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目的:探讨早期乳腺癌侵犯乳头的概率和相关危险因素。方法:收集北京大学人民医院2008年10月至2014年3月行乳腺癌标准乳房切除术病例1 190例,比较临床乳头异常组(54例)与无明显异常组(1 136例)乳头浸润率差异,分析相关临床病理因素与隐匿性乳头浸润的相关性。将单因素分析具有统计学意义的指标纳入二元Logistic回归模型行多因素分析,筛选独立预测因子。结果:所有标本乳头浸润率为6.0%(71/1 190),其中临床乳头异常组为40.7%(22/54)显著高于无明显异常组的4.3%(49/1 136)(χ~2=121.9,P<0.001)。单因素分析显示病变位置(中央象限、外周象限)、肿瘤至乳头距离(≤2 cm、>2 cm)、脉管癌栓、肿瘤(包括原位癌)长径(≤3.5 cm、>3.5 cm)、T分期、N分期和TNM分期与隐匿性乳头浸润有关。多因素分析显示病变位置、肿瘤至乳头距离、T分期和N分期是乳头浸润的独立预测因子。结论:临床乳头无明显异常者乳头浸润概率较低。肿瘤位于外周、至乳头距离>2 cm、T_1~T_2、N_0~N_1的病例保留乳头风险更低。
Objective: To investigate the probability of breast cancer invasion of the nipple and related risk factors. Methods: A total of 1 190 breast cancer mastectomy cases were collected from Peking University People’s Hospital from October 2008 to March 2014. The papillary invasion rate was compared between clinical papillary dysfunction group (54 cases) and non-obvious abnormal group (1 136 cases) The correlation between clinicopathological parameters and occult papillary infiltration was analyzed. Univariate analysis of the statistical significance of indicators into the binary Logistic regression model for multivariate analysis, screening independent predictors. Results: The rate of papillary invasion was 6.0% (71/1 190) in all samples, of which 40.7% (22/54) in clinical papillary abnormality group was significantly higher than that in non - abnormal group (4.3%) (χ ~ 2 = 121.9, P <0.001). Univariate analysis showed that the lesion location (central quadrant, peripheral quadrant), tumor-papillary distance (≤2 cm,> 2 cm), vascular tumor thrombus, and tumor ), T staging, N staging and TNM staging were associated with occult papillary invasion. Multivariate analysis showed that the location of the lesion, tumor-to-nipple distance, T stage and N stage were independent predictors of papillary infiltration. Conclusion: There is a low probability of nipple infiltration in patients with no clinical nipple abnormalities. Tumor located in the periphery, to the nipple distance> 2 cm, T_1 ~ T_2, N_0 ~ N_1 cases of lower nipple retention risk.