原发性双侧乳腺癌103例的临床病理分析

背景与目的：和单侧乳腺癌相比，目前对双侧乳腺癌（bilateral breast cancer）的了解相当有限。本研究探讨原发性双侧乳腺癌的临床病理特征及其治疗和预后。方法：回顾了2001年1月～2005年6月间复旦大学附属肿瘤医院103位确诊为原发性双侧乳腺癌患者的临床资料。双侧乳腺癌患者占同期全部患者的3．22％，同时性（12个月以内）双侧乳腺癌27例。并分别回顾了发病年龄、月经情况、肿块大小、治疗方式等资料，侧重分析单／双侧，第一／第二侧，同时／异时性乳腺癌的临床分期、腋淋巴结状态和病理类型的差别。结果：双侧乳腺癌较单侧乳腺癌起病早（P〈0．001）。舣侧发病中位间隔时间48个月（0～480个月）。比较单／双侧乳腺癌发现双侧癌有更多O／I期病例，单侧癌中浸润性导管癌比例较高（P=0．017）。双侧乳腺癌内第一／第二侧间临床病理指标无显著差异；而同时性双侧乳腺癌较异时性痛淋巴结转移数更少（P=0．031），浸润程度更低（P=0．031），导管内癌比例更高（P=0．012）。未发现浸润性小叶癌在单／双侧间发病有差别。治疗方式上，第二侧癌行单纯乳房切除术和保乳手术的比例大大提高（10．8％和2.6％，P=0．042）。按第二原发出现算起，经过中位13个月的随访，有3例复发或转移，1例死亡。结论：对侧乳腺癌发生间隔时间不定，单侧发生后宜积极随访以早期检出对侧病变。同时性双侧乳腺癌有较早的临床分期和较高的DCIS比例，为乳腺癌保乳手术提供了条件，但也不能忽视双侧乳腺癌潜在较高的恶性程度。

Clinical and pathologic analysis of primary bilateral breast cancer: a report of 103 cases

Background and purpose:The investigation of bilateral breast cancer(biBC) was less reported compared with unilateral breast cancer(uniBC).We investigated the clinical and pathological features of primary bilateral breast cancer(biBC),and evaluated their effects on the therapeutic modalities and prognosis of biBC.Methods:Medical records of patients diagnosed as primary biBC were reviewed at the Shanghai Cancer Hospital during the period of 2001-2005.Data were analyzed retrospectively focusing on the clinical stage,pathologic characteristics between the unilateral and bilateral,first and second,synchronous(less than 12 months) and metachronous breast carcinoma.Results:BiBC patients constituted 3.22% of 3 200 breast cancer patients in this period,and they had earlier onset than the unilateral breast cancer(uniBC) cases,with the median time of 48 months from the first cancer to the occurrence of contralateral one.There was no significant difference between the uniBC and biBC of lymph nodes status,however,more stage 0-I tumors were found in biBC(P=0.004) and higher proportion of invasive ductal carcinoma in uniBC(P=0.017).We also found less lymph nodes(P=0.031),lower proportion of invasive cancer(P=0.031),more DCIS(P=0.012)in synchronous breast cancer.In terms of treatment,the opportunity for simple mastectomy or breast-conserving surgery was much more for the second primary breast cancer(10.8% vs 2.6% P=0.042).Three patients relapsed locally or distantly and one patient died during the median 13 months follow-up time.Conclusions:Surveillance is necessary to screen the contralateral breast cancer once the primary breast cancer occurred.The synchronous breast cancer has better features such as earlier stage and higher proportion of DCIS, which make the breast-conserving surgery possible.However,it needs more investigations to reveal the potential aggressive features of biBC.