Fracchia A A, Robinson D, Legaspi A, Greenall M J, Kinne D W, Groshen S
Cancer. 1985 Mar 15;55(6):1414-21. doi: 10.1002/1097-0142(19850315)55:6<1414::aid-cncr2820550641>3.0.co;2-d.
The presence of bilateral invasive breast cancer places the patient in a state of double jeopardy. At Memorial Sloan-Kettering Cancer Center, the overall 10-year recurrence rate for unilateral Stage I breast cancer was 16%, whereas the recurrence rate for simultaneous, bilateral Stage I breast carcinoma was 29%: almost twice as high. The average 10-year survival of all patients with negative axillary nodes was 57%. In this retrospective analysis of 403 patients with bilateral primary operable breast cancer treated at Memorial Sloan-Kettering Cancer Center, significant differences were noted in the disease-free survival between patients with bilateral noninvasive cancer, bilateral invasive cancer, and the combination of invasive and in situ cancers. Bilateral intraductal cancer and lobular carcinoma in situ offered an excellent prognosis. The combination of preinvasive cancer on one side and infiltrating carcinoma on the other had the next best survival. The in situ lesion, when treated by mastectomy, did not alter the patients' life expectancy from that of the general population with unilateral breast cancer, thus indicating that surgeons should strive to detect breast cancer in its preinvasive form. The 5- and 10-year relapse-free survival of patients with bilateral invasive disease, regardless of axillary nodal status and tumor size, was 60% and 51%, respectively, for patients with a bilateral presentation and 54% and 38%, respectively, for carcinomas presenting metachronously. More important in determining prognosis, however, was the number of axillary nodes involved and the level of involvement. Invasion of bilateral axillary nodes at all levels predicted a poor prognosis. Because of this shortened survival, systemic adjuvant therapy should be considered for patients with bilateral invasive disease. The most common preinvasive breast cancer was lobular carcinoma in situ and the most frequently invasive tumor was infiltrating duct cancer. Since a contralateral breast cancer at the time of definitive treatment of the first side does not always present as a mass or with positive mammography, a random biopsy of the second breast is recommended. This should be done in the upper, outer quadrant and should include the subareolar area. With prompt adequate treatment, it is expected that survival from bilateral breast cancer should improve.
双侧浸润性乳腺癌的存在使患者处于双重危险状态。在纪念斯隆凯特琳癌症中心，单侧Ⅰ期乳腺癌的总体10年复发率为16%，而同时发生的双侧Ⅰ期乳腺癌的复发率为29%：几乎是前者的两倍。所有腋窝淋巴结阴性患者的平均10年生存率为57%。在对纪念斯隆凯特琳癌症中心治疗的403例双侧原发性可手术乳腺癌患者的回顾性分析中，发现双侧非浸润性癌、双侧浸润性癌以及浸润性癌与原位癌组合的患者在无病生存期方面存在显著差异。双侧导管内癌和小叶原位癌预后良好。一侧为癌前病变而另一侧为浸润性癌的组合，其生存率次之。原位病变经乳房切除术后，患者的预期寿命与单侧乳腺癌的一般人群无异，这表明外科医生应努力在癌前阶段检测出乳腺癌。双侧浸润性疾病患者，无论腋窝淋巴结状态和肿瘤大小如何，双侧同时发病患者的5年和10年无复发生存率分别为60%和51%，异时发病的癌患者分别为54%和38%。然而，在判断预后方面更重要的是腋窝淋巴结受累的数量和受累程度。双侧各级腋窝淋巴结均受累预示预后不良。由于生存期缩短，对于双侧浸润性疾病患者应考虑进行全身辅助治疗。最常见的癌前乳腺癌是小叶原位癌，最常见的浸润性肿瘤是浸润性导管癌。由于在首次患侧进行确定性治疗时，对侧乳腺癌并不总是表现为肿块或乳腺X线摄影呈阳性，因此建议对另一侧乳房进行随机活检。应在上外象限进行，且应包括乳晕下区域。通过及时充分的治疗，预计双侧乳腺癌患者的生存率应会提高。
