双侧原发性乳腺癌腋窝淋巴结转移特点及其与预后的相关性分析

Characteristics of Axillary Lymph Node Metastasis in Bilateral Primary Breast Cancer and Its Correlation with Prognosis

目的 探究双侧原发性乳腺癌临床病理特点,分析腋窝淋巴结转移与临床病理的相关性。方法 回顾性选取2006年1月至2022年3月两家医院收治的96例女性双侧原发性乳腺癌患者临床病理资料,分析患者腋窝淋巴结转移及预后特点。结果 96例双侧原发性乳腺癌患者,第一癌91例为浸润性癌,55例发生腋窝淋巴结转移,转移率60.4%;第二癌81例为浸润性癌,36例发生腋窝淋巴结转移,转移率44.4%;两侧腋窝淋巴结转移差异无统计学意义(P>0.05)。单因素分析发现,第二癌肿块长径越长、组织学分级越高同侧腋窝淋巴结转移率更高(P<0.05);第二癌ER表达阴性较ER阳性表达同侧腋窝淋巴结转移率更高(P<0.05)。单因素生存分析提示,双侧腋窝淋巴结转移组较无转移组及单侧转移组无病生存率低(P<0.05),双侧病灶ER、PR一致阴性患者预后最差,ER、PR一致阳性患者预后最好(P<0.05),双侧pTNM高分期(III期)较双侧低分期及单侧高分期预后更差(P<0.05)。多因素生存分析显示双侧ER阳性是影响BPBC患者无病生率的保护性因素,双侧肿瘤pTNM高分期是其危险因素。结论 双侧原发性乳腺癌两侧癌灶有一定独立性;双侧腋窝淋巴结转移者有更高的局部复发及远处转移风险,预后不良,需密切随访监测。

Objective To investigate the clinical pathological characteristics of bilateral primary breast cancer,analyze the correlation between axillary lymph node metastasis and clinicopathology.Methods The clinicopathological data of 96 female patients with bilateral primary breast cancer admitted to two hospitals from January 2006 to March 2022 were retrospectively selected to analyze the axillary lymph node metastasis and prognostic characteristics of patients.Results Among 96 patients with bilateral primary breast cancer,91 cases of the first cancer were invasive cancer,55 cases had axillary lymph node metastasis,and the metastasis rate was 60.4%;81 cases of the second cancer were invasive cancer,36 cases had axillary lymph node metastasis,and the metastasis rate was 44.4%;there was no significant difference in the axillary lymph node metastasis between the two sides(P>0.05).Univariate analysis revealed that the longer the length of the second cancer mass and the higher the histological grade,the higher the rate of ipsilateral axillary lymph node metastasis(P<0.05);the rate of ipsilateral axillary lymph node metastasis was higher in the group with negative ER expression than in the group with positive ER expression(P<0.05).Univariate survival analysis suggested that the disease-free survival rate was lower in the bilateral axillary lymph node metastasis group than in the no metastasis group and the unilateral metastasis group(P<0.05),and the prognosis was worst in patients with consistent negative ER and PR in bilateral lesions and best in patients with consistent positive ER and PR(P<0.05),and the prognosis was worse in bilateral high pTNM stage(stage III)than in bilateral low stage and unilateral high stage(P<0.05).Multivariate Cox regression analysis showed that bilateral ER positivity was a protective factor affecting the disease-free survival rate of BPBC patients,and bilateral high pTNM stage of tumor was its risk factor.Conclusion Bilateral primary breast cancer has a certain degree of independence between the two sides.Those with bilateral axillary lymph node metastasis have a higher risk of local recurrence and distant metastasis,and have a poor prognosis,requiring close follow-up and monitoring.