Abdalla I, Thisted R A, Heimann R
Department of Radiation and Cellular Oncology, The Pritzker School of Medicine, The University of Chicago Hospitals, Illinois, USA.
Cancer J. 2000 Jul-Aug;6(4):266-72.
To evaluate the clinical and pathological features of breast cancer patients who develop contralateral breast cancer (CBC) and assess the impact of the second breast cancer on their prognosis.
This retrospective study includes 2136 women with stage I-III breast cancer treated between 1927 and 1987 at the University of Chicago Hospitals. A total of 132 (6.2%) developed CBC during a median follow-up period of 14.2 years; all of them were treated with mastectomy for both breast cancers. We compare the prognostic characteristics, treatments, and outcomes of patients who developed bilateral breast cancer with those who had only unilateral breast cancer (UBC). We also compare the features of the first and the second tumors among patients with bilateral breast cancer (BBC).
The annual incidence rate for CBC remained constant at an average rate of 0.23%, resulting in a cumulative incidence rate of 6.2%. Patients with BBC were significantly younger than those with UBC (median age, 51 years vs 54 years). No other significant differences were observed between BBC and UBC patients. Among BBC patients, the second cancer was smaller (2.0 cm vs 3.0 cm) and was associated with a lower incidence of axillary node involvement (29% vs 52%). The development of CBC was associated with worse survival (hazard ratio = 1.46 in comparison with patients who did not develop CBC, 95% CI of 1.09-1.95). On multivariate analysis, factors that decreased the disease-specific survival (DSS) in patients with BBC were a higher number of positive lymph nodes of the first and second cancers, a larger size of the second cancer, and a shorter interval between the two primaries.
At the time of diagnosis of first breast cancer, BBC patients were significantly younger than UBC patients. The second cancer among the BBC patients was at an earlier stage than the first one; however, no difference was noticed in the pathological feature between the cancer in the UBC patients and the first cancer of BBC patients. There is an indication that the longer the interval between the two cancers, the better the survival of the BBC patients.
评估发生对侧乳腺癌（CBC）的乳腺癌患者的临床和病理特征，并评估第二原发性乳腺癌对其预后的影响。
这项回顾性研究纳入了1927年至1987年间在芝加哥大学医院接受治疗的2136例I - III期乳腺癌女性患者。在中位随访期14.2年期间，共有132例（6.2%）发生了CBC；所有患者均接受了双侧乳腺癌的乳房切除术。我们比较了发生双侧乳腺癌患者与仅患有单侧乳腺癌（UBC）患者的预后特征、治疗方法及结局。我们还比较了双侧乳腺癌（BBC）患者中第一和第二肿瘤的特征。
CBC的年发病率保持恒定，平均为0.23%，累积发病率为6.2%。BBC患者明显比UBC患者年轻（中位年龄，51岁对54岁）。在BBC和UBC患者之间未观察到其他显著差异。在BBC患者中，第二原发性癌较小（2.0 cm对3.0 cm），且腋窝淋巴结受累发生率较低（29%对52%）。CBC的发生与较差的生存率相关（与未发生CBC的患者相比，风险比 = 1.46，95%可信区间为1.09 - 1.95）。多因素分析显示，降低BBC患者疾病特异性生存（DSS）的因素包括第一和第二原发性癌阳性淋巴结数量较多、第二原发性癌体积较大以及两个原发性癌之间的间隔时间较短。
在诊断第一原发性乳腺癌时，BBC患者明显比UBC患者年轻。BBC患者中的第二原发性癌比第一原发性癌处于更早阶段；然而，UBC患者的癌与BBC患者的第一原发性癌在病理特征上未发现差异。有迹象表明，两个癌之间的间隔时间越长，BBC患者的生存率越高。
