Prognosis of bilateral synchronous breast cancer in Vaud, Switzerland

Out of 6084 first breast cancers registered between 1974 and 1993 in the Cancer Registry of the Swiss Canton of Vaud, 81 (1.3%) were synchronous bilateral breast cancers (BBCs). The 5-year relative survival rates were 73% for women with unilateral breast cancer (UBC) and 65% for those with synchronous BBC. The corresponding 10-year figures were 59% and 51%. This large, population-based series indicates that women with synchronous BBC have a moderately lower long-term survival than women with UBC.     

同时性双侧原发乳腺癌的危险因素与预防

同时性双侧原发乳腺癌是指两侧乳腺同步发生原发肿瘤,总体发病率较低,但近年来随着隐匿型乳腺癌的发现增加,其总体呈上升趋势。同时性双侧原发乳腺癌的发病机制尚未明确,老龄、一级乳腺癌家族史、癌前病变硬化性腺病与首发癌病理特点是目前认可的危险因素。与单侧乳腺癌相比,同时性双侧原发乳腺癌预后不佳。应增强高风险女性风险意识,定期检...     

Prognostic significance of synchronous and metachronous bilateral breast cancer

Women previously treated for primary operable breast cancer are at increased risk of developing cancer in the contralateral breast, but the clinical significance of this development is unclear. The purpose of this study was to assess the impact of synchronous bilateral breast cancer or the development of a metachronous contralateral breast primary on the prognosis. In a series of 3210 women age < or = 70 years treated between 1975 and 1995 for primary operable breast cancer, 106 were identified to have bilateral breast cancer. Of these women, 26 were noted to have synchronous bilateral breast primaries (0.8%), and 80 developed a contralateral breast cancer after treatment for an initial primary breast cancer. Using life-tables analysis, there was a significant difference in survival between women with unilateral breast cancer, those with synchronous bilateral breast cancers, and those with metachronous contralateral breast with survivals at 16 years of 53.8%, 42.4%, and 60.1%, respectively (p < 0.0001), from the date of the diagnosis of the first primary tumor. There was no difference in survival seen between the three groups when survival was calculated from the date of diagnosis of the second primary in cases of metachronous contralateral breast cancer (p = 0.31). When contralateral breast cancer was incorporated as a time-dependent covariate in a Cox multivariate model together with the three factors used to determine the Nottingham Prognostic Index (invasive tumor size, grade, and lymph node stage), contralateral breast cancer continued to be a significant prognostic determinant (p = 0.02). The survival of women with synchronous bilateral breast cancer or metachronous breast cancers diagnosed within 2 years of the original primary was worse than those with unilateral disease. However, the time duration to metachronous contralateral breast cancer did not have prognostic significance in a multivariate model compared with the prognostic features of the original primary.     

A rare presentation of bilateral,synchronous male breast cancer

Rarity of male breast cancer limits available clinical research and data for management guidance and screening guidelines for patients at high risk. Here, we report on a patient with bilateral, synchronous male breast cancer with discussion of risk factors and need for possible screening.     

同时性双侧乳腺癌与异时性双侧乳腺癌预后差异的Meta分析

目的:系统评价同时性双侧乳腺癌(SBBC)与异时性双侧乳腺癌(ABBC)预后差异。方法:计算机检索国内外数据库,收集相关文献,经文献筛选、质量评价和资料提取后,对符合纳入标准的研究采用Revman 5.3软件进行Meta分析。结果:共纳入7个研究,共711例患者,其中SBBC患者225例,ABBC患者486例。Meta分析结果显示,SBBC患者组1、5、10年生存率均明显低于ABBC患者(OR=0.41,95%CI=0.22-0.77,P=0.005;OR=0.52,95%CI=0.39~0.69,P0.00001;OR=0.43,95%CI=0.25-0.74,P=0.003)。结论:在同等医疗条件下,SBBC的预后可能差于ABBC,但仍需作进一步的完整评估。     

大肠癌同时性肝转移外科治疗的预后因素分析

目的探讨大肠癌同时性肝转移及其与预后有关的危险因素,提高大肠癌肝转移的诊治水平。方法回顾性分析1994年8月至2004年2月间收治的大肠癌同时性肝转移106例的临床资料,对15项临床病理指标进行统计分析,并用单因素分析和Logistic回归分析与同期收治的无复发性肝转移的大肠癌1052例进行比较。同时对大肠癌肝转移行根治性切除、姑息性切除和探查性手术的生存状况用KaplanMeier法和COX回归方法进行分析比较。结果单因素分析显示,肠梗阻、腹水、盆腔结节、腹膜侵犯、浆膜浸润、周围脏器受累以及肿瘤长径、浸润肠壁的周径、浸润深度都与大肠癌同时性肝转移显著相关;Logistic回归分析发现,浸润深度、浆膜浸润、盆腔转移结节和腹水是影响大肠癌同时性肝转移最重要的因素。根治性切除57例(53.8%),姑息性切除39例(36.8%)和探查性手术后10例(9.4%)平均生存期和中位生存期分别为41.0和34.0个月、23.6和18.0个月以及16.5和12.0个月,三组差异有统计学意义(P=0.0095)。手术方式、肿瘤部位和盆腔结节是影响大肠癌同时性肝转移预后的主要因素。结论大肠癌浸润达浆膜、有盆腔转移结节和腹水者可能合并肝转移,根治性切除可以明显提高大肠癌同时性肝转移的生存率。     

Association of molecular subtype concordance and survival outcome in synchronous and metachronous bilateral breast cancer

BackgroundThe aim of this study was to analyze the association of molecular subtype concordance and disease outcome in patients with synchronous bilateral breast cancer (SBBC) and metachronous breast cancer (MBBC).Patients and methodsPatients diagnosed with SBBC or MBBC in the Surveillance, Epidemiology, and End Results (SEER) database or Comprehensive Breast Health Center (CBHC) Ruijin Hospital, Shanghai were retrospectively reviewed and included. Clinicopathologic features, molecular subtype status concordance, and prognosis were compared in patients with SBBC and MBBC. Other prognostic factors for breast cancer-specific survival (BCSS) and overall survival (OS) were also identified for bilateral breast cancer patients.ResultsTotally, 3395 and 115 patients were included from the SEER and Ruijin CBHC cohorts. Molecular subtype concordance rate was higher in the SBBC group compared to MBBC in both SEER cohort (75.8% vs 57.7%, p < 0.001) and Ruijin CBHC cohort (76.2% vs 45.2%, p = 0.002). Survival analyses indicated that SBBC was related to worse BCSS than MBBC (p = 0.015). Molecular subtype discordance was related to worse BCSS (hazard ratio (HR), 1.64, 95% confidential interval (CI), 1.18–2.27, p = 0.003) and OS (HR, 1.59, 95% CI, 1.24–2.04, p < 0.001) in the SBBC group, but not for the MBBC group (p = 0.650 for BCSS, p = 0.669 for OS).ConclusionsMolecular subtype concordance rate was higher in the SBBC group than MBBC group. Patients with discordant molecular subtype was associated with worse disease outcome in the SBBC patients, but not in MBBC, which deserves further clinical evaluation.     

Survival after resection of synchronous bilateral lung cancer

Objective: Due to recent advances in imaging, the incidence of patients presenting with bilateral lung lesions is increasing. A single contralateral lung lesion can be an isolated metastasis or a synchronous second primary lung cancer. For the revision of the TNM in 2009, the International Association for the Study of Lung Cancer Staging Committee proposes that patients with contralateral lung nodules remain classified as M1 disease. In this retrospective study, the survival after resection of synchronous bilateral lung cancer is evaluated. Methods: From our database of bronchial carcinoma, all patients with bilateral synchronous lung lesions between 1990 and 2007 were retrieved. We analysed 57 patients in which, after functional assessment and thorough staging, the decision was taken to treat the disease with bilateral resection. All these files were retrospectively reviewed. Twenty-one patients were excluded from this analysis because only one side was resected (n = 15) or one of the lesions was non-neoplastic on final pathology (n = 6). Results: Thirty-six patients underwent bilateral resection for synchronous multiple primary lung cancer. All resections were performed as sequential procedures. In 23 patients, one side was anatomically resected (2 pneumonectomies) and the contralateral side was resected by limited resection. In 10 patients a bilateral lobectomy was performed, and 3 patients had bilateral limited resections. Postoperative mortality was 2.8%. Eighteen patients had a tumour with a different histological pattern, confirmed by comparing both specimens by an experienced senior pathologist. The median survival after resection of synchronous bilateral lung cancer in our series was 25.4 months with a 5-year survival rate of 38%. There was no significant difference in survival between patients with different versus same histology. This survival is much higher compared to the survival of assumed stage IV disease. Conclusions: Our study shows that selected patients with bilateral lung cancer may benefit from an aggressive approach, with acceptable morbidity and mortality, and rewarding long-term survival. Patients with a single contralateral lung lesion should not be treated as disseminated disease (stage IV). After extensive searching for metastatic spread, bilateral surgical resection should be considered in fit patients.     

A case of bilateral multiple lung cancer resected by synchronous bilateral thoracotomy

A 59-year-old female with multiple lung cancer, located in left upper lobe and in right upper lobe received synchronous bilateral thoracotomy. The patient underwent left upper division segmentectomy and right S3 segmentectomy. Histological examination showed large cell carcinoma in the left side and small cell carcinoma in the right side. The patient died 5 years and 3 months after operation. If general condition and pulmonary function permit, bilateral thoracotomy for multiple lung cancer is recommended.