中国实用外科杂志

中国实用外科杂志 ›› 2025, Vol. 45 ›› Issue (06): 702-707.DOI: 10.19538/j.cjps.issn1005-2208.2025.06.18

• 论著 • 上一篇    下一篇

基于倾向性评分匹配乳腺Paget病与常见乳腺癌临床病理特征及生存预后对比研究

郑程程1，徐维宇1，黄海荣2，胡    浩3，苑    著1   

  1. 1首都医科大学附属北京友谊医院普通外科中心 消化健康全国重点实验室 国家消化系统疾病临床医学研究中心，北京100050；2北京市房山区良乡医院普通外科，北京102400；3北京市门头沟区医院普外与肿瘤中心，北京102300
  • 出版日期:2025-06-01 发布日期:2025-07-01

  • Online:2025-06-01 Published:2025-07-01

摘要： 目的    分析乳腺Paget病（PDB）与常见乳腺癌的临床病理特征及预后。方法    回顾性分析2014年1月至2024年1月在首都医科大学附属北京友谊医院乳腺外科行手术并病理证实伴浸润性导管癌（IDC）或导管原位癌（DCIS）的20例PDB病人和60例乳腺癌病人，采用倾向性评分匹配（PSM）于SPSS 26.0中进行1∶1最邻近匹配（卡钳值0.03），比较匹配前后两组的年龄、绝经状态及常见合并症，免疫组化［人表皮生长因子受体-2（HER-2）、雌激素受体（ER）、孕激素受体（PR）］、分子分型及增殖细胞核抗原（Ki-67）增殖指数差异，并通过Kaplan-Meier生存曲线和Log-Rank检验评估总生存期（OS）。结果    匹配前PDB组平均发病年龄58.85岁，乳腺癌组52.48岁（P=0.037），高血压病占比40.0% vs.15.0%（P=0.040），TNM分期更早（P=0.025）。PDB组更常出现乳头溢液或皮肤改变（P＜0.001），ER、PR阴性率显著升高，HER-2阳性率达75.0%，分子分型以HER-2富集型为主（P＜0.01），Ki-67增殖指数差异无统计学意义。匹配后基线趋于平衡（P＞0.05），但PDB组仍呈现更高HER-2阳性率（75.0% vs. 31.3%，P=0.013）和HER-2富集型比例（68.7% vs. 18.7%，P=0.013）。随访至2024-07-01，中位87个月，匹配后共4例病人死亡（PDB组2例、乳腺癌组2例），1年、3年、5年OS分别为100.0%、88.5%和83.8%，组间差异无统计学意义（P=0.663）。结论    PDB在临床表现和病理特征上与常见乳腺癌存在显著差异，尤其以HER-2富集型为主的免疫组化特点，但两者总体生存率相似。

关键词: 乳腺Paget病, 乳腺癌, 倾向性评分匹配, 临床病理特征

Abstract: To analyze the clinicopathological characteristics and prognosis of breast Paget disease (PDB) compared with common breast cancer (BC). Methods  A retrospective study was conducted on 20 PDB patients and 60 BC patients who underwent surgery with histopathological confirmation of invasive ductal carcinoma (IDC) or ductal carcinoma in situ (DCIS) at the Breast Surgery Department of Beijing Friendship Hospital, Capital Medical University, between January 2014 and January 2024. Propensity score matching (PSM) was performed in SPSS 26.0 using 1∶1 nearest-neighbor matching (caliper=0.03) to balance age, menopausal status and common comorbidities. The immunohistochemical profiles (ER, PR, HER-2), molecular subtypes and Ki-67 proliferation index were compared, and overall survival (OS) was assessed via Kaplan-Meier curves with the Log-Rank test. Results  Before matching, the mean age at diagnosis was 58.85 years in the PDB group versus 52.48 years in the BC group (P=0.037). Hypertension prevalence was higher in PDB (40.0% vs.15.0%, P=0.040), and TNM stage was earlier (P=0.025). PDB patients are more often presented with nipple discharge or skin changes (P<0.001). In the PDB group, ER and PR negativity rates were significantly increased, and HER-2 positivity reached 75.0%, with the HER-2-enriched subtype predominant (P<0.01). Ki-67 index differences were not significant between the two groups. After matching, baseline characteristics were balanced (P>0.05), but the PDB group still showed higher HER-2 positivity (75.0% vs. 31.3%, P=0.013) and HER-2-enriched subtype proportion (68.7% vs. 18.7%, P=0.013). Follow-up was conducted until July 01, 2024, with a median of 87 months, 4 deaths occurred (2 in the PDB group and 2 in the BC group) after matching. The 1-, 3- and 5-year OS rates were 100%, 88.5% and 83.8%, respectively, with no significant differences between the two groups (P=0.663). Conclusion    Breast Paget disease differs significantly from common breast cancer in clinical presentation and pathological features—especially a predominance of the HER-2-enriched immunophenotype—while overall survival is comparable between the two groups.

Key words: breast Paget disease, breast cancer, propensity score matching, clinicopathological characteristics