双侧原发性乳腺癌的分子生物学特征

Molecular biological characteristics of bilateral primary breast cancer

目的:探讨双侧原发性乳腺癌(bilateral primary breast cancer,BPBC)的分子生物学特征。方法:回顾性分析325例BPBC与650例单侧乳腺癌(unilateral breast cancer,UBC)患者的临床病理资料,应用单因素分析和Logistic回归多因素分析,寻找BPBC发生的相关分子生物学依据。结果:与UBC患者比较,BPBC患者第一癌发病年龄早、有乳腺癌家族史、肿瘤直径>5cm及临床Ⅲ期患者较多(P均<0.05)。在分子生物学特征方面,BPBC第一癌患者雌激素受体(estrogen receptor,ER)和孕激素受体(progesterone receptor,PR)阴性比率、p53阳性率和细胞增殖核抗原Ki67高表达者均高于UBC患者(P<0.05);人表皮生长因子受体2(human epidermal growth factor receptor2,Her-2)表达在二者间的差异无统计学意义(P>0.05)。其中乳腺癌家族史、肿瘤直径>5cm、p53阳性为BPBC发生的独立危险因素,ER(+)或PR(+)者发生BPBC的风险下降。结论:BPBC与UBC在生物学行为上存在一定的差异,对于年轻、有乳腺癌家族史、激素受体阴性,p53阳性及Ki67高表达的乳腺癌患者要注意检查对侧乳腺癌的发生。

Objective：To evaluate the molecular biological characteristics of bilateral primary breast cancer（BPBC）.Methods：The clinicopathological characteristics of 325 patients with BPBC and 650 patients with unilateral breast cancer（UBC） were retrospectively analyzed.The evidence of molecular biology related to the occurrence of BPBC was evaluated by univariate analysis and multivariate Logistic regression analysis.Results：The early occurrence of first primary breast cancer,a family history of breast cancer,a maximum tumor diameter of more than 5 cm,and clinical stage Ⅲ were more frequent in BPBC patients than in UBC patients（P0.05）.The negative rates of estrogen receptor（ER） and progesterone receptor（PR）,the positive rate of p53,and the incidence of high expression of Ki67 were higher in BPBC patients than those in UBC patients（P0.05）,but there was no difference in the expression of human epidermal growth factor receptor 2（Her-2） between BPBC patients and UBC patients（P0.05）.The characteristics including a family history of breast cancer,a maximum tumor diameter of more than 5 cm and positive expression of p53 in BPBC were independent risk factors.The patients with positive ER or positive PR had a lower risk of BPBC.Conclusion：There are differences in biological characteristics between BPBC and UBC.The breast cancer patients with the characteristics including young woman,a family history of breast cancer,negative expression of hormone receptor,positive expression of p53,and high expression of Ki67 should pay attention to the occurrence of contralateral breast cancer.