双侧乳腺癌的诊治及预后分析(附13例报告)

目的:探讨双侧乳腺癌的临床特征、治疗及预后. 方法: 回顾性分析我院1997年10月-2008年10月收治13例原发性双侧乳腺癌,均接受手术、化疗、放疗、内分泌等综合治疗. 结果: 本组13例中同时性双侧乳腺癌4例,异时性双侧乳腺癌9例,平均年龄49.5岁,病理类型以浸润性导管癌和特殊类型为主,随访至今,其中1例同时性双侧乳腺癌双侧病理分期均为Ⅱb,术后2年因骨、脑转移死亡.1例异时性双侧乳腺癌,第一癌病理分期为Ⅱb,第二癌病理分期为Ⅲa,术后3年(以第二次手术后时间计算)骨、肝转移死亡. 结论: 原发性双侧乳腺癌的预后与临床分期、年龄、同时性、异时性有关.     

乳腺癌合并肺孤立性结节外科治疗的临床分析

为了探讨外科治疗在乳腺癌合并肺孤立性结节诊断及治疗中的作用,对13例乳腺癌根治术同期行肺孤立性结节手术切除的临床资料进行回顾性分析。结果:手术治疗的13例患者中,肺孤立性病灶的病理结果6例为原发性肺癌,5例为乳腺癌肺转移,2例为良性病变;手术方式:1998年以前患者采用小切口开胸手术(4例),之后的患者采用胸腔镜辅助小切口手术(9例)。术后并发症为皮下气肿和支气管胸膜瘘,无手术死亡。初步研究结果提示,乳腺癌合并的肺孤立性结节并不都是肺转移瘤,乳腺癌合并肺孤立性结节应该尽可能取得病理诊断,得到正确的治疗。     

双侧乳腺癌的诊治及预后分析（附13例报告）

目的：探讨双侧乳腺癌的临床特征、治疗及预后。方法：回顾性分析我院1997年10月-2008年10月收治13例原发性双侧乳腺癌,均接受手术、化疗、放疗、内分泌等综合治疗。结果：本组13例中同时性双侧乳腺癌4例,异时性双侧乳腺癌9例,平均年龄49．5岁,病理类型以浸润性导管癌和特殊类型为主,随访至今,其中1例同时性双侧乳腺癌双侧病理分期均为Ⅱb,术后2年因骨、脑转移死亡。1例异时性双侧乳腺癌,第一癌病理分期为Ⅱb,第二癌病理分期为Ⅲa,术后3年（以第二次手术后时间计算）骨、肝转移死亡。结论：原发性双侧乳腺癌的预后与临床分期、年龄、同时胜、异时性有关。     

合并甲状腺癌的多原发性癌的临床及病理特征分析

  目的  分析合并甲状腺癌的多原发性癌患者的临床及病理特征。  方法  回顾性分析2007年10月至2017年3月云南省肿瘤医院确诊的4 861例甲状腺癌患者,从中筛选出290例（5.97%）合并其他恶性肿瘤的多原发癌患者,分析其临床及病理特征。  结果  筛选出290例甲状腺癌患者,其中7例（2.4%）为三原发性恶性肿瘤,283例（97.6%）为双原发性恶性肿瘤。以肿瘤发生时间分类:83例（28.6%）为同时性多原发性癌,207例（71.4%）为异时性多原发性癌。248例（85.5%）患者以其他恶性肿瘤为首发,甲状腺癌为后发现。本研究以女性256例（88.3%）、年龄≥45岁191例（65.9%）、甲状腺乳头状癌281例（96.9%）多见。甲状腺癌最常合并的原发癌是乳腺癌44.5%（129/290）,其次是宫颈癌、肺癌、结直肠癌等。  结论  年龄≥45岁女性恶性肿瘤患者,尤其是乳腺癌患者,在随访复查过程中建议进行甲状腺癌筛查。      

双侧原发性乳腺癌267例临床分析

目的探讨双侧原发性乳腺癌（bilateral primary breast cancer, BPBC）的临床病理特征及治疗和预后。方法回顾性分析267例双侧原发性乳腺癌患者的临床资料。结果第一侧为浸润性小叶癌为双侧乳腺癌发病的危险因素。双侧原发性乳腺癌占同期手术治疗乳腺癌的约4％,同时性双侧乳腺癌占18％,异时性双侧乳腺癌占82％。双侧原发性乳腺癌的治疗均应遵循普通乳腺癌的治疗原则。异时性双乳癌的总生存率（OS）高于同时性双乳癌。结论单侧乳腺癌患者,对侧乳腺癌发生的危险度逐年增加,应建立完善的随访制度,做到早期发现,早期诊断及早期治疗第二癌,提高双侧乳腺癌患者的治愈率及生存率。     

术后首发肺转移的三阴性乳腺癌临床病理特点及预后因素分析

目的:分析和探讨术后首发肺转移的三阴性乳腺癌患者的临床病理特点,以及可能影响生存的预后因素。方法:对71例术后首发肺转移三阴性乳腺癌患者的临床资料进行回顾性分析,通过COX分析影响总生存的预后因素。结果:71例术后首发肺转移三阴性乳腺癌患者中以浸润性导管癌为主（97.2%）,术后中位无病间期为14.4个月,发生肺转移后的1、2、3年生存率分别为81.7%、45.1%、16.7%。单因素分析显示,新辅助治疗、原发肿瘤大小、淋巴结转移状态、临床分期、一线化疗最佳疗效、肺转移灶数目与预后相关（P＜0.05）。多因素分析显示,是否行新辅助治疗和肺转移灶数目是术后首发肺转移患者的独立预后因素（P＜0.05）。结论:术后首发肺转移三阴性乳腺癌患者术后无病间期短,远期生存率较低,是否行新辅助治疗和肺转移灶数目是影响术后首发肺转移患者转移后总生存期的独立预后因素。     

565例双侧原发性乳腺癌临床病理特征分析

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。方法收集1971年1月-2011年11月间我院诊治的565例双乳癌患者临床资料。对比分析同时性双乳癌（bilateral synchronous breastcancer）和异时性双乳癌（bilateral asynchronous breast cancer）在发病年龄、发病间隔、月经情况、家族史、肿瘤体积、临床分期、淋巴结数目、激素受体等临床病理特征的差异。结果异时性双乳癌首发癌年龄要早于同时性双乳癌（P<0.05）。同时性/异时性双乳癌在家族史、肿瘤体积、临床分期、腋淋巴结数目方面的差异均无统计学意义（P>0.05）。同时性双乳癌两侧病灶内分泌受体表达一致率高于异时性双乳癌(P<0.01)。无论同时性或异时性双乳癌其第二癌的肿瘤体积、临床分期和腋淋巴结情况都优于第一癌。同时性双乳癌与异时性双乳癌5年无病生存率与10年总生存率之间的差异有统计学意义(P<0.01)。 结论双侧原发性乳腺癌第二癌与第一癌可视为两个完全不同的癌灶。单侧发生乳癌之后对侧乳癌发生的累积危险度逐年增加,应建立完善的随访制度。异时性双乳癌的5年无病生存率与10年总生存率均高于同时性双乳癌。     

多原发性支气管肺癌

目的 探讨多原发性支气管肺癌的诊断与治疗,以减少误诊。方法 经手术、病理证实的673例原发性肺癌中,多原发性肺癌3例,占0.4％。结果 3例均为同时性双原发癌,组织学类型组合:鳞癌——鳞癌。2例在诊治中忽视了对侧肺内病变,造成漏诊,在术后随访中得以确诊。结论 多原发性肺癌的确诊依据是:各个肿瘤在组织学上均应具备原发性肺癌的病理特征。肺癌患者术后出现临床症状,且纤维支气管镜检阳性,只要排除支气管残端癌复发,多为第二个原发癌。肺癌规范性肺切除术是多原发性肺癌的首选术式,对于T_1N_0M_0的周围型肺癌,可选用局限性肺切除术。加强术后随访工作,对于多原发性肺癌的发现有重要意义。     

原发性卵巢类癌6例及文献复习

目的:探讨卵巢类癌的临床和病理特点、治疗及预后.方法:回顾性分析中国医学科学院中国协和医科大学肿瘤医院1975年9月～2008年9月治疗的6例原发性卵巢类癌临床病理资料,并进行文献复习.结果:6例患者中5例(83.3%)发生下腹痛症状,检查发现盆腹腔肿物;2例(33.3%)发生类癌综合征表现;2例合并卵巢畸胎瘤.全部患者接受手术治疗,术后均无辅助治疗.病理组织学类型分别为:岛状型4例,小梁型1例,粘液型1例.手术病理分期:Ⅰ A期3例,Ⅰ C期3例.1例Ⅰ C期患者术后1个月发生肿瘤复发转移,行全身化疗后肿瘤未控.术后5个月死于本病.其余54例患者随诊9个月至33年,除1例死于原发肺癌外,4例均无瘤生存.结论:原发卵巢类癌非常罕见,诊断需除外转移性类癌.本病为低度恶性,早期患者可单纯手术治疗.多数预后良好.本组复发病例化疗疗效差.     

24例双侧原发性乳腺癌临床疗效分析

目的 :探讨双侧原发性乳腺癌 (BPBC)的诊断标准、治疗原则及预后。方法 :回顾性分析了1981年 10月～ 1999年 12月收治的 2 4例BPBC患者的临床资料。结果 :2 4例BPBC患者经根治手术及术后综合治疗后按首发侧癌和第二侧癌计算 5年、10年生存率分别为 77.3%、52 .6%和 4 7.4 %、2 5 0 % ,其中 4例患者第二侧癌治疗后存活 10年以上。结论 :BPBC的治疗原则与单侧乳腺癌相比无明显差别 ,临床分期是判断BPBC预后的主要依据。     

Multiple primary lung cancer

From November 1957 to June 1984, 30 patients with multiple primary lung cancer were diagnosed, basing on clinical features, diagnostic means, histologic type, treatment and prognosis. Out of 3,815 cases of resected primary lung cancer, the incidence of multiple primary cancer was 0.8%. There were 10 synchronous and 20 metachronous cases. There were 17 unilateral, only 1 simultaneous bilateral and 12 contralateral after resection of cancer in the opposite lung. Four of the 10 synchronous cases were definitely diagnosed preoperatively. Among the 20 metachronous cases, 9 were definitely diagnosed as a second primary lesion and the other 11 were proved by thoracotomy. Pathologically, 19 had identical types (15 squamous cell and 4 adenocarcinoma) but 11 had double types (9 squamous cell + adenocarcinoma, 2 squamous cell + anaplastic). The average survival of these 30 patients was 27.1 months, that in the synchronous group was 29 months and that in the metachronous group was 26.2 months. The 5 year survival rate of the synchronous cases was 35%, that of the metachronous cases was 42%. The clinicopathological criteria of multiple primary lung cancer, early diagnostic and operative procedure are also discussed.     

Features of second primary cancer in patients with gastric cancer

BACKGROUND: In order to improve the prognosis of gastric cancer patients, the timely identification of second primary cancers is considered to be a crucial clinical problem. METHODS: We analyzed the clinicopathological data of 2250 patients with gastric cancer with regard to both synchronous and metachronous second primary cancers. RESULTS: Of 2250 patients, 95 (4.2%) had a second primary cancer. Both colorectal and lung cancer were frequently detected, followed by cancer in the liver, esophagus and breast. Regarding the time of detection for such second cancers, 65% of colorectal cancers were detected synchronously, while more than 80% of lung cancers were detected metachronously. The prognosis of gastric cancer patients with a second primary cancer was more negatively influenced by a second primary cancer than by a primary gastric cancer. CONCLUSION: Since gastric cancer patients may develop synchronous and metachronous second cancers in other organs, effective preoperative and postoperative diagnostic modalities both for second primary cancers, as well as for the recurrence of gastric cancer, need to be developed.     

合并肺癌的多原发恶性肿瘤70例临床病理特征分析北大核心

目的:探讨合并肺癌的多原发恶性肿瘤(multiple primary malignancies,MPM)患者临床病理特征。方法:收集2017年01月01日至2019年12月31日陕西省肿瘤医院收治的3438例肺癌患者病例资料,回顾性分析其中70例合并肺癌MPM患者的临床病理特征。结果:同时多原发肿瘤(synchronous MPM,SMPM)16例,异时多原发肿瘤(metachronous MPM,MMPM)54例,男女比例为1∶1.06(男34例,女36例);入组病例次原发肿瘤发生的年龄为(61.37±11.22)岁;初原发肿瘤和次原发肿瘤发生平均时间间隔77.09月;肺癌先发组(lung cancer first,LCF)和其他器官肿瘤先发组(other cancer first,OCF)中肺癌病理类型均以肺腺癌最为多见,共42例(60.00%);肺癌分期为Ⅳ期患者共38例(54.29%);62.86%(44/70)患者伴有肺门或纵隔淋巴结转移;吸烟患者更容易出现SMPM。男性OCF组的初原发肿瘤中胃癌比例最高(31.82%,7/22),而原发性乳腺癌在女性中OCF组比例最高(32.26%,10/31)。结论:无病生存期超过5年的肿瘤患者应长期随访监测多原发肿瘤的发生;初原发乳腺癌、宫颈癌、胃癌患者应加强次原发肺癌的筛查,初原发肺癌患者应加强双原发肺癌及次原发胃癌、食管癌的筛查,以尽早发现MPM的发生,规范治疗,争取治愈机会。     

The impact of bilateral breast cancer on the prognosis of breast cancer: a comparative study with unilateral breast cancer

BACKGROUND: The clinical significance of bilateral breast cancer is unclear and its influence on prognosis is controversial. We assessed the impact of synchronous and metachronous bilateral breast cancer on the prognosis compared with unilateral breast cancer. METHODS: Between January 1, 1960 and December 31, 2001, 1,214 women were treated for primary operable breast cancers. Thirteen (1.1%) had synchronous bilateral breast cancer; 33 (2.7%) had a metachronous contralateral breast cancer. We compared age at operation, menopausal status, clinical stage, tumor size and histology, lymph node status, hormone receptor status, and use of adjuvant chemotherapy or hormone therapy, and we analyzed the impact of these factors on recurrence and survival in the 46 patients with bilateral breast cancer and the 1,168 patients with unilateral breast cancer. RESULTS: The 5-and 10-year disease-free survival rates, respectively, were 65% and 65% in metachronous cases, 85.7% and 64.3% in synchronous cases, and 77.9% and 72.1% in unilateral cases. There was no significant difference in overall survival among the three groups. On multivariate analysis, metachronous bilaterality, tumor size, lymph node status and adjuvant hormone therapy were each independent risk factors for recurrence, whereas bilaterality of breast cancer did not influence overall survival. CONCLUSIONS: Our data suggest that metachronous bilateral breast cancer is associated with shorter disease-free survival than synchronous bilateral or unilateral breast cancer, although overall survival does not differ among the 3 groups. Patients with metachronous bilateral breast cancer should be followed particularly closely in order to detect recurrence early and maximize quality of life.     

Clinical features and outcomes of patients with stage I multiple primary lung cancers

The number of patients with multiple primary lung cancers (MPLC) is rising. We studied the clinical features and factors related to outcomes of MPLC patients using the database of surgically resected lung cancer (LC) cases compiled by the Japanese Joint Committee of Lung Cancer Registry. From the 18 978 registered cases, 9689 patients with clinical stage I non-small-cell lung cancer who achieved complete resection were extracted. Tumors were defined as synchronous MPLC when multiple LC was simultaneously resected or treatment was carried out within 2 years after the initial surgery; metachronous MPLC was defined as second LC treated more than 2 years after the initial surgery. Of these cases, 579 (6.0%) were synchronous MPLC and 477 (5.0%) metachronous MPLC, with 51 overlapping cases. Female sex, nonsmoker, low consolidation-tumor ratio (CTR), and adenocarcinoma were significantly more frequent in the synchronous MPLC group, whereas patients with metachronous MPLC had higher frequencies of male sex, smoker, chronic obstructive pulmonary disease (COPD), and nonadenocarcinoma. There was no significant difference in survival rate between patients with and without synchronous or metachronous MPLC. Age, gender, CTR for second LC, and histological combination of primary and second LC were prognostic indicators for both types of MPLC. Logistic regression analysis showed that female sex, history of malignant disease other than LC, and COPD were risk factors for MPLC incidence. The present findings could have major implications regarding MPLC diagnosis and identification of independent prognostic factors, and provide valuable information for postoperative management of patients with MPLC.     

The role of surgery in the management of solitary pulmonary nodule in breast cancer patients.

AIMS: To assess the role of surgery in the diagnosis and treatment of a solitary pulmonary nodule (SPN) in patients who had received previous surgery for breast cancer. METHODS: A series of 79 consecutive patients who underwent surgery for an SPN between 1990 and 2003 after a curative resection for breast cancer were reviewed. RESULTS: Surgical diagnosis was obtained by open procedure before 1996 (37 cases), and by video-assisted thoracoscopic surgery (VATS) after 1996 (33 out of 42 cases, 9 open procedures) and intraoperative evaluation. Histology of SPN was primary lung cancer in 38 patients, pulmonary metastasis of breast cancer in 27, and benign condition in 14. VATS was converted to open procedure for anatomical resection in primary lung cancer and for the palpation of the lung in metastatic disease. Average disease-free interval from the initial mastectomy was significantly longer in primary lung cancer than in metastatic patients (179+/-107 vs 51+/-27 moths). Manual palpation identified multiple pulmonary nodules in 3 out of 27 metastatic patients. Five-year survival rate after pulmonary metastasectomy was 38% and was significantly influenced by disease-free interval; 5-year survival rate after resection of primary lung cancer was 43% and was significantly influenced by the pathological stage. CONCLUSIONS: VATS is a good procedure for diagnostic management of peripheral SPN. As SPN in breast cancer patients is primary lung cancer in half cases, it deserves confirmation of pathological diagnosis and appropriate surgical treatment. When breast cancer metastasis is demonstrated, open procedure must be performed to palpate the entire lung to exclude previously unknown nodules.     

Bilateral breast cancer: differential diagnosis using histological and biological parameters

BACKGROUND: Contralateral breast cancer is either a metastatic lesion or the second primary cancer. From biological and therapeutic viewpoints, it is important to differentiate metastatic lesions from second primary cancer in bilateral breast cancer. METHODS: Based on Chaudary's histological criteria, we analysed the tumors in 14 and 27 patients with synchronous and metachronous bilateral breast cancers with full histological and biological evaluations. The Nottingham combined histological grade and immunohistochemistry (IHC) for the estrogen receptor, progesterone receptor and cerbB-2 were used. RESULTS: The median age of the patients at first diagnosis was 41 years (range, 26-68 years) and the median time interval between first and second tumors was 34 months (range; 7-209 months) in metachronous cancers. The histopathological type was found in 93% of synchronous cancers and 59% of metachronous cancers (P = 0.02). The concordance rates of T stage and TNM stage were 71 and 64% respectively in synchronous cancers, while they were 24 and 32% respectively in metachronous cancers (P = 0.03). For progesterone receptor status, the concordance rates were 86 and 52% in synchronous and metachronous cancers respectively (P = 0.03). In addition, there was no statistically significant difference in terms of N stage, histological grade, intraductal component, estrogen receptor status, or cerbB-2 expression. CONCLUSION: In spite of the limitation of Chaudary's criteria and the number of patients involved, the combination of histopathological type, T stage and TNM stage shows that synchronous cancers are closer to same clonal lesions (metastatic lesions) than metachronous cancers and that a biomarker, such as progesterone receptor status, plays a role in addition to the histological parameters in differentiating metastatic cancers from second primary cancers.     

双原发肺癌的诊断及外科治疗

目的 探讨双原发性肺癌的合理诊断及有效的外科治疗方法。方法 对34例双原发肺癌患者的临床资料进行回顾性分析。结果 全组双原发肺癌共34例，占同期收治肺癌患者的1．2％。异时性22例，同时性12例。异时第二原发肺癌行肺叶切除，局部切除11例，探查1例，手术并发病发生率、手术死亡率及5年生存率分别为13．6％、4．6％和25．0％。同时双原发肺癌行肺叶及全肺切除各2例，其余均至少有1个肿瘤行局部切除，无手术并发症及手术死亡5年生存率14．3％。结论 双原发性肺 癌的诊断率较低，应加强术前检查、术后随诊及鉴别诊断。术式选择过于保守及淋巴结清扫不彻底，是患者预后不佳的主要原因，应引起重视。     

乳腺癌多原发癌的临床病理特征及预后分析

  目的   探讨乳腺癌多原发癌（multiple primary cancers,MPCs）患者的临床病理特征及预后因素。   方法   回顾性分析2005年1月至2015年12月天津医科大学肿瘤医院收治的226例乳腺癌MPCs患者的临床病理资料,应用单因素及多因素分析方法分析其临床病理学特征及影响预后的因素。   结果   226例中74例（32.7%）为同时型MPCs,152例（67.3%）为异时型MPCs。在第二原发恶性肿瘤中甲状腺癌最常见,为90例。患者的中位随访时间为84.75（4.1~384.5）个月,226例患者的3年及5年总生存率分别为91.7%和82.9%。乳腺癌MPCs患者的病理特征以肿瘤负荷大（65.5% vs. 34.5%,P=0.005）和ER受体阳性（76.1% vs. 23.9%,P=0.046）多见,异时型MPCs更倾向于高龄人群（62.4% vs. 37.6%,P < 0.001）。无淋巴结转移（95%CI:0.341~0.932,P=0.025）和异时型MPCs（95%CI:0.033~0.220,P < 0.001）患者预后佳。   结论   甲状腺是最常见的第二原发肿瘤,肿瘤负荷大及ER受体阳性患者易发生乳腺癌MPCs,高龄患者易患异时型MPCs,有无淋巴结转移和MPCs的类型是患者预后的独立影响因素。      

Clinical characteristics and clinicopathological correlations of bilateral breast cancer in China: A multicenter study from Chinese Society of Breast Surgery (CSBrS-006)

Objective:To investigate the clinical characteristics and clinicopathological correlations of bilateral breast cancer(BBC)in China.Methods:Data of 440 patients diagnosed with BBC in 2018 were collected from 33 centers of the Chinese Society of Breast Surgery.Demographic characteristics,bilateral tumor characteristics,and comprehensive treatment data were obtained.Correlations between the clinicopathological characteristics of bilateral tumors were analyzed.Results:The proportion of BBC was 0.22%-3.08%.A total of 33(7.5%)patients had a family history of malignant tumors,304(69.1%)patients had synchronous BBC.Only 1(0.2%)patient was male.More than half of all patients received concurrent or asynchronous endocrine/chemotherapy,32.5%of all human epidermal growth factor receptor 2(HER2)-positive patients received HER2-targeted therapy,and approximately 21.6%of all patients received radiotherapy.The most common pathological cancer type was invasive ductal cancer(>60%).Approximately 70%of all patients had bilateral hormone receptor(HR)-positive tumors and presented with a single breast mass.Significant correlations were found with pathological type,histological grade,locations of tumor,molecular subtype,Ki-67 index,tumor site and size of bilateral tumors.Results of the subgroup analysis showed more clinicopathological characteristics when synchronous BBC was compared with metachronous BBC.Conclusions:In China,the clinicopathological characteristics of bilateral tumors showed significant correlations,and more significant clinicopathological correlations were observed when synchronous BBC was compared with metachronous BBC.