子宫内膜癌患者再发乳腺癌的临床病理特征及预后分析

Clinicopathological characteristics and prognosis of breast cancer patients with a history of endometrial cancer

目的探索子宫内膜癌(EMC)患者再发乳腺癌(BC)的临床病理特征及预后特点。方法回顾性分析1324例有EMC病史的BC患者,按照诊断年份匹配单发BC患者作为对照组,比较其临床病理特征(包括诊断年龄、患侧、病理类型、组织学分化程度、激素受体状态、淋巴结转移和临床分期)及肿瘤特异性生存率。结果EMC患者BC的发病率为1.69%,是普通人群的4~8倍。与原发BC相比,继发BC诊断年龄>60岁的比例较高,淋巴结转移的比例较低。二者患侧、病理类型、分化程度、激素受体状态、临床分期均无显著差异。EMC病史是BC的独立保护因子(HR=0.653,P=0.002),对于激素受体阳性患者,继发患者的特异性生存率优于原发BC患者(P=0.0001),而对于激素受体阴性患者,原发及继发患者BC特异性生存率无显著差异(P=0.329)。结论EMC患者BC发病率显著增高,可能与二者共同的激素依赖性及相似的易感基因有关,EMC病史对激素受体阳性BC可能具有一定的保护作用。

Objective To analyze the clinicopathological features and prognostic characteristics of breast cancer(BC) patients with a history of endometrial cancer(EMC). Methods A thousand three hundred and twenty-four BC patients with a history of EMC were analyzed retrospectively. Patients with primary BC were matched as controls according to the distribution of year of diagnosis. The clinicopathological features and tumor-specific survival were compared including the age of diagnosis, the affected side, type of pathology, histological degree of differentiation, hormone receptor status, lymph node metastasis and clinical staging. Results The incidence of BC in patients with EMC was 1.69%, which was 4-8 times that of the general population. Compared with primary BC, secondary BC had a higher diagnostic age of more than 60 years and a lower proportion of lymph node metastasis. There were no significant differences in the affected side, pathological type, differentiation degree, hormone receptor status and clinical stage between the two groups. The history of EMC is an independent protective factor for BC(HR=0.653, P=0.002). For patients with positive hormone receptors, secondary BC patients showed better survival than primary BC patients(P=0.0001), while for hormone receptor negative patients, there was no significant difference in BC-specific survival between the two groups(P=0.329). Conclusions The increased morbidity of BC in EMC patients may be associated with a common hormonedependent and similar susceptibility genes. The history of EMC may have protective effect for hormone receptor-positive BC patients.