双侧原发性乳腺癌两侧肿瘤病灶的差异性分析

Comparison of tumor lesions on two sides of bilateral primary breast cancer

目的通过研究双侧原发性乳腺癌(BPBC)两侧病灶的组织病理学及临床特征差异,探究BPBC发病的危险因素,并对BPBC患者的治疗和预后进行分析,为双侧乳腺癌的预防、诊断和治疗提供循证依据。方法按照BPBC诊断及纳入排除标准,筛选2016年1月1日至2018年12月31日的BPBC患者,对纳入患者的临床资料包括基本信息、组织病理学、临床治疗等进行回顾性分析。结果 BPBC患者初次发病年龄34~73岁,中位发病年龄48岁,平均发病年龄(50.42±10.91)岁。其中异时性双侧原发性乳腺癌(MBPBC)第一原发癌的发病年龄早于同时性双侧原发性乳腺癌(SBPBC)首发癌的发病年龄,但差异无统计学意义(P=0.187)。第二原发癌初诊时的临床分期早于第一原发癌,以0~Ⅱ期居多(58.33%),但差异无统计学意义(P>0.05)。两侧癌灶均以浸润性导管癌为主要病理类型,两侧之间雌激素受体(ER)、孕激素受体(PR)表达及分子分型一致性较差(Kappa<0.4)。结论 BPBC两侧肿瘤病灶在免疫组化表达、分子分型、临床分期方面具有差异,第一原发癌发病早是BPBC发病的重要预测因素,在第一原发癌灶发病后的5~10年容易罹患对侧乳腺癌。BPBC患者的治疗与单侧乳腺癌的治疗无明显差异,每一侧肿瘤均应按照独立的肿瘤病灶进行最大限度的根治性治疗。

Objective To investigate the histopathological and clinical features of tumor lesions on two side of bilateral primary breast cancer(BPBC). Methods Clinical and pathological data of BPBC patients admitted in Sino-Japanese Friendship Hospital from January 2016 to December 2018 were analyzed. Results The age of primary onset was 34~73 years old with a median age of 48 years and an average age of(50.42±10.91)years. There was no significant difference in the onset age of the first primary cancer between metachronous bilateral primary breast cancer(MBPBC) and synchronous bilateral primary breast cancer(SBPBC)(P=0.187), although there was a earlier trend. There was a trend of more 0~Ⅱ clinical stage(58.33%) of the second primary cancer at the initial diagnosis compared to that of the first primary cancer, but there was no significant difference(P >0.05) between them. Invasive ductal carcinoma was the main pathological type on both sides of the tumor, and the consistency of expression of estrogen receptor(ER), progesterone receptor(PR) and molecular typing were poor(Kappa<0.4). Conclusion The tumor lesions on two sides of BPBC have different immunohistochemical expression, molecular typing and clinical staging. The early onset of primary cancer and high BMI are important predictors of BPBC onset;after the onset of the first primary cancer, it is likely to develop contralateral breast cancer in 5 to 10 years.