原发性双侧乳腺癌预后分析

Prognostic Analysis of Primary Bilateral Breast Cancer

目的探讨原发性双侧乳腺癌的预后。方法回顾了119例原发性双侧乳腺癌患者的临床病理资料。分析双侧乳腺癌的预后情况及年龄和月经因素对预后的影响。结果双侧乳腺癌占同期可手术乳腺癌的3.67%(119/3239)。双侧乳腺癌患者中位年龄46岁,双侧发病中位间隔时间为48个月。双侧癌发生间隔时间按24个月来划分同时性(43/119)和异时性乳腺癌。从第二侧原发肿瘤手术算起,中位随访48个月,单侧和双侧乳腺癌的总生存率(OS)差异无显著性,但后者的无病生存率(DFS)较低(P=0.0469);同时性和异时性乳腺癌的DFS(P=0.5399)和OS(P=0.5829)的差异无显著性。单因素分析发现第二原发癌发病≤45岁、双侧均绝经前发病或分别绝经前后发病的患者预后较差;多因素分析发现第二原发癌发生年龄是独立预后因素。结论从第二原发肿瘤手术起随访,单侧和双侧乳腺癌的OS无显著差别,但后者DFS较差;同时性和异时性双侧乳腺癌的预后相似。第二原发癌发病年龄是双侧乳腺癌患者的重要预后指标。

Objective To study the prognosis of primary bilateral breast cancer（BBC）. Methods Medical records of 119 patients diagnosed as primary BBC were retrospectively reviewed. The prognosis of BBC and the impact of age and menstrual status were analysed. Results The BBC was 3.67 % （119/3239） of the operable breast cancer patients at the same period. The medium age of BBC was 46 and the medium period of the diagnosis of both sides was 48 months. The BBC was diagnosed as synchronous BBC when the second cancer was diagnosed within a period of 24 months after diagnosis of the first tumor. Otherwise, it was diagnosed as metachronous BBC. The medium follow-up period was 48 months from the second operation. There was no significant difference in overall survival（OS） between unilateral breast cancer（UBC） and BBC （P = 0. 2421）,but the latter had a lower disease-free survival （DFS） （P= 0. 0469）. There was no significant difference between synchronous and metachronous BBC in both DFS （P = 0. 5399） and OS （P = 0. 5829）. This study also found younger age was an independent prognostic factor for BBC both in univariate and multivariate analysis. Conclusion If the follow-up period begins from the occurrence of second primary tumor,OS is not significantly different between UBC and BBC,although the latter has a lower DFS. In addition,synchronous and metachronous BBC have a similiar prognosis. The occurrance age of the second tumor is an important prognostic factor in BBC.