乳腺癌与甲状腺癌双原发的临床特征及预后

Clinical characteristics and prognostic analysis of double primary breast cancer and thyroid cancer

目的探讨乳腺癌甲状腺癌双原发患者的临床特征和预后。方法回顾性收集2001—2020年于中国医学科学院肿瘤医院确诊乳腺癌甲状腺癌双原发癌患者的临床病理资料,生存分析采用Kaplan-Meier法,多因素分析采用Cox风险回归模型。结果全组98例患者均为女性,第一肿瘤确诊年龄为26~72岁,中位年龄47岁。乳腺癌再发甲状腺癌(乳甲)组18例,甲状腺癌再发乳腺癌(甲乳)组60例,乳腺癌及甲状腺癌同时发生(二者确诊时间间隔在3个月内,同时)组20例。乳甲组、甲乳组和同时组患者乳腺癌病理分级、乳腺癌术后是否放疗、是否合并其他肿瘤差异均有统计学意义(均P<0.05)。全组98例患者中,复发转移14例,死亡7例,因肿瘤原因死亡患者均为甲状腺癌再发乳腺癌者。乳甲组、甲乳组和同时组患者的死亡及复发转移情况差异无统计学意义(均P>0.05)。单因素分析显示,乳腺癌分期、雌激素受体(ER)与总生存有关(均P<0.05),乳腺癌家族史、乳腺癌分期、ER与无复发转移有关(均P<0.05)。多因素分析显示,乳腺癌家族史、ER阳性、肿瘤确诊顺序(甲状腺癌再发乳腺癌)是无复发转移的独立影响因素(均P<0.05)。结论乳腺癌甲状腺癌双原发癌患者中,ER阴性为预后独立不良影响因素。

Objective To explore and describe clinicopathological characteristics and prognosis of patients with double primary breast cancer(BC)and thyroid cancer(TC).Methods Medical records of 98 patients diagnosed with double primary breast and thyroid cancer in National Cancer Center(NCC)/Cancer Hospital between January 1,2001 and December 31,2020 were retrospectively collected.All of the patients were followed up until January 1,2021 to acquire survival data.Univariate survival analysis was conducted by Kaplan-Meier method,and multivariate survival analysis was carried out using the Cox proportional hazard model.Results All of 98 patients in the group were women.The age at diagnosis of the first tumor ranged from 26-72 years old,and the median age was 47 years old.The BC recurring TC(breast methyl)group included 18 cases,TC recurring BC(methyl breast)group included 60 cases,BC and TC simultaneously occurred group(the two are diagnosed within 3 months)included 20 cases.There were statistically significant differences in breast cancer pathological grading,breast cancer postoperative radiotherapy,and combined with other tumors in breast methyl group,methyl breast group and the simultaneous group(P<0.05).Among the 98 patients,14 had recurrence and metastasis,and 7 died.The patients who died from tumors were all those with TC recurrence of BC.There were no statistically significant differences in the death,recurrence and metastasis of patients in the breast methyl group,methyl breast group and the simultaneous group(P>0.05).Univariate analysis showed that BC stage and estrogen receptor(ER)were related to overall survival(P<0.05),while the family history of BC,BC stage,and ER were not related with the recurrence and metastasis(P<0.05).Multivariate analysis showed that BC family history,ER positive,and the order of tumor diagnosis(TC recurring BC)were independent influencing factors for the recurrence and metastasis(P<0.05).Conclusion ER negative is a poor prognostic factor for the double primary breast and thyroid cancer.