B(35.3%),2 patients with Luminal A(5.9%),and 0 patients with triple-negative type;TNM pathological stage: 10 cases(22.2%)in Tis,5 cases(11.1%)in stage II,22 cases(48.9%)in stage III,and 0 cases(0)in stage IV.All patients underwent surgery,41 cases(91.1%)underwent modified radical mastectomy,2 cases(4.5%)underwent radical mastectomy,1 case(2.2%)with simple mastectomy plus sentinel lymph node biopsy,1 case with breast-conserving surgery plus sentinel lymph node biopsy(2.2%),postoperative patients were referred to the NCCN guidelines at that time,including 32 cases of postoperative chemotherapy,11 cases of postoperative radiotherapy,13 cases of targeted therapy,and 10 cases of endocrine therapy.The follow-up period was 14-113 months,the median follow-up time was 53 months,5 patients were lost to follow-up,and the follow-up rate was 88.9%.There were 13 cases of recurrence and metastasis,including 6 cases(46.1%)of lung metastasis,4 cases(30.8%)of bone metastasis,2 cases(15.4%)of liver metastasis,1case(7.7%)of brain metastasis.The peak of recurrence and metastasis is 2-4 years after operation(53.8%).Fourteen patients died,11 were breast cancer-related deaths,and 3 died of other cancers.The 5-year disease-free survival rate was 58.3%,and the5-year overall survival rate was 71.6%.Univariate survival analysis showed that clinical type,pathological type,lymph node status,TNM pathological stage and patient survival time were correlated(P<0.05).Patients with clinically palpable masses,invasive carcinomas,lymph node metastasis,and high TNM grades were found to have a worse prognosis.Conclusion: The incidence of MPD is more common in postmenopausal women,the clinical manifestations are diverse and the imaging examination may be negative,which is prone to missed diagnosis and misdiagnosis.Therefore,pathologicalexamination should be performed on patients with highly suspicious negative results in clinical physical examination and imaging examination.MPD patients with clinically accessible mass or positive imaging examination are more likely to be associated with potentially invasive cancer and axillary lymph node metastasis.In patients with MPD complicated with invasive cancer,the components of invasive breast cancer are similar to the immunohistochemistry of Paget cells,which are usually ER and PR negative and Her-2 positive.Simple MPD has a better prognosis,but patients with underlying tumors have a poor prognosis.Palpable masses,invasive carcinoma,lymph node metastasis and high TNM stage are risk factors affecting the prognosis. |
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