双侧原发性乳腺癌的预后因素分析

目的:探讨双侧原发性乳腺癌(bilat eralprimarybreastcancer,BPBC)的生存结果 及其预后因素。方法:对1970年1月～2000 年12月我院收治的54例BPBC的临床资料进 行回顾性分析。结果:同时性和异时性BPBC 分别为16例和38例。同时性和异时性BPBC (从第二侧癌确诊起计算生存率)的5年总生存 率分别为49.1%和54.0%,8年总生存率分别 为32.1%和33.1%,两组比较差异无统计学意 义,P=0.5193;双侧腋窝淋巴结阴性、一侧阳 性和双侧阳性患者的5年总生存率分别为 75.6%、43.8%和28.9%,8年总生存率分别 65.5%、32.9%和0,总体比较差异有统计学意 义,P=0.0023;第一侧癌0～ⅡA期患者的5 年和8年总生存率分别为64.5%和51.6%, ⅡB～Ⅲ期者分别为38.6%和19.3%,两组比 较差异有统计学意义,P=0.0409;第二侧癌 0～ⅡA期患者的5年和8年总生存率分别为 60.9%和50.9%,ⅡB～Ⅲ期者分别为37.9% 和0,两组比较差异有统计学意义,P=0.021 3;在异时性BPBC中,间隔时间1～2年、2～5 年和>5年者的5年总生存率分别为52.6%、 58.7%%和85.7%,8年总生存率分别为 36.2%、42.2%和61.2%,总体比较差异有统 计学意义,P=0.0412。结论:同时性和异时性 BPBC的生存率结果相似。单因素分析表明双 侧腋窝淋巴结状况和第一、二侧癌的     

双侧原发性乳腺癌的预后因素分析

目的：探讨双侧原发性乳腺癌（bilateral primary breast cancer，BPBC）的生存结果及其预后因素。方法：对1970年1月～2000年12月我院收治的54例BPBC的临床资料进行回顾性分析。结果：同时性和异时性BPBC分别为16例和38例。同时性和异时性BPBC（从第二侧癌确诊起计算生存率）的5年总生存率分别为49．1％和54．0％，8年总生存率分别为32．1％和33．1％，两组比较差异无统计学意义，P=0．5193；双侧腋窝淋巴结阴性，一侧阳性和双侧阳性患者的5年总生存率分别为75．6％、43.8％和28.9％，8年总生存率分别65．5％、32．9％和0，总体比较差异有统计学意义，P=0．0023；第一侧癌0～ⅡA期患者的5年和8年总生存率分别为64．5％和51．6％，ⅡB～Ⅲ期者分别为38．6％和19．3％，两组比较差异有统计学意义，P=0．0409；第二侧癌0～ⅡA期患者的5年和8年总生存率分别为60．9％和50．9％，ⅡB～Ⅲ期者分别为37．9％和0，两组比较差异有统计学意义，P=0．0213；在异时性BPBC中，间隔时间1～2年、2～5年和〉5年者的5年总生存率分别为52．6％、58．7％％和85．7％，8年总生存率分别为36．2％、42．2％和61．2％，总体比较差异有统计学意义，P=0．0412。结论：同时性和异时性BPBC的生存率结果相似。单因素分析表明双侧腋窝淋巴结状况和第一、二侧癌的病理分期是影响BPBC生存率的主要因素，两侧癌发生的间隔时间〉5年者的预后比同时性或间隔时间在5年以内者好。多因素分析表明双侧腋窝淋巴结阴性是独立的预后因素。     

Survival after bilateral breast cancer: results from a population-based study

Background Controversy exists on the impact of bilaterality of breast cancer on survival. We used population-based data to compare survival of women with unilateral versus bilateral breast cancer. Patients and methods At the Geneva cancer registry, we identified all 7,912 women diagnosed with invasive breast cancer between 1970 and 2002. Breast cancers were categorized as unilateral, synchronous bilateral (contralateral tumour diagnosed within six months after the first tumour) and metachronous bilateral (contralateral tumour diagnosed over six months after the first tumour). With multivariate modelling we compared characteristics and survival between women with unilateral and bilateral disease. Results Patients with synchronous bilateral tumours (n = 155, 2.0%) had more often lobular histology and less frequently stage I disease than women with unilateral disease. Women with metachronous breast cancer (n = 219, 2.8%) received less often chemotherapy or hormone therapy for their first tumours. Ten-year disease-specific survival was similar (66%) after unilateral and metachronous bilateral breast cancer, but worse after synchronous bilateral cancer (51%). After adjustment, breast cancer mortality risks were not significantly increased for women with either synchronous or metachronous bilateral disease (Hazard ratios 1.1 (0.8–1.5) and 0.8 (0.5–1.4), respectively). Conclusion This large population-based study indicates that bilaterality of breast cancer is not associated with impaired survival.     

Familial bilateral breast cancer

The occurrence of bilateral breast cancers in three members of one family is reported. In two members, evidence of a distinct primary lesion in each breast was verified. The occurrence of unilateral breast cancer and other cancers in other members of the family was surveyed. Recommendations for early detection and surveillance in familial breast cancer at the present time should be by aggressive and close follow-up of the affected members. Absence of reliable markers preclude effective surveillance for early detection or susceptibility.     

原发性双侧乳腺癌

原发性双侧乳腺癌(PBBC)的总体发病率不高,但近年来有逐渐增高的趋势,所以有必要提高对这一疾病的认识.本文复习国内外的相关文献,系统阐述PBBC的病因、流行病学特点、诊断、治疗,特别是预防等相关问题.根据乳腺两侧的原发病灶间隔期是否超过6个月,将PBBC分为同时性和异时性.对于危险因素各家论述涉及较多,其中基因研究是热点所在,也是目前研究的重点.因为PBBC不是转移癌,它与单侧乳腺癌的愈后没有明显差别,所以一经确诊应该采取积极治疗.对于PBBC的预防方法,各家提出意见不一,其中也存在一些争论.     

Tumor-associated antigens in bilateral breast cancer

The purpose of our present study is to determine whether monoclonal antibodies can define an antigenic phenotype which expresses itself in a concordant fashion in synchronous bilateral breast cancer. The monoclonal antibodies DF.3 and B72.3 were reacted (ABC immunoperoxidase) with formalin-fixed, paraffin-embedded sections of bilateral synchronous breast cancers from 19 patients. MAb DF.3 demonstrated a P less than .01 correlation of right-sided vs left-sided reactivity. This suggested that MAb DF.3 could be used as a biologic marker for synchronous bilateral breast cancer. We hypothesized that the majority of clinically asynchronous breast cancers are really biologically synchronous. We used the immunoperoxidase technique in a similar fashion on bilateral metachronous tumors in 17 patients. DF.3 antigen expression correlated (right to left side) at P less than .01 value. This data, supported by previous information, suggests that the term "metachronous" breast cancer is a clinically arbitrary definition but that biologically most "metachronous" cancers may well be synchronous.     

Estrogen receptors in bilateral breast cancer

Estrogen receptor status, tumor histology, and the interval between the development of tumors were assessed in 99 patients with bilateral breast cancer. Tumors were first grouped into those simultaneously detected in both breasts or within 12 months of each other (synchronous bilateral breast cancer, of which there were 64) and second, those detected within more than 12 months of each other (asynchronous bilateral breast cancer, of which there were 35). Nineteen percent of all tumors were lobular carcinomas. Overall, the rate of receptor discordance between the two tumors was not significantly different from that previously reported between biopsies of primary tumor and metastases in patients with unilateral breast cancer. Synchronous receptor-positive tumors occurred significantly more frequently than expected, suggesting that the development of the two tumors was influenced by a common mechanism. In patients with asynchronous bilateral breast cancer there was a significantly longer interval between tumors if both were receptor-positive compared with concordant receptor-negative tumors and tumors with discordant receptor status. There was a significant discordance in the receptor status of asynchronous tumors when the histology also differed, indicating that the tumors in this group were likely to be separate primary tumors.     

Phenotypic similarities in bilateral breast cancer

Bilateral breast cancers that develop at similar times in an individual are likely to have been subjected to similar hormonal, environmental and genetic influences during tumourogenesis compared with metachronous tumours. As such, it is possible that tumour phenotype in synchronous bilateral breast cancer may display similar biological characteristics. The aim of this study was to identify phenotypic similarities between synchronous and metachronous bilateral breast cancers which may suggest a common origin. Thirty-three cases of synchronous and 46 cases of metachronous bilateral breast cancer that displayed similar tumour type were analysed for concordance in relation to various histological and immunohistochemical parameters. A higher level of concordance was demonstrated for synchronous cases with the highest level seen for oestrogen receptor. It is likely that this is related to similar tumourogenic pathways occurring at equivalent exposure times to various environmental and hormonal influences, although, in a proportion of cases, inherited genetic factors may play a role.     

双侧乳腺癌的预后因素

目的：探讨影响双侧乳腺癌患者生存率的预后因素。方法：对21例经病理组织学证实的双侧原发性乳腺癌患者进行回顾性分析。其中，同时性双侧乳腺癌4例（19%），异时性双侧乳腺癌17例（81%），接受手术，放疗，化疗等单一或综合治疗，分析乳腺癌的多种预后因素与术后生存率的关系。结果：主要的预后因素与肿瘤振奋小，浸润淋巴结的数目，最初的正确治疗和两侧乳癌的间距时间等有关。二、五、十年的生存率各为90%（19/21），71.4%(15.21),66.7%(14.21)。结论：若双侧乳腺癌的治疗正确。仍有相当高的五年生存率，两侧乳腺癌之间的间距时间是最突出的预后因素。与生态2率呈正相关系。早期诊断，早期治疗第二原发癌仍是提高生存率的关键。     

Survival in breast cancer is familial

Several earlier studies have assessed survival in breast cancer based on familial risk of this disease. The results have been conflicting and suggest that the risk and prognostic factors of cancer are largely distinct. As a novel concept, we searched for familial clustering of survival, i.e., concordance of survival among family members. We used the nation-wide Swedish Family-Cancer Database to estimate hazard ratios (HRs) for cause-specific and overall survival in invasive breast cancer. HR shows the probability of death in the study group compared the reference group. The study covered 1277 mother-daughter pairs with familial breast cancer. Their median follow-up times for survival ranged from 96 to 122 months. When the survival in daughters was analyzed according to the mothers' length of survival, there was a concordance of prognosis. The HR was 0.65 in daughters whose mothers had survived > or = 120 months compared to daughters whose mothers had survived less than 36 months (P-value for trend 0.02). When the analysis was reversed and HRs were derived for mothers, the results were essentially similar (P-value for trend 0.02). The survival did not differ between patients with familial or sporadic breast cancer. The results are consistent in showing that both good and poor survival in breast cancer aggregates in families, which is a novel population-level finding for any cancer. The consistency of the results suggests that the prognosis in breast cancer is in part heritable which is likely to be explained by yet unknown genetic mechanisms.     

Survival in familial breast cancer patients

This study was conducted to measure survival in breast cancer patients differing in their familiarity of the disease. A total of 556 familial patients and 4551 general patients were evaluated. Survival was higher with bilateral than unilateral disease in both groups of patients. This difference was observed only when survival was measured from the first primary; it disappeared when survival was measured from the second primary. Three groups of familial patients, who likely differed in genetic risk, had similar survival curves. They were also similar to a general series patients when stage of disease was controlled and the comparison involved primarily unilateral patients. Previous reports of increased survival in familial and bilateral patients were thus not confirmed. The previous results were likely the consequence of bias arising from measuring survival from the first primary. Survival does not appear to be influenced by family history or laterality of breast cancer.     

Survival from contralateral breast cancer

First primary, or unilateral, breast cancer (UBC) cases diagnosed in 1960–89 at the Cancer Institute (WIA), Chennai, India were followedup until December 31, 1994. Patients with UBC (n=3163) and those who developed second cancer in the contralateral breast (CBC) after the initial breast cancer (n=67 or 2.1% of UBC) were analysed.Compared to UBC patients, those who developed CBC were younger at the time of diagnosis of initial breast cancer and had higher frequency of breast cancer among the family members. The relative survival rate takes into account competing causes of death and was estimated as the ratio of observed survival rate to the expected survival rate. The cumulative relative survival from UBC at 5 and 10 years were 51% and 41%, respectively, and the corresponding rates for CBC were 47 and 30% the survival difference seen between UBC and CBC patients was not statistically significant. The survival rates among younger, middle-aged and older women were significantly different from each other in UBC but not in CBC patients. Both UBC and CBC with early stage disease had a better survival compared to late stage disease. Survival advantage was also seen among both UBC and CBC patients with family history of breast cancer compared to those without. The multivariate analysis by the life table proportional hazards model showed that the age at diagnosis is an independent prognostic factor for breast cancer. The study results should be interpreted in the light of small sample size of second cancers.     

原发性双侧乳腺癌的预后分析

目的分析影响双侧乳腺癌患者生存率的预后因素.方法对18例经病理组织学证实的原发性双侧乳腺癌患者进行回顾性分析.其中同时发生3例(16.7%);先后发生15例(83.3%),均接受手术、放疗、化疗等综合治疗.分析原发性肿瘤临床T分期、腋下淋巴结的转移、月经情况及两侧乳腺癌发生的间隔时间与患者生存率的关系.结果原发性肿瘤临床T分期、腋下淋巴结的转移及两侧乳腺癌发生的间隔时间为患者的主要预后因素.结论原发性双侧乳腺癌患者的原发灶大小、淋巴结浸润及两侧癌发生的间隔时间与患者的预后有显著关系;第二原发乳腺癌患者的早期发现,早期治疗可提高生存率.     

Factors influencing survival in bilateral breast cancer

One Hundred And Four Patients With Bilateral Breast Cancers, Detected Clinically, Were Studied. Patients With Synchronous Lesions Experienced The Worst Survival. Lymph Node Metastases In The Second Mastectomy Had Obvious Adverse Effect On Survival. The Development Of Scirrhous Carcinoma In The Second Breast Did Not Alter Survival. A Maximum Of 21 Patients Might Have Been Adversely Affected By The Development Of A Second Cancer Because Of Lymph Node Metastases In The Second Breast Only. Survivorship Data Suggest The Adequacy Of Treatment Of Contralateral Breast Cancers When They Become Detectable By Clinical Means Alone.     

Molecular pathogenesis of bilateral breast cancer

Bilateral breast cancer (biBC) offers intriguing possibilities for molecular genetic investigations, however it is disproportionally less studied than its unilateral counterpart. By now, genetic research has succeeded to resolve at least two important aspects of biBC pathogenesis. First, it has been confirmed, that the vast majority if not all biBC arise due to clonally independent events but not due to contralateral metastatic spread. Second, unselected biBC cases have been shown to have a modest prevalence of BRCA germ-line mutations (approximately 5%), although a considerable frequency of BRCA defects (up to 20%) has been observed in early-onset and/or familial forms of the disease. Other data related to biBC appear to be at suggestive stage. Recent reports demonstrate, that the tumors forming biBC pair may show similarities of their molecular portraits, especially if they develop synchronously. This observations imply that the host factors may determine not only the level of breast cancer susceptibility, but also the molecular variant of the disease development. Apart from this, biBC may serve as a very demonstrative case group in the studies of breast cancer predisposing low-penetrance gene polymorphisms, because it is more likely to accumulate unfavorable allele combinations than the unilateral patients. The utility of this approach has been already exemplified by several scientific publications. Further research on the biBC molecular pathogenesis may significantly contribute to the general understanding of the process of malignant transformation.     

双侧乳腺癌研究进展

Women diagnosed with breast cancer have a significantly higher risk of developing contralateral breast carcinoma. When the dignosis of “bilateral breast cancer (BBC)” is established, the challenges for the doctors are to determine contralateral breast carcinoma is metastasis or primary lesions. The pathological type, receptor status, biological behavior and the prognosis of bilateral breast cancer are the issues have to be considered. On the other hand, we discuss which type of breast cancer trend to be bilateral breast cancer, thus more effective follow-up and preventive procedures would be applied on the patients with bilateral breast cancer to improve their quality of life and the curative rate.