Gong Soo Jung, Rha Sun Young, Jeung Hei Cheul, Roh Jae Kyung, Yang Woo Ick, Chung Hyun Cheol
Department of Internal Medicine, Eulji University School of Medicine, Seoul, Korea.
Jpn J Clin Oncol. 2007 Jul;37(7):487-92. doi: 10.1093/jjco/hym056. Epub 2007 Aug 1.
Contralateral breast cancer is either a metastatic lesion or the second primary cancer. From biological and therapeutic viewpoints, it is important to differentiate metastatic lesions from second primary cancer in bilateral breast cancer.
Based on Chaudary's histological criteria, we analysed the tumors in 14 and 27 patients with synchronous and metachronous bilateral breast cancers with full histological and biological evaluations. The Nottingham combined histological grade and immunohistochemistry (IHC) for the estrogen receptor, progesterone receptor and cerbB-2 were used.
The median age of the patients at first diagnosis was 41 years (range, 26-68 years) and the median time interval between first and second tumors was 34 months (range; 7-209 months) in metachronous cancers. The histopathological type was found in 93% of synchronous cancers and 59% of metachronous cancers (P = 0.02). The concordance rates of T stage and TNM stage were 71 and 64% respectively in synchronous cancers, while they were 24 and 32% respectively in metachronous cancers (P = 0.03). For progesterone receptor status, the concordance rates were 86 and 52% in synchronous and metachronous cancers respectively (P = 0.03). In addition, there was no statistically significant difference in terms of N stage, histological grade, intraductal component, estrogen receptor status, or cerbB-2 expression.
In spite of the limitation of Chaudary's criteria and the number of patients involved, the combination of histopathological type, T stage and TNM stage shows that synchronous cancers are closer to same clonal lesions (metastatic lesions) than metachronous cancers and that a biomarker, such as progesterone receptor status, plays a role in addition to the histological parameters in differentiating metastatic cancers from second primary cancers.
对侧乳腺癌要么是转移性病变，要么是第二原发性癌。从生物学和治疗学观点来看，区分双侧乳腺癌中的转移性病变和第二原发性癌很重要。
基于乔杜里的组织学标准，我们对14例同步性双侧乳腺癌患者和27例异时性双侧乳腺癌患者的肿瘤进行了全面的组织学和生物学评估分析。采用诺丁汉联合组织学分级以及雌激素受体、孕激素受体和cerbB-2的免疫组织化学（IHC）检测。
异时性癌患者首次诊断时的中位年龄为41岁（范围26 - 68岁），首次与第二次肿瘤之间的中位时间间隔为34个月（范围7 - 209个月）。同步性癌中93%以及异时性癌中59%可发现组织病理学类型（P = 0.02）。同步性癌中T分期和TNM分期的一致性率分别为71%和64%，而异时性癌中分别为24%和32%（P = 0.03）。对于孕激素受体状态，同步性癌和异时性癌中的一致性率分别为86%和52%（P = 0.03）。此外，在N分期、组织学分级、导管内成分、雌激素受体状态或cerbB-2表达方面，无统计学显著差异。
尽管乔杜里标准存在局限性且涉及患者数量有限，但组织病理学类型、T分期和TNM分期的综合结果表明，同步性癌比异时性癌更接近同一克隆性病变（转移性病变），并且除了组织学参数外，孕激素受体状态等生物标志物在区分转移性癌和第二原发性癌中也发挥作用。
