双侧原发性乳腺癌90例临床病理及预后分析

Analysis of clinicopathological features and prognosis of 90 cases of bilateral primary breast cancer

目的分析双侧原发性乳腺癌(bilateral primary breast cancer,BPBC)的临床病理学特征,并探讨影响其预后的相关因素。方法收集90例BPBC患者的临床病理资料,分析并总结其中73例双侧浸润性乳腺癌(bilateral invasive breast cancer,BIBC)患者的临床病理特征与预后的相关性。结果90例BPBC中73例为BIBC,4例为双侧乳腺原位癌,13例为单侧浸润性癌、单侧原位癌,11例患者死亡,均为BIBC组患者。双侧乳腺癌的组织病理学和免疫表型特征倾向一致性。BIBC中第一原发癌的临床分期、肿瘤T分期及肿瘤细胞增殖活性高于第二原发癌(P<0.05)。多因素生存分析发现,双侧乳腺癌ER阳性是预后相关保护因素,双侧乳腺癌高临床分期是预后危险因素(P<0.05)。结论BPBC中BIBC数量最多,预后最差。双侧乳腺癌临床病理特征及激素受体表达与患者预后显著相关,ER一致阳性者预后最佳,ER一致阴性者及双侧乳腺癌高临床分期的患者预后最差。

Purpose To study the clinicopathologic characteristics and relevant factors affecting prognosis of patients with bilateral primary breast cancer.Methods The clinical-patho-logical data of 90 patients with bilateral primary breast cancer were collected,and the correlation between clinicopathological features and prognosis 73 patients with bilateral invasive breast cancer were analyzed and summarized.Results Of the 90 patients with BPBC,there were 73 patients with bilateral invasive breast cancer,4 patients with bilateral breast cancer in situ,and 13 patients with unilateral invasive breast cancer and unilateral breast cancer in situ,all 11 death cases were from BIBC group.The histopathological and immunohistochemical characteristics of bilateral lesions tend to be consistent.Compared with the second primary carcinoma,the clinical stages,tumor T stage and the Ki-67 proliferative activity in the first primary cancer of the BIBC were higher(P<0.05).Multivariate survival analysis showed that ER concordant-positive was the protective factors,and bilateral high clinical stages was a prognostic risk factor in BIBC(P<0.05).Conclusion BIBC is the most common and worst prognosis in BPBC.Clinicopathological characteristics and the expression of hormone receptors are significantly correlated with prognosis,patients with ER concordant-positive tumors have the best prognosis,whereas patients with ER concordant-negative tumors and bilateral high clinical stages have the worse outcomes.