双侧乳腺癌临床病理学特征及与p53突变的相关性研究

Study on the clinicopathological characteristics of bilateral breast cancer and the mutation of p53

目的 探讨双侧乳腺癌的临床病理学特征及预后,并与p53基因突变进行相关性研究.方法 回顾性分析48例双侧乳腺癌病例的临床资料,对比、归纳总结双侧乳腺癌两侧癌的临床病理学特征.采用免疫组织化学方法,检测获得的33例双侧乳腺癌组织切片的P53蛋白表达情况,以同时期141例单侧乳腺癌的组织切片作为检测对照组.结果 双侧乳腺癌患者5年生存率为70.5％,患者首发侧癌发生的中位年龄为47.5（27～69）岁,两侧乳腺癌的中位间隔时间为9.5个月.双侧乳腺癌病理类型中浸润性导管癌占了主要的比例,同一患者发生的两侧乳腺癌ER受体一致率为88.5％,HER2受体一致率为81.8％.双侧乳腺癌相对单侧乳腺癌有更高的p53突变率（45.5％：26.2％ ,x2 =4.711,P=0.030）,p53阳性及阴性的双侧乳腺癌患者总生存期差异无统计学意义（x2=0.434,P=0.510）.结论 双侧乳腺癌的主要病理类型是浸润性导管癌,两侧癌ER、HER2受体情况具有很高的一致性;双侧乳腺癌患者的总生存期与单侧乳腺癌相似;相对于单侧乳腺癌,双侧乳腺癌患者具有更高的p53突变率.

Objective To investigate the clinical pathologic characteristics and prognosis of bilateral breast cancer, and to determine whether clinical factors is related to p53 gene mutation.Methods Archival material was reviewed from 48 cases of bilateral breast cancar.The clinical and pathological features of bilateral breast cancer were compared and summarized.Immunohistochemical stains for P53 were performed on 33 cases of bilateral breast cancer, 141 cases of unilateral breast cancer were also examined as control.Results The five-year survival rate for bilateral breast cancer patients was 70.5%.The median age when bilatereral breast cancer first dignosed was 47.5 （range from 27 to 69）.The median time interval between the first and the subsequent breast cancer diagnosis was 9.5 months.Invasive ductal breast carcinoma was the main pathologic type of bilateral breast cancer.88.5% of bilateral breast cancer would have the same estrogen receptor （ER） status and 81.8% would have the same human epidermal growth hormone receptor 2 （HER2） status between the first and secondary primary tumors.Mutation p53 was more common among the bilateral breast cancer patients compared with the unilateral breast cancer patients （45.5% vs.26.2%, x2 =4.711 ,P =0.030）.There was no difference on the overall survival between bilateral breast cancer with p53 （＋） and p53 （-）（x2 =0.434,P =0.510）.Conclusion The main pathologic type of bilateral breast cancer is invasive ductal breast carcinoma, there is a good match of the ER and HER2 status between the first breast cancer and the contralateral one.Bilateral breast cancer patients have a similar overall survial with the unilateral breast cancer.p53 mutation is more common among bilateral breast cancer patients than those with unilateral breast cancer.