子宫体、乳腺双原发癌的临床病理特征

Clinical characteristics of the double primary malignant tumors of uterine corpus/breast

目的探讨子宫体、乳腺双原发癌的临床病理特征。方法回顾性分析首都医科大学附属北京朝阳医院2004年1月至2015年1月收治子宫体、乳腺双原发癌患者(双癌组)29例和子宫体恶性肿瘤患者(单癌组)319例的临床病理资料。结果双癌组合并糖尿病(χ^2=8.02,P=0.007)、肿瘤家族史(χ^2=31.76,P<0.001)及其他部位恶性肿瘤(χ^2=31.76,P<0.001)的比例显著高于单癌组,双癌组Ⅱ型子宫体恶性肿瘤(χ^2=5.52,P=0.030)及低分化癌(χ^2=8.39,P=0.020)的构成比明显高于单癌组。单癌组的总生存率(overall survival,OS)明显优于双癌组(Log-rank=6.75,P=0.011)。分层分析显示,在双癌组中,首发子宫体癌的双癌患者Ⅱ型子宫内膜癌的构成比明显高于首发乳腺癌组(58.33%vs 11.76%,χ^2=6.882,P=0.014)。首发子宫体癌与首发乳腺癌的两癌发病间隔时间显著不同,前者的间隔时间明显缩短(t=2.23,P=0.028)。两组双原发癌间隔时间的分布差异有统计学意义(χ^2=9.60,P=0.010)。结论合并乳腺癌的子宫体恶性肿瘤与子宫体恶性肿瘤的临床、病理特征不同。乳腺癌后子宫体恶性肿瘤与子宫体恶性肿瘤术后发生乳腺癌的临床、病理特征不同。

Objective To investigate the clinical and pathological characteristics of the double primary malignant tumors of uterine corpus/breast.Methods A case-control study was performed for the clinical and pathological data of 29 patients with primary malignant uterine tumor and breast cancer(double cancers group)and 319 patients with only endometrial malignancy(single cancer group)who had visited Beijing Chaoyang Hospital during January 2004 to January 2015.Results Double cancers group showed a significantly higher percentage of patients with diabetes(χ^2=8.02,P=0.007),family history of cancer(χ^2=31.76,P<0.001),with other primary tumor(χ^2=31.76,P<0.001),and typeⅡendometrial carcinoma(χ^2=5.52,P=0.030)and poorly-differentiated cancer tissue(χ^2=8.39,P=0.02)compared with endometrial malignant group.Endometrial cancer group had a significantly better overall survival compared with double cancers group(Log-rank=6.75,P=0.011).Stratified analysis showed that the group of double cancers with primary endometrial malignancy showed a significantly higher percentage of patients with typeⅡendometrial carcinoma(58.33%vs 11.76%)than that with primary breast cancer,with a significantly shorter interval between the two tumors(t=2.23,P=0.028).Conclusion The clinical and pathological characteristics of endometrial malignancy with primary breast cancer is different from that of only endometrial malignancy.The clinical and pathological characteristics of breast cancer with primary malignant uterine tumor is different from that of endometrial malignant with primary breast cancer.