双侧原发乳腺癌的流行病学特点与临床分析

目的探讨双侧原发乳腺癌(Bilateral Primary Breast Cancer,BPBC)的流行病学和临床及病理特点,寻找早期诊断、合理治疗和改善预后的方法.方法总结该科从1994～2002年31例经手术和病理证实的双侧原发乳腺癌,从发病率、发病年龄、月经状态、间隔时间、肿瘤分期和病理、诊断和治疗、复发和转移及生存率等方面进行分析.结果双侧原发乳腺癌占同期乳腺癌手术的1.84%,高发年龄≤45岁,占77.40%(24/31),绝经前的占83.80%(26/31),平均间隔时间5年6个月,第一、二原发癌均以浸润性非特异型癌为主(分别占74.20%和77.40%),临床分期均以Ⅱa期为主(分别占32.30%和35.50%),第一、二原发癌雌、孕激素受体情况基本相同,第一、二原发癌术前新辅助化疗率为61.30%(19/31)和80.60%(25/31),术后均行辅助治疗,术后远处转移率分别为16.10%和38.70%,术后1,3和5年生存率分别为93.50%,83.90%和71.00%.结论严格对绝经前乳腺癌术后妇女的随诊,能尽早检出第二原发乳腺癌,合理和积极的治疗可取得满意的疗效.

Clinical analysis and epidemical features of bilateral primary breast cancer

Objective: Study epidemical, clinical and pathologic features of bilateral primary breast cancer (BPBC) to find the solutions for BPBC early diagnosis, reasonal treatments and prognostic improvement. Methods: The survey data, used in this chapter, are based on 31-case BPBC patients from 1994 to 2002, which were diagnosed by surgical and pathological identification in our department of oncology. To illustrate the BPBC, we analyze the patients' incidence, age, menstrual state, interval time, tumor stage and pathology, diagnosis and treatment, recurrence and metastasis, survival rate. Results: 1.84 percent of patients' with breast cancer during this period had BPBC, the high risk age of patients with BPBC is less than 45 years old 77.4%, (24/31), the major patients with BPBC are premenopausual 83.8% (26/31), the median time of interval is 5 years and 6 months, the major first and second primary tumor are infiltrative non-specific carcinoma(74.2% and 77.4%), the majority of BPBC are stage IIa (32.3% and 35.5%), the first and second primary tumor all most have the same report of ER and PgR, the neoadjuvant chemotherapy rate are 61.3% (19/31) and 80.6% (25/31), all patients received adjuvant therapy after operation, the remote metastasis rate are 16.1% and 38.7%, the 1yr, 3yr, 5yr cause-specific surviving rate are 93.5%, 83.9% and 71.0%. Conclusions: The strict follow-up must be performed for the premenopasual women with the first primary tumor, to identify the second primary tumor, the reasonable and positive treatment will have the delightful value.