单侧、双侧、同期双侧和异时双侧乳腺癌的预后比较：最近十年（2008-2018 年）研究的荟萃分析。
The prognostic comparison among unilateral, bilateral, synchronous bilateral, and metachronous bilateral breast cancer: A meta-analysis of studies from recent decade (2008-2018).
机构信息
Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P. R. China.
Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P. R. China.
出版信息
Cancer Med. 2019 Jun;8(6):2908-2918. doi: 10.1002/cam4.2198. Epub 2019 Apr 30.
BACKGROUND
The incidence of bilateral breast cancer (BBC) is increasing nowadays comprising 2%-11% of all breast cancer (BC). According to the interval time between the first and second cancer, BBC could be divided into synchronous (SBBC) and metachronous (MBBC). However, this interval time is quite different across studies. It remains controversial whether the survival of BBC, SBBC, and MBBC is similar or worse compared to that of unilateral breast cancer (UBC), and whether the survival of SBBC is similar or worse compared to MBBC. To better understand the survival of UBC, BBC, SBBC, and MBBC and how the interval time would influence the prognosis of SBBC and MBBC, we performed this meta-analysis on studies from recent 10 years (2008-2018).
METHODS
Databases of PubMed, Embase, and Web of Science were searched for relevant studies within recent 10 years. Hazard ratio (HR) was adopted to evaluate the difference of overall survival (OS) of UBC, BBC, SBBC, and MBBC. HR of OS comparisons were performed between BBC vs UBC, SBBC vs UBC, MBBC vs UBC, and SBBC vs MBBC with 3, 6, 12 months as the interval time, respectively.
RESULTS
There were 15 studies of 72 302 UBC and 2912 BBC included in the meta-analysis. The summary HR of OS comparison between BBC vs UBC was 1.68 (95% CI: 1.28-2.20), SBBC vs UBC was 2.01 (95% CI: 1.14-3.55), MBBC vs UBC was 3.22 (95% CI: 0.75-13.78). When 3, 6, 12 months were used as the interval time, the summary HR of the OS comparison between of SBBC vs MBBC were 0.64 (95% CI: 0.44-0.94), 1.17 (95% CI: 0.84-1.63) and 1.45 (95% CI: 1.10-1.92), respectively.
CONCLUSION
BBC and SBBC showed worse prognosis in terms of OS compared to UBC while MBBC manifested similar or non-superior survival as UBC. The OS comparison between SBBC and MBBC changed with different interval time used. The longer the interval time used, the worse the survival of SBBC. SBBC with interval of 3-12 months between the two cancers had the worst prognosis. When 6 months was used to differentiate SBBC from MBBC, these two clinical entities showed similar OS.
背景
双侧乳腺癌（BBC）的发病率正在上升，占所有乳腺癌（BC）的 2%-11%。根据两次癌症发生的时间间隔，BBC 可分为同步性（SBBC）和异时性（MBBC）。然而，不同研究之间的间隔时间存在差异。与单侧乳腺癌（UBC）相比，BBC、SBBC 和 MBBC 的生存情况是否相似或更差，以及 SBBC 的生存情况是否与 MBBC 相似或更差，仍存在争议。为了更好地了解 UBC、BBC、SBBC 和 MBBC 的生存情况，以及间隔时间如何影响 SBBC 和 MBBC 的预后，我们对最近 10 年（2008-2018 年）的研究进行了这项荟萃分析。
方法
检索 PubMed、Embase 和 Web of Science 数据库，以获取最近 10 年的相关研究。采用风险比（HR）评估 UBC、BBC、SBBC 和 MBBC 的总生存率（OS）差异。分别用 3、6、12 个月作为间隔时间，比较 BBC 与 UBC、SBBC 与 UBC、MBBC 与 UBC、SBBC 与 MBBC 之间的 OS 比较 HR。
结果
共有 15 项研究纳入了 72302 例 UBC 和 2912 例 BBC。BBC 与 UBC 比较的 OS 汇总 HR 为 1.68（95%CI：1.28-2.20），SBBC 与 UBC 比较的 HR 为 2.01（95%CI：1.14-3.55），MBBC 与 UBC 比较的 HR 为 3.22（95%CI：0.75-13.78）。当以 3、6、12 个月作为间隔时间时，SBBC 与 MBBC 之间 OS 比较的汇总 HR 分别为 0.64（95%CI：0.44-0.94）、1.17（95%CI：0.84-1.63）和 1.45（95%CI：1.10-1.92）。
结论
与 UBC 相比，BBC 和 SBBC 的 OS 预后更差，而 MBBC 的 OS 与 UBC 相似或无优势。SBBC 和 MBBC 之间的 OS 比较因所用间隔时间而异。间隔时间越长，SBBC 的生存越差。SBBC 两次癌症之间的间隔为 3-12 个月时，预后最差。当用 6 个月来区分 SBBC 和 MBBC 时，这两种临床实体的 OS 相似。
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