Prognostic significance of synchronous and metachronous bilateral breast cancer
Prognostic significance of synchronous and metachronous bilateral breast cancer
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DOI：
10.1007/bf03215857
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发表时间：
2001-09-01
影响因子：
2.6
通讯作者：
Blamey, RW
中科院分区：
文献类型：
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作者：
Kollias, J;Ellis, IO;Blamey, RW
既往接受过原发性可手术乳腺癌治疗的女性患对侧乳腺癌的风险增加，但这种发展的临床意义尚不清楚。本研究的目的是评估同步双侧乳腺癌或异时对侧原发性乳腺癌的发展对预后的影响。在1975年至1995年期间接受原发性可手术乳腺癌治疗的3210名年龄小于或等于70岁的妇女中，106名被确定患有双侧乳腺癌。在这些女性中，26例（0.8%）有同步双侧原发性乳腺癌，80例在治疗原发性乳腺癌后发生对侧乳腺癌。使用寿命表分析，单侧乳腺癌、同时双侧乳腺癌和异时性对侧乳腺癌患者之间的生存率有显著差异，从第一个原发性肿瘤诊断之日起，16年生存率分别为53.8%、42.4%和60.1%（p < 0.0001）。在异时性对侧乳腺癌病例中，从第二原发灶诊断日期计算生存率时，三组之间的生存率无差异（p = 0.31）。当对侧乳腺癌作为时间依赖性协变量与用于确定诺丁汉预后指数（浸润性肿瘤大小、分级和淋巴结分期）的三个因素一起纳入考克斯多变量模型时，对侧乳腺癌仍然是一个重要的预后决定因素（p = 0.02）。原发病后2年内诊断为双侧同时性乳腺癌或异时性乳腺癌的妇女的生存率比单侧乳腺癌的妇女差。然而，异时性对侧乳腺癌的持续时间在多变量模型中与原始原发性乳腺癌的预后特征相比没有预后意义。
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 less than or equal to 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.