双侧原发性乳腺癌的危险因素及预后分析  

Risk factors and prognosis of bilateral primary breast cancer:a report of 205 cases

作　　者：王彤[1] 荀培[1] 李海欣[1] 陈可欣[1] 刘红[1] 

机构地区：[1]天津医科大学附属肿瘤医院乳腺科,天津300060

出　　处：《中国医学前沿杂志（电子版）》2010年第3期63-66,共4页Chinese Journal of the Frontiers of Medical Science(Electronic Version)

摘　　要：目的探讨双侧原发性乳腺癌(BPBC)发生的危险因素,比较其与单侧乳腺癌(UBC)的预后。方法收集205例BPBC和1677例UBC患者的临床病理及随访资料,比较两者在病史背景、临床情况、组织病理学特征及预后方面的差异。结果 BPBC占同期全部乳腺癌患者的1.5%;BPBC患者较UBC患者:40岁之前及绝经前发病比例高,初潮年龄早,初产年龄晚,既往乳腺良性疾病史及乳腺癌家族史阳性率高,肿瘤直径>5cm比例高,均具有统计学意义(P≤0.05);以上后三者为BPBC发生的独立危险因素,其中有乳腺癌家族史的乳腺癌患者罹患对侧乳腺癌的风险增加约1.6倍(OR=2.631);二者放疗及内分泌治疗方面无显著差异(P>0.05)。BPBC远处转移率为20.0%,与UBC(23.1%)相比无显著差异性(P=0.322);UBC的5年、10年生存率为81.4%和72.3%,以第一癌为起点计算生存时间,BPBC5年生存率87.4%,10年生存率80.2%,与UBC相比无统计学差异(P=0.141);以第二癌为起点计算生存时间,BPBC5年生存率80.0%,10年生存率72.4%,与UBC相比亦无显著差异(P=0.437)。结论 BPBC与UBC的预后无显著差异。有乳腺癌家族史、肿瘤直径>5cm、既往乳腺病史及40岁前发病的乳腺癌患者是发生对侧乳腺癌的高危人群,应格外重视术后对侧乳腺的监测。BPBC的发生与雌激素有密切关系,可能成为预防BPBC的干预靶点。Objective To evaluate the risk factors and prognosis of bilateral primary breast cancer(BPBC).Methods 205 BPBC and 1677 unilateral breast cancer(UBC) records were reviewed and analyzed relatively.Results BPBC was 1.5% of the entire breast cancer cases.The risk factors for BPBC founded by univariate analysis:younger than 40 when having the first cancer,early menarche,giving birth to the first child late,premenopause,mammary disease history,breast cancer family history,and the tumor larger than 5cm(P≤0.05).No significantly differences were found in radiotherapy or hormonal therapy(P>0.05).The independent risk factors determined by multivariate analysis:breast cancer family history,the tumor larger than 5 cm and benign mammary disease history.The UBC patients with breast cancer family history have about 1.6 times increased risk to get contra lateral breast cancer(OR=2.631).There is no significant difference between the metastatic rate of BPBC and UBC(20.0%:23.1%;P=0.322).five-year and ten-year overall survival rates(OS) of UBC were 81.4% and 72.3%;When calculated from the time of the first cancer,five-year and ten-year OS of BPBC were 87.4% and 80.2%,no significant difference from UBC(P=0.141);When calculated from the time of the second cancer,5-year and 10-year OS of BPBC were 80.0% and 72.4%,no significant difference from UBC either(P=0.437).Conclusion BPBC and UBC have the similar prognosis.The breast cancer patients who have the breast cancer family history,tumor larger than 5 cm,benign mammary disease history or get the cancer younger than 40 years old have higher risk to get the contra lateral breast cancer.BPBC has a strong relationship with female sex hormone,which could be a solution for prophylaxis.

关 键 词：乳腺肿瘤 双侧原发性乳腺癌 危险因素 预后 

分 类 号：R737.9[医药卫生—肿瘤]