乳腺与肺双原发性癌的临床病理特征分析

目的:探讨乳腺癌合并原发性肺癌患者的临床病理特征及同时手术的安全性。方法:回顾性收集1999 年1月至2017年12月中国医学科学院肿瘤医院收治的乳腺癌合并肺癌患者共计94例，经病例筛选后共71例纳入本研究，对纳入研究的双原发性癌患者临床病理特点进行分析。结果:71例患者中，乳腺癌作为首发癌合并肺癌 63例，肺癌作为首发癌合并乳腺癌 8例，两组患者在乳腺肿瘤大小、淋巴结转移数目、临床分期、病理类型、ER表达、Ki-67指数、HER-2表达、手术方式及有无放化疗史方面的差异均无统计学意义（均P>0.05），但乳腺癌首发组患者无进展生存期优于肺癌首发组（P<0.05）。在同时性双原发性癌 28 例中，6 例患者（21.4%）同时接受乳腺癌及肺癌手术，围手术期无并发症发生，术后病情平稳。以乳腺癌作为首发癌的41例异时性双原发性癌中，中位间隔为57.3个月，肺结节平均观察时间为10个月。肺癌临床分期Ⅰ期以下占82.9%，病理类型中93%为腺癌。发现肺结节的早晚与乳腺癌术后复查及随访有关。结论:乳腺癌首发的双原发性癌患者预后较好；同时手术治疗乳腺癌及肺癌是安全可行的；在异时性双原发性癌中，肺癌一般是在乳腺癌术后 5 年内发现的，乳腺癌术后规律及时的随访有助于肺癌早期发现。

Analysis of clinicopathological features of double primary breast cancer and lung cancer

Objective:To analysis the clinicopathological features of double primary breast cancer and lung cancer and explore the safety of concomitant surgical treatment.Methods:A total of 94 patients with breast cancer and lung cancer in Cancer Hospital of Chinese Academy of Medical Sciences from January 1999 to December 2017 were retrospectively collected.71 patients were finally included in this study.The clinicopathological characteristics of breast cancer and primary lung cancer were analyzed.Results:Among the 71 double primary cases,63 patients firstly appear breast cancer,while 8 patients show up lung cancer first.There was no significant association in breast tumor size,the status of lymph node metastases,clinical-stage,pathological type,ER expression,Ki-67 index,HER-2 expression,surgical method,and history of radiotherapy and chemotherapy(P>0.05)between the two groups.But the progression-free survival of breast cancer patients with second primary lung cancer(BC2LuC)was better than lung cancer patients with second primary breast cancer(LuC2BC)(P<0.05).Among the 28 cases of synchronous double primary cancer,6 patients(21.4%)underwent surgery for breast cancer and lung cancer at the same time.There were no perioperative complications and the condition was stable after operation.For breast cancer patients with metachronous second primary malignancy of lung cancer,the median interval was 57.3 months and the average observation time for pulmonary nodules was 10 months.82.9%lung cancer are below stage I and 93%of the pathological types were adenocarcinoma.The foundation of lung nodules was related to breast cancer postoperative review and follow-up.Conclusion:Breast cancer with second primary lung cancer(BC2LuC)has a better prognosis.Concomitant surgery for synchronous breast and lung cancer was feasible and safe.In metachronous cases,lung cancers tended to be detected within 5 years after surgery for breast cancer.Careful follow-up for postoperative breast cancer may contribute to the detection of early-stage lung cancer.