565例双侧原发性乳腺癌临床病理特征分析

Analysis of Clinical and Pathological Features of 565 Cases of Bilateral Primary Breast Cancer

目的探讨原发性双侧乳腺癌(bilateral primary breast cancer,BPBC)患者的临床病理特征。方法收集1971年1月—2011年11月间我院诊治的565例双乳癌患者临床资料。对比分析同时性双乳癌(bilateral synchronous breast cancer)和异时性双乳癌(bilateral asynchronous breast cancer)在发病年龄、发病间隔、月经情况、家族史、肿瘤体积、临床分期、淋巴结数目、激素受体等临床病理特征的差异。结果异时性双乳癌首发癌年龄要早于同时性双乳癌(P<0.05)。同时性/异时性双乳癌在家族史、肿瘤体积、临床分期、腋淋巴结数目方面的差异均无统计学意义(P>0.05)。同时性双乳癌两侧病灶内分泌受体表达一致率高于异时性双乳癌(P<0.01)。无论同时性或异时性双乳癌其第二癌的肿瘤体积、临床分期和腋淋巴结情况都优于第一癌。同时性双乳癌与异时性双乳癌5年无病生存率与10年总生存率之间的差异有统计学意义(P<0.01)。结论双侧原发性乳腺癌第二癌与第一癌可视为两个完全不同的癌灶。单侧发生乳癌之后对侧乳癌发生的累积危险度逐年增加,应建立完善的随访制度。异时性双乳癌的5年无病生存率与10年总生存率均高于同时性双乳癌。

Objective To investigate the clinical and pathological features of primary bilateral breast cancer（BPBC）.Methods Medical records of BPBC patients were reviewed from the Tianjin Medical University Cancer Institute and Hospital during 1.1971—11.2011 Data of the synchronous and asynchronous breast cancer were analyzed,including the age of tumor onset,the time interval between two cancer,menstruation,family history,the size of tumor,clinical stage,pathologic characteristics.Results First cancer onset age of the asynchronous breast cancer was earlier than that of synchronous breast cancer（P0.05）.There were no statistical difference between synchronous and asynchronous breast cancer on family history,the size of tumor,clinical stage and pathologic characteristics（P0.05）.The concordance rate of endocrine receptors in synchronous was higher than that in asynchronous breast cancer（P0.01）.Clinical stage,tumor size and the number of involved axillony nodes of the second tumor in both synchronous and asynchronous breast cancer were lower than those of the first tumor.The difference of five-year disease-free survival and ten-year overall survival between synchronous and asynchronous breast cancer had statistically significant（P0.01）.Conclusion The first tumor and the second tumor could been seen as independent disease.Surveillance was necessary to screen the contralateral breast cancer once the primary breast cancer occurred.Five-year disease-free survival and ten-years overall survival in asynchronous breast cancer was higher than those in synchronous breast cancer.