同时性与异时性双侧原发性乳腺癌临床病理分析

Clinicopathological analysis of synchronous and metachronous bilateral primary breast cancer

目的探讨同时性与异时性双侧原发性乳腺癌(bilateral primary breast cancer,BPBC)的临床病理特征、免疫表型及预后差异。方法回顾性分析2006年1月至2020年6月佛山市妇幼保健院经病理确诊的57例BPBC患者的临床病理资料,其中同时性双侧乳腺癌(synchronous bilateral breast cancer,SBBC)20例,异时性双侧乳腺癌(metachronous bilateral breast cancer,MBBC)37例,并对患者进行随访,随访时间截止于2020年12月。比较SBBC与MBBC第一和第二原发癌的组织学类型、T分期、脉管累及、TNM分期、腋窝淋巴结转移和免疫表型差异,并对二者的预后进行分析。结果SBBC与MBBC患者第一和第二原发癌的组织学类型均以非特殊型浸润性癌和导管原位癌最多见,T分期以T1和T2期为主,脉管以未受累及为主,TNM分期以Ⅰ和Ⅱ期为主。MBBC患者第二原发癌的腋窝淋巴结转移率高于SBBC患者(P<0.05)。SBBC患者第一原发癌雌激素受体(estrogen receptor,ER)和人表皮生长因子受体-2(human epidermal growth factor receptor-2,HER2)阳性率均高于MBBC患者第一原发癌,但SBBC患者第二原发癌HER2阳性率低于MBBC患者第二原发癌(均P<0.05)。SBBC患者第一和第二原发癌ER、孕激素受体(progesteronereceptor,PR)和HER2表达一致性均高于MBBC患者(均P<0.05)。Kaplan-Meier生存曲线显示,SBBC与MBBC患者总生存期比较差异无统计学意义(χ^(2)=3.278,P=0.070)。结论SBBC与MBBC患者第一和第二原发癌的临床病理特征及免疫表型有一定差异,MBBC患者两侧肿瘤病灶异质性较大,但二者预后无明显差异。

Objective To investigate the clinicopathological features,immunophenotype and prognosis of synchronous and metachronous bilateral primary breast cancer(BPBC).Methods The clinicopathological data of 57 patients with BPBC who were pathologically confirmed in Foshan Women and Children Hospital from January 2006 to June 2020 were retrospectively analyzed.Twenty cases were synchronous bilateral breast cancer(SBBC)and 37 cases were metachronous bilateral breast cancer(MBBC).The patients were followed up until December 2020.The differences in histological type,T stage,vascular involvement,TNM stage,axillary lymph node metastasis,and immunophenotype of the first and second primary cancers were compared between SBBC and MBBC,and the prognosis was analyzed.Results Non-specific invasive breast carcinoma and ductal carcinoma in situ were the most common histological types of the first and second primary cancers in patients with SBBC and MBBC.T stage was mainly T1 and T2,the vessels were mainly uninvolved,and TNM stage was mainly stageⅠandⅡ.The axillary lymph node metastasis rate of the second primary cancer in patients with MBBC was higher than that in patients with SBBC(P<0.05).The positive rates of estrogen receptor(ER)and human epidermal growth factor receptor-2(HER2)in the first primary cancer of patients with SBBC were both higher than those of patients with MBBC,but the positive rate of HER2 in the second primary cancer of patients with SBBC was lower than that of patients with MBBC(all P<0.05).The expression consistency of ER,progesterone receptor(PR)and HER2 in the first and second primary cancers of patients with SBBC was higher than that of patients with MBBC(all P<0.05).Kaplan-Meier survival curve showed that there was no significant difference in overall survival between patients with SBBC and MBBC(χ^(2)=3.278,P=0.070).Conclusion The clinicopathological features and immunophenotypes of the first and second primary cancers in patients with SBBC and MBBC are different to some extent.The heterogeneity of tumor lesions in patients with MBBC is larger than that of patients with SBBC,but there is no significant difference in prognosis between them.