2022 年第 5 期 第 17 卷

同时性和异时性双侧乳腺癌临床病理特征的一致性及对预后的影响

Concordance of pathological characteristics and effect on prognosis between synchronous and metachronous bilateral breast cancer

作者：白燕刘笑玎牛一茹吴焕文梁智勇

英文作者：Bai Yan Liu Xiaoding Niu Yiru Wu Huanwen Liang Zhiyong

单位：中国医学科学院北京协和医学院北京协和医院病理科，北京100730

英文单位：Department of Pathology Peking Union Medical College Hospital Chinese Academy of Medical Sciences & Peking Union Medical College Beijing 100730 China

关键词：同时性双侧乳腺癌；异时性双侧乳腺癌；分子亚型

英文关键词：Synchronousbilateralbreastcancer；Metachronousbilateralbreastcancer；Molecularsubtype

• 摘要：

• 目的 探讨同时性双侧乳腺癌（SBBC）和异时性双侧乳腺癌（MBBC）临床病理特征的一致性及对预后的影响。方法 回顾性分析北京协和医院2010年10月至2020年12月收治140例双侧乳腺癌(BBC)患者的临床资料。根据两侧肿瘤发病间隔时间将患者分为MBBC组（39例）和SBBC组（101例）。收集患者的初诊年龄、乳腺癌家族史、手术方式、肿瘤直径、淋巴结转移情况、TNM分期、组织学类型、组织学分级、雌激素受体（ER）、孕激素受体（PR）、人表皮生长因子受体2（HER-2）表达情况和Ki-67指数等临床和病理资料。比较SBBC组与MBBC组患者的初诊年龄和乳腺癌家族史，两侧肿瘤分子亚型的分布情况、临床病理特征的一致性情况及对BBC患者总生存期的影响。结果 MBBC组初诊年龄小于SBBC组［（48±11）岁比（54±13）岁］，MBBC组第一癌TNBC型比例高于SBBC组［30.8%（12/39）比12.9%（13/101）］(均P＜0.05)。SBBC组第一癌和第二癌肿瘤组织学分级、ER和HER-2表达情况的一致率均高于MBBC组［69.3%（70/101）比46.2%（18/39）、85.1%（86/101）比56.4%（22/39）、89.1%（90/101）比69.2%（27/39）］（均P＜0.05）。多因素分析结果表明，双侧肿瘤TNM分期均为Ⅲ期（比值比=60.391，95%置信区间：2.101~1 735.475）、双侧为TNBC型（比值比=23.057，95%置信区间：5.671~93.746）或一侧为TNBC型（比值比=4.643，95%置信区间：1.030~20.934）均为BBC患者总生存期的危险因素（均P＜0.05）。结论  与SBBC组比较，MBBC组患者更年轻，分子亚型TNBC比例更高，双侧肿瘤分子亚型的一致性较低；双侧TNM分期均为Ⅲ期以及双侧或一侧分子亚型为TNBC型均为BBC患者总生存期的危险因素。

• Objective  To explore the concordance of clinicopathological characteristics and effect on prognosis between synchronous bilateral breast cancer (SBBC) and metachronous bilateral breast cancer (MBBC). Methods The clinical data of 140 patients with bilateral breast cancer (BBC) admitted to Peking Union Medical College Hospital from October 2010 to December 2020 were retrospectively analyzed. According to the interval of tumors on both sides, patients were divided into MBBC group (39 cases) and SBBC group (101 cases). Clinical and pathological data were collected from age of onset, family history of breast cancer, surgical approach, tumor diameter, lymph node metastasis, TNM stage, histological type, histological grade, estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor-2 (HER-2) and Ki-67 index. The age of onset, family history of breast cancer, distribution of tumor molecular subtypes on both sides, the concordance of clinicopathological characteristics between SBBC group and MBBC group, and their impact on the overall survival of BBC patients were compared. Results  The age at onset of MBBC group was younger than that of SBBC group ［(48±11)years vs (54±13)years］ and rate of TNBC type in MBBC group was higher than that in SBBC group ［30.8%（12/39） vs 12.9%（13/101）］(both P<0.05). The concordance rates of tumor histological grade, ER, and HER-2 between the first cancer and the second cancer of SBBC group were higher than those of MBBC group ［69.3%（70/101） vs 46.2%（18/39）, 85.1%（86/101） vs 56.4%（22/39）, 89.1%（90/101） vs 69.2%（27/39）］(all P<0.05). Multivariate analysis showed that TNM stage of bilateral tumors as stage Ⅲ (odds ratio=60.391, 95% confidence interval: 2.101-1 735.475), bilateral TNBC type (odds ratio=23.057, 95% confidence interval: 5.671-93.746) or unilateral TNBC type (odds ratio=4.643, 95% confidence interval: 1.030-20.934) were risk factors for the overall survival of BBC patients (all P<0.05). Conclusions Compared with SBBC group, patients in MBBC group are younger, the proportion of molecular subtype TNBC is higher, and the concordance of bilateral tumor molecular subtype is lower. Bilateral TNM stage Ⅲ and bilateral or unilateral molecular subtype TNBC are risk factors for the overall survival of BBC patients.