| ObjectiveAs a previously rare cancer type,bilateral primary breast cancer(BPBC)focuses on the primary nature of the lesion source.Age has been recognized as an important factor affecting the biological behavior of breast cancer(BC)which means breast cancer at different ages has different tumor characteristics.So far,studies on BPBC,diagnosis and prognosis of young and old BC have been very complete,but most studies have not performed age division for BPBC patients.In addition,studies on BC at different ages are mostly related to Unilateral Breast Cancer(UBC),while studies involving bilateral lesions are rare.Therefore,the tumor characteristics and biological behavior of BPBC at different ages are still not clear.Compared with UBC,BPBC has a higher tumor load and invasive degree despite a lower incidence,so it is particularly important to clarify its biological characteristics.Based on this background,this study mainly conducted a retrospective analysis of the clinicopathological characteristics and prognosis of BPBC patients of different ages,aiming to provide new enlightenment for the clinical diagnosis and treatment of BPBC patients.MethodsThe clinicopathological and follow-up data of 105 patients with bilateral primary breast cancer treated in the Department of Breast Surgery of the First Affiliated Hospital of Zhengzhou University from January 2017 to January 2020 were analyzed.The diagnostic criteria are in accordance with the guidelines for the diagnosis and treatment of breast cancer issued by the Chinese Society of Clinical Oncology(CSCO)and implemented by the Pathology Department of our hospital.The subjects were all adult women and were divided into younger(≤40 years old)and older(>40 years old)groups according to the age of bilateral breast onset.All patients received standard treatment in our hospital and were followed up regularly.The survival time was calculated from the day of operation for the first primary cancer,the follow-up visit endpoint of the death cases was defined as the date of death,and the follow-up of the surviving cases ended on January 30,2021.The clinicopathological and follow-up data of the enrolled patients were complete without defect.Retrospective analysis was performed on the pathological type,molecular type,tumor core volume,histological grade,clinical stage,number of positive lymph nodes,recurrence and distant metastasis,characteristics and differences of immunohistochemical expression,consistency of immunohistochemical expression and overall prognosis of bilateral lesions in two groups.Normal distribution of measurement data was represented by mean±standard deviation(x±s).Independent sample T test was used for intergroup comparison.The count data and grade data were represented by the number of cases and rate(%).The group χ2 test was used to compare the difference of count data describing clinicopathological features between groups,and the nonparametric ranksum test(Mann-Whitney test)was used to compare the difference of grade data describing clinicopathological features between groups.Immunohistochemical expression consistency was tested by Kappa test and the Kappa value was used as the comparison standard.The larger the Kappa value was,the better the consistency was.Prognostic factors associated with overall survival were included in the Cox proportional risk regression model,and risk factors with P<0.05 in univariate analysis were included in the Cox multifactor proportional risk regression model.Test levelα=0.05.Results1.Based on the baseline data,there were 3 cases(7.3%)in the young group and 20 cases(31.3%)in the middle and old group,the difference was statistically significant(P=0.004);There were no significant differences in age of menarche,BMI,benign breast history,malignant family history,SBPBC or MBPBC(P>0.05).2.In the young group,there were 4 cases(9.8%)of Tis stage,15 cases(36.6%)of T1 stage,14 cases(34.1%)of T2 stage,0 cases of T3 stage and 8 cases(19.5%)of T4 stage.There were 4 cases(6.3%)in Tis stage,35 cases(54.7%)in T1 stage,19 cases(29.7%)in T2 stage,5 cases(7.8%)in T3 stage,and 1 case(1.5%)in T4 stage.The difference in T stage was statistically significant(P=0.045).There were 28 patients(68.3%)with lymph node metastasis in the young group and 30 patients(46.9%)in the middle and old group,and the difference in lymph nodes was statistically significant(P=0.031).There were 32 patients(78.0%)with high expression of Ki-67 in the young group and 34 patients(53.1%)in the middle and old group,and the difference in ki-67 expression was statistically significant(P=0.01).There were 2 cases(4.9%),7 cases(17.1%),17 cases(41.4%),4 cases(9.8%)and 11 cases(26.8%)of primary cancer in the young group at 0 stage,Ⅰ stage,Ⅱ stage,Ⅲstage and Ⅳ stage,respectively.In the young group,there were 7 cases(17.1%),12 cases(29.3%),8 cases(19.5%),2 cases(4.9%)and 12 cases(29.2%)of the second primary cancer in 0 stage,Ⅰ stage,Ⅱ stage,Ⅲ stage and Ⅳ stage,respectively.There were 4 cases(6.2%),17 cases(26.6%),33 cases(51.6%),7 cases(10.9%)and 3 cases(4.7%)of the first primary cancer in the middle aged group at 0 stage,Ⅰstage,Ⅱ stage,Ⅲstage and Ⅳstage,respectively.There were 10 cases(15.6%),33 cases(51.6%),17 cases(26.6%),1 case(1.5%)and 3 cases(4.7%)of patients with second primary cancer in 0 stage,stage,Ⅱ stage,Ⅲstage and IVstage in middle and elderly group,respectively.The TNM staging of bilateral primary cancer was significantly different(P1=0.019,P2=0.025);There were 20 cases(48.8%)of recurrence or distant metastasis in the young group and 14 cases(21.9%)in the middle and old group,the difference was statistically significant(P=0.004).3.Kappa consistency test results showed that all BPBC patients showed consistency of immunohistochemical index expression in bilateral cancer hearth(P<0.01);Among them,54 cases of patients in middle and old age group had consistent expression of ER,52 cases of PR,53 cases of HER-2,and 56 cases of Ki67.The expression of ER was consistent in 36 cases,PR in 40 cases,HER-2 in 32 cases and Ki-67 in 36 cases in young group.The larger Kappa values of PR and HER2 in the middle and older group suggested better expression consistency,while the larger Kappa values of ER and Ki-67 in the young group suggested better expression consistency.4.Cox univariate test showed that T stage of the first cancer(P=0.002),N stage of the first cancer(P=0.004),histological grade of the first cancer(P=0.035),bilateral TNM stage(P=0.001),recurrence and distant metastasis(P=0.046)could affect the survival of patients.Multivariate analysis showed that histological grade of the first cancer(P=0.035),bilateral TNM stage(P1=0.034,P2=0.007),recurrence and distant metastasis(P=0.027)were independent prognostic factors.(P<0.05).Conclusion1.The clinicopathological and tumor biological characteristics of young BPBC are relatively poor,with large tumor diameter,low degree of tissue differentiation,late clinical stage,strong invasion and metastasis ability,and more prone to lymph node and distant metastasis.2.Middle-aged and elderly BPBC has relatively good clinicopathological and tumor biological characteristics,with high positive rate of hormone receptor,low expression rate of HER-2 and Ki-67,low histological grade,slow progression and good biological behavior.3.The expression of immunohistochemical indexes in bilateral cancer foci of BPBC had good consistency.The expression consistency of ER and Ki-67 was better in young BPBC,and the expression consistency of PR and HER-2 was better in middle-aged and elderly BPBC.4.The T and N stages and histological grade of the first primary cancer,TNM stage of the first and second primary cancer,and whether there is recurrence or distant metastasis can affect BPBC survival;Histological grade of the first primary cancer,TNM stage of the first and second primary cancer,recurrence or distant metastasis were independent risk factors for BPBC prognosis. |
PDF Full Text Request