双侧原发性乳腺癌的危险因素及预后分析

目的探讨双侧原发性乳腺癌(BPBC)发生的危险因素,比较其与单侧乳腺癌(UBC)的预后。方法收集205例BPBC和1677例UBC患者的临床病理及随访资料,比较两者在病史背景、临床情况、组织病理学特征及预后方面的差异。结果 BPBC占同期全部乳腺癌患者的1.5%;BPBC患者较UBC患者:40岁之前及绝经前发病比例高,初潮年龄早,初产年龄晚,既往乳腺良性疾病史及乳腺癌家族史阳性率高,肿瘤直径>5cm比例高,均具有统计学意义(P≤0.05);以上后三者为BPBC发生的独立危险因素,其中有乳腺癌家族史的乳腺癌患者罹患对侧乳腺癌的风险增加约1.6倍(OR=2.631);二者放疗及内分泌治疗方面无显著差异(P>0.05)。BPBC远处转移率为20.0%,与UBC(23.1%)相比无显著差异性(P=0.322);UBC的5年、10年生存率为81.4%和72.3%,以第一癌为起点计算生存时间,BPBC5年生存率87.4%,10年生存率80.2%,与UBC相比无统计学差异(P=0.141);以第二癌为起点计算生存时间,BPBC5年生存率80.0%,10年生存率72.4%,与UBC相比亦无显著差异(P=0.437)。结论 BPBC与UBC的预后无显著差异。有乳腺癌家族史、肿瘤直径>5cm、既往乳腺病史及40岁前发病的乳腺癌患者是发生对侧乳腺癌的高危人群,应格外重视术后对侧乳腺的监测。BPBC的发生与雌激素有密切关系,可能成为预防BPBC的干预靶点。

Risk factors and prognosis of bilateral primary breast cancer:a report of 205 cases

Objective To evaluate the risk factors and prognosis of bilateral primary breast cancer(BPBC).Methods 205 BPBC and 1677 unilateral breast cancer(UBC) records were reviewed and analyzed relatively.Results BPBC was 1.5% of the entire breast cancer cases.The risk factors for BPBC founded by univariate analysis:younger than 40 when having the first cancer,early menarche,giving birth to the first child late,premenopause,mammary disease history,breast cancer family history,and the tumor larger than 5cm(P≤0.05).No significantly differences were found in radiotherapy or hormonal therapy(P>0.05).The independent risk factors determined by multivariate analysis:breast cancer family history,the tumor larger than 5 cm and benign mammary disease history.The UBC patients with breast cancer family history have about 1.6 times increased risk to get contra lateral breast cancer(OR=2.631).There is no significant difference between the metastatic rate of BPBC and UBC(20.0%:23.1%;P=0.322).five-year and ten-year overall survival rates(OS) of UBC were 81.4% and 72.3%;When calculated from the time of the first cancer,five-year and ten-year OS of BPBC were 87.4% and 80.2%,no significant difference from UBC(P=0.141);When calculated from the time of the second cancer,5-year and 10-year OS of BPBC were 80.0% and 72.4%,no significant difference from UBC either(P=0.437).Conclusion BPBC and UBC have the similar prognosis.The breast cancer patients who have the breast cancer family history,tumor larger than 5 cm,benign mammary disease history or get the cancer younger than 40 years old have higher risk to get the contra lateral breast cancer.BPBC has a strong relationship with female sex hormone,which could be a solution for prophylaxis.