25例原发性双侧乳腺癌(BPBC)临床分析

 目的  探讨原发性双侧乳腺癌(bilateral primary breast cancer,BPBC)患者的临床病理特征。方法  回顾性分析2004年1月至2011年12月复旦大学附属中山医院普外科乳腺组25例BPBC患者的临床资料,分析并总结其临床病理特征及生存情况。结果  25例BPBC患者中,同时性BPBC(synchronous BPBC,SBPBC)13例,异时性BPBC(metachronous BPBC,MBPBC)12例。SBPBC患者首发癌的肿瘤体积大于第二原发癌(P<0.05)。在处理第二原发癌灶时,SBPBC组6例行改良根治术,1例行保乳术,6例采取其他手术治疗;而MBPBC组10例行改良根治术,2例行保乳手术;两组差异有统计学意义(P<0.05)。在分子分型方面,SBPBC组中Luminal A型更多见,MBPBC组中三阴性型更多见;比较两组患者首发癌或第二原发癌分子分型的分布,差异均有统计学意义(P<0.05),但两侧癌在分子分型方面的一致性较差(K＜0.40)。以发现首发癌为随访起始时间,SBPBC与MBPBC患者的总生存率差异有统计学意义(P<0.05);以诊断第二原发癌为随访起点,两组患者的总生存率差异无统计学意义(P＞0.05)。结论  BPBC两侧癌的临床病理特征无明显差异,SBPBC与MBPBC分子分型的分布不同,两组患者处理第二原发灶的手术方式不同,SBPBC患者的生存率较MBPBC差。

Clinical analysis of bilateral primary breast cancer (BPBC) :a report of 25 cases

Objective   To investigate the clinical characteristics of bilateral primary breast cancer(BPBC) patients.Methods   Medical records of 25 patients with BPBC were analyzed retrospectively at Zhongshan Hospital during Jan.,2004 to Dec.,2011,including their clinical and pathological characteristics as well as their survival status.Results   Within the 25 cases,13 were diagnosed as synchronous bilateral breast cancer(SBPBC),while the rest 12 presented metachronous bilateral tumors (MBPBC).Tunor size of primary breast cancer was larger than the second primary breast cancer in the SBPBC group (P<0.05).To deal with the second primary breast cancer,six patients with SBPBC had modified radical mastectomy,one had breast conserving surgery and the other 6 took other kinds of surgery.While patients with MBPBC were more likely to have modified radical mastectomy (10 cases,the other 2 had breast conserving surgery).It showed significant difference with regard to subtypes of first or second tumor that was compared between synchronous and metachronous tumors (P<0.05).With regard to molecular types,synchronous tumors had a higher rate of luminal A subtype,while triple negative subtype were found in most of metachronous cases.The distribution of molecular types of primary or second primary breast cancer between SBPBC and MBPBC was significantly different (P<0.05).They had discordant phenotypes in both groups (K＜0.40).If we calculated survival from the time of the initial tumor development,SBPBC had a poorer prognosis than MBPBC (P＜0.05).There was no statistically significant difference in overall survival between groups if we calculated from the time of the second tumor development (P＞0.05).Conclusions   The clinical features of BPBC showed no obvious differences with each other.The distribution of each subtype varied in SBPBC and MBPBC,and the management of second primary breast cancer showed a difference statistically.The synchronous tumor was associated with poorer survival in comparison to metachronous tumor.