Fisher E R, Fisher B, Sass R, Wickerham L
Cancer. 1984 Dec 15;54(12):3002-11. doi: 10.1002/1097-0142(19841215)54:12<3002::aid-cncr2820541231>3.0.co;2-v.
Sixty-six confirmed instances of clinically metachronous second breast cancers were encountered over a 10-year period in 1578 women with invasive breast cancer enrolled in Protocol 4 of the National Surgical Adjuvant Breast Project (NSABP). Seven of the second cancers were in situ, yielding an incidence of 3.7% invasive and 0.5% noninvasive cancers. Except for a peak of 1.75% in the second postoperative year, the annual incidence based on patients at risk was constant and less than 1%. Ninety-three percent of the second cancers occurred within 7 years and 80% within 5 years following mastectomy for the initial primary. All of the second cancers were regarded as being primarily of mammary origin exhibiting either: (1) an in situ component; (2) dissimilar but well-recognized patterns of primary breast cancers; or (3) the appearance of scar cancer, a recently described morphologic feature characteristically observed in some primary breast cancers. A search for factors that might be predictive of bilaterality was performed. Thirty-eight pathologic and eight clinical factors were assessed, including family history. Although the latter was 1.5 to 2 times more frequent in patients with bilateral disease, this estimate was not statistically significant. On the other hand, a statistically significant association with bilateral disease was found when the initial tumor measured more than 2.0 cm, was associated with invasive cancer or proliferative fibrocystic disease, nipple involvement, absent nodal sinus histiocytosis, lobular carcinoma in situ in the vicinity of the dominant mass, or was of the lobular invasive or tubular types. However, the degree of risk of these discriminants was no greater than 2 to 3:1. Despite the clinical scrutiny imposed by the NSABP protocol second tumors measured only 1 cm less than the first, measuring on average 2.4 cm, which reflects the difficulty attendant on the clinical detection of so-called early breast cancers. Yet, no significant difference in pathologic nodal status was noted between the first and second cancers or that of patients with unilateral disease. Furthermore, there was no difference in survival rate between patients who developed a second cancer and those with unilateral disease.(ABSTRACT TRUNCATED AT 400 WORDS)
在参与国家外科辅助乳腺项目（NSABP）方案4的1578例浸润性乳腺癌女性患者中，10年间共发现66例经临床确诊的异时性第二原发性乳腺癌。其中7例第二原发性癌为原位癌，浸润性癌的发生率为3.7%，非浸润性癌的发生率为0.5%。除术后第二年发病率峰值为1.75%外，基于危险人群的年发病率保持恒定且低于1%。93%的第二原发性癌发生在初次原发性乳腺癌乳房切除术后7年内，80%发生在5年内。所有第二原发性癌均被认为主要起源于乳腺，表现为：（1）原位成分；（2）不同但公认的原发性乳腺癌模式；或（3）瘢痕癌的出现，这是最近描述的一种形态学特征，在一些原发性乳腺癌中特征性地观察到。对可能预测双侧性的因素进行了研究。评估了38个病理因素和8个临床因素，包括家族史。虽然后者在双侧疾病患者中的发生率是单侧疾病患者的1.5至2倍，但这一估计无统计学意义。另一方面，当最初肿瘤直径超过2.0 cm、与浸润性癌或增殖性纤维囊性疾病相关、乳头受累、无淋巴结窦组织细胞增多症、优势肿块附近有小叶原位癌或为小叶浸润性或管状类型时，发现与双侧疾病有统计学意义的关联。然而，这些判别因素的风险程度不超过2至3：1。尽管NSABP方案进行了临床检查，但第二原发性肿瘤比第一原发性肿瘤平均小1 cm，平均直径为2.4 cm，这反映了临床检测所谓早期乳腺癌的困难。然而，第一原发性癌和第二原发性癌之间或单侧疾病患者的病理淋巴结状态无显著差异。此外，发生第二原发性癌的患者与单侧疾病患者的生存率无差异。（摘要截短至400字）
