乳腺、卵巢双原发癌9例临床分析

Clinical analysis of nine patients with double primary breast and ovarian cancer

目的总结乳腺、卵巢癌双原发癌患者的临床病理特征,并讨论其可能原因及防治策略。方法回顾性分析2010年1月至2016年12月间重庆医科大学附属第二医院及四川省绵阳市中心医院收治的9例乳腺、卵巢双原发癌患者的临床资料。随访时间为24~312个月,中位随访时间为120个月。结果 9例患者中,6例首发乳腺癌,2例首发卵巢癌,1例为同时性乳腺、卵巢双原发癌。2例患者进行了BRCA基因检测,1例患者存在BRCA1基因突变。9例患者乳腺首发临床症状均为乳房包块;卵巢首发症状中6例为腹胀,2例为阴道异常流血,1例为卵巢肿物。有乳腺标本免疫组织化学检测结果的5例患者中,ER均阴性表达,其中4例为三阴性乳腺癌。9例患者均进行了乳腺癌根治术,并全部接受了化疗,有3例患者术后进行了放射治疗,1例患者术后接受了他莫昔芬内分泌治疗,无患者接受抗HER-2治疗。9例患者中除1例患者拒绝卵巢手术外,其余8例患者均进行了卵巢癌全面分期手术,9例患者均接受了静脉化疗,3例患者接受了腹腔灌注化疗,无患者接受放射治疗。9例患者的中位发病年龄为46岁(36~51岁),中位发病间隔时间为93个月(0~300个月),确诊第二癌后的中位无进展生存时间为19个月(7~22个月)。7例患者发生卵巢癌复发转移,随访期间3例患者死亡。6例无家族史者发生两癌的中位间隔时间为122个月,3例有家族史者发生两癌的中位间隔时间为21个月;3例患者发生首发癌时年龄<45岁,其发生第二原发癌的中位间隔时间为258个月,6例患者发生首发癌时年龄≥45岁,其发生第二原发癌的中位间隔时间为36个月。结论乳腺、卵巢双原发癌患者的首发起病年龄较小,诊断卵巢癌时多已出现明显临床症状,有家族史的患者两癌的间隔时间明显缩短。患者的治疗以手术和化疗为主。

] Objective To summarize the clinicopathological features of nine patients with doubleprimary breast and ovarian cancer, and explore the possible causes and prevention and treatment measures.Methods The clinical records of nine patients with double primary breast and ovarian cancer in the SecondAffiliated Hospital of Chongqing Medical University and the Central Hospital of Mianyang from January 2010 toDecember 2016 were retrospectively analyzed. They were followed up for 24-312 months, median 120 months.Results Among these patients, six patients firstly had breast cancer, two patients firstly had ovarian cancerand one patient had synchronal breast and ovarian cancer. Two patients received the detection of BRCA genes,including one with BRCA1 gene mutation. The first clinical symptom of the breast was mass in nine cases. Thefirst clinical symptom of the ovary was abdominal distension in six cases, unusual vaginal bleeding in two casesand the mass in one case. Five patients with immunohistochemical results were ER negative, including four patients with triple-negative breast cancer. All patients underwent radical mastectomy for breast cancer andchemotherapy, three patients received postoperative radiotherapy, one patient had endocrine therapy oftamoxifen after surgery and none received anti-HER-2 therapy. Except one patient who refused ovarian surgery,the other eight patients underwent the staging surgery of ovarian cancer. All patients received intravenouschemotherapy, three patients received intraperitoneal infusion chemotherapy and none received radiotherapy.The median age of onset in nine patients was 46 years old （ range ： 36-51 years）. The median interval of thetwo cancers was 93 months（range： 0-300 months） and the median progression-free survival after the diagnosisof the second cancer was 19 months（range： 7-22 months）. Seven patients had the recurrence or metastasis ofovarian cancer, and three patients died in the follow-up. The median interval of the two cancers in six patientswithout family breast ovarian cancer history was 122 months while three patients with family history had amedian interval of 21 months. Three patients who were diagnosed with the first cancer at the age〈45 years hada median interval of 258 months between the onsets of two cancers; six patients who were diagnosed with thefirst cancer at the age 逸 45 years had a median interval of 36 months. Conclusion Patients with doubleprimary breast and ovarian cancer have a young age of onset. Most patients have obvious clinical symptoms andadvanced stage when they are diagnosed with ovarian cancer. The patients with family history tend to have ashort median interval between the onsets of two cancers. These patients are mainly treated by surgery andchemotherapy