乳腺癌多原发癌的临床病理特征及预后分析

Clinical characteristics and prognosis of multiple primary cancers involving breast cancer

目的:探讨乳腺癌多原发癌(multiple primary cancers,MPCs)患者的临床病理特征及预后因素。方法:回顾性分析2005年1月至2015年12月天津医科大学肿瘤医院收治的226例乳腺癌MPCs患者的临床病理资料,应用单因素及多因素分析方法分析其临床病理学特征及影响预后的因素。结果:226例中74例(32.7%)为同时型MPCs,152例(67.3%)为异时型MPCs。在第二原发恶性肿瘤中甲状腺癌最常见,为90例。患者的中位随访时间为84.75(4.1~384.5)个月,226例患者的3年及5年总生存率分别为91.7%和82.9%。乳腺癌MPCs患者的病理特征以肿瘤负荷大(65.5%vs.34.5%,P=0.005)和ER受体阳性(76.1%vs.23.9%,P=0.046)多见,异时型MPCs更倾向于高龄人群(62.4%vs.37.6%,P<0.001)。无淋巴结转移(95%CI:0.341~0.932,P=0.025)和异时型MPCs(95%CI:0.033~0.220,P<0.001)患者预后佳。结论:甲状腺是最常见的第二原发肿瘤,肿瘤负荷大及ER受体阳性患者易发生乳腺癌MPCs,高龄患者易患异时型MPCs,有无淋巴结转移和MPCs的类型是患者预后的独立影响因素。

Objective：To investigate the clinical characteristics and prognoses of breast cancer patients with other multiple primary cancers （MPCs）. Methods：A total of 226 patients who underwent surgery for breast cancer and other MPCs at Tianjin Medical Univer-sity Cancer Inseitute and Hospital between January 2005 and December 2015 were retrospectively selected. Clinical and pathological features and prognostic factors were investigated using univariate and multivariate analyses. Results：Of the 226 patients with breast cancer, 74 （32.7%） had synchronous cancers and 152 （67.3%） had metachronous cancers. Thyroid was the most prevalent cancer among the accompanying malignancies, affecting 90 patients. During a mean follow-up duration of 84.75 （4.13-84.5） months, the 3-year and 5-year overall survival rates of the 226 patients were 91.7%and 82.9%, respectively. Patients with MPCs showed a large tu-mor size （65.5%vs. 34.5%, P=0.005） and were positive for ER （76.1%vs. 23.9%, P=0.046） at the time of breast cancer diagnosis. The metachronous MPC group mainly comprised the elderly compared with the synchronous MPC group （62.4%vs. 37.6%, P〈0.001）. MPC patients presenting with early lymph node stage （HR：0.341-0.932, P=0.025） and metachronous cancers （HR：0.033-0.220, P〈0.001） ex-hibited a better prognosis than the others. Conclusion：Thyroid cancer was the most frequently accompanying tumor. Patients with MPCs showed a large tumor size and were positive for ER. The metachronous MPC group demonstrated a preference for older people. Lymph node stage and style of MPCs are the independent factors for prognosis.