222 cases of bilateral primary breast cancer prognostic factors
【Abstract】 Objective To study the bilateral primary breast cancer (Bilateral Primary Breast Cancer, BPBC) and its prognostic factors. Methods of Tianjin Medical University
Cancer Hospital in March 1972 ~ December 2003 admitted to 222 BPBC clinical data of patients with prognostic factor analysis. Results BPBC The 5,10-year cumulative survival rates
were 78.73%, 69.09%. sBPBC the overall survival rates compared
with mBPBC difference, but no statistical significance. The first side of node-positive result, and the second side of node-positive result, and the second side of tumor size, histological grading of the second side of the role of survival was statistically significant. Conclusion At the same time and the survival rate of metachronous BPBC similar. The second side of tumor ? 5cm, bilateral lymph node-positive
poor prognosis. Multivariate analysis showed that the second side of tumor size and the first side, second side with lymph
node-positive factors influencing the prognosis.
Key words bilateral primary breast cancer; prognosis; survival rate
Prognostic of 222 Cases Bilateral Primary Breast Cancer
Abstract: Objective To evaluate the outcome and prognosis
analyze of bilateral primary breast cancer (BPBC). Methods The
clinical data of 222 patients with BPBC, admitted to Tianjin Medical University Cancer Institute and Hospital from March 1972 to December 2003 were collected and analyzed on prognosis
factors. Results 5 year and 10 year Cumulative Survival
rate of BPBC were 78.73% and 69.09%. Cumulative Survival rate of sBPBC (Synchronous BPBC, sBPBC) is lower than mBPBC's (Metachronous BPBC, mBPBC), but there is no significant difference . The status of bilateral lymph node of and tumor size of secondary cancer affect the survival of BPBC significantly. Conclusion The survival rate of sBPBC is similar to that of mBPBC. The prognosis of patients with negative lymph node of two sides and tumor size <5cm of
secondary cancer are better than those with positive lymph node and tumor size ? 5cm. The results of multivariate
analysis showed that tumor size of secondary cancer and lymph node status ofbilateral breast cancer are prognostic factors of bilateral primary breast cancer.
Key words: Bilateral breast cancer; Prognostic analysis; Survival Rate
0 Introduction
As the breast is subject to the role of female hormones affect the symmetry of the target organ, the possibility of
cancer occurring on both sides, and the side of the breast disease, the contralateral breast as the only target organ, so the possibility of a marked increase in cancer occurrence , that is, unilateral breast cancer patients have a high risk of development of bilateral breast cancer. Donovan [1] through the study found that the side of the risk of breast cancer, the contralateral breast recurrence risk of new breast cancer was 5 times higher than the general population. Pomerantz et al [2] reported that the side contralateral breast cancer
occurrence in patients with cancer whose chances of women in the census 2 ~ 7 times. With the Breast Cancer Detection and Diagnosis and treatment advances in technology improvements in survival in patients with unilateral breast cancer patients
generally longer on one side contralateral breast cancer after treatment of breast cancer occurring opportunities are also increasing. Bilateral primary breast cancer pairs (Bilateral
Primary Breast Cancer, BPBC) the incidence of a majority in
the country reported at 2.1% or less [3], the highest 4.97% [4]. Currently in the country on the primary bilateral breast cancer survival rates vary widely reported, and the mostly small sample of relevant research findings, a larger number of
cases is still a lack of information in support of the longer follow-up observation of the multi-factor analysis of the
systematic study of . To this end, we Tianjin Medical University Cancer Hospital admitted 222 cases of BPBC clinical data and follow-up results of the prognostic factor analysis, the results reported as follows.
An object and method
1.1 The object of study
March 1972 ~ December 2003 pairs of bilateral primary breast cancer were treated 222 cases of breast cancer patients, both female, aged 26 to 95 years old, with a median age of 45.55 years with a mean age of 47.27 years. Survival years from the start to the second side of the day of surgery until death, recurrence, metastasis or last follow-up time.
The two breast cancer interval calculation, using the second admission date to the date of the first operation time interval shall prevail.
1.2 Case inclusion criteria
(1) on both sides have surgery. (2) side or the second side to check the ingredients, see carcinoma in situ, that is,
or possession of lobular carcinoma in situ component. (3) The second occurred in the first lateral side of at least five years after treatment, and no other distant parts of the transfer, but also consider the primary lesion. (4)
Organization Type: both sides of the breast cancer tissue types are completely different.
1.3 Statistical Methods
Application of SPSS11.5 statistical package used for statistical analysis of survival using Kaplan Meier's
method, the analysis of prognostic factors using Cox univariate and multivariate analysis of prognostic factors of grouping data using Kaplan Meier method and Log Rank
test done .
2 Results
2.1 The incidence of
As of the end of December 2003, in the cancer hospital admissions over the same period, 20 308 breast cancer patients found 222 cases of BPBC patients, BPBC incidence of patients was 1.09%, of which pairs of simultaneous bilateral primary breast cancer (Synchronous Bilateral Primary Breast Cancer, sBPBC) 69 cases, the incidence of 0.34%, metachronous bilateral primary pairs of breast cancer (Metachronous Bilateral Primary Breast Cancer, mBPBC) 153 cases, incidence rate of 0.75%.
2.2 survival
Follow-up to early April 2006, 49 cases of death due to cancer, 49 cases had distant metastases. The shortest follow-
up time was 51 days, up to 7520 days with an average of 2059 days. Total mortality rate was 22.07%, BPBC cumulative survival rate of patients in Table 1. sBPBC and the cumulative survival rate in patients with mBPBC comparison, in Table 2. Table 1 222 cases of bilateral primary breast cancer in patients with cumulative survival rate (slightly) Table 2 sBPBC and mBPBC cumulative survival rate in patients with
(omitted)
69 cases sBPBC the average survival time of 4993 days, 153 cases of mBPBC the average survival time of 5041 days, Log
rank statistic of 1.01, P = 0.3157. Can also be seen from the table, the overall survival rate sBPBC more mBPBC difference, but no statistical significance.
2.3 Analysis of prognostic factors
2.3.1 Single-factor analysis
Application of univariate Cox regression model analysis, it will affect the survival outcome was statistically
significant factor in an extract, such as Table 3. Table 3 on the survival outcome in patients with single-factor Cox
regression analysis (omitted)
2.3.2 Comparison of the prognosis of group
In the single-factor analysis, statistically significant
factor in first side of node-positive, and the second side of node-positive, and the second side of tumor size, and the second side of the histological grade, grouped by Kaplan
Meier cumulative survival method comparison, in Table 4. Table 4 A comparison of cumulative survival rates of groups (omitted)
The first side of the prognosis of node-negative group
was better than lymph node-positive group; second side of
tumor <5cm group than the second side of the prognosis of tumors ? 5cm group of good; second side of the prognosis of node-negative group was better than lymph node-positive group;
histology ? ~ ? grade group prognosis is good histology three groups.
2.3.3 Multi-factor analysis
In the single-factor analysis, statistically significant
factors such as the first side of node-positive, and the
second side of node-positive, and the second side of tumor size, histological grade side of the introduction of the second Cox model multivariate analysis, using forward selection fitting the main effect model. Eventually enter the variable effect equation and its numerical table 5. Death results in Table 5 Multivariate Cox regression analysis (omitted)
However, because histological grading inspection is carried out in recent years, early breast cancer, and there is no such examination, the absence of the value of this factor more, so when brought into the second side of histological grade to enter multi-factor analysis, Only 87 cases of valid cases. If you do not bring the results of the second side of
histological grade, effective cases of 206 cases of multi-
factor analysis of the results in table 6. Death results in Table 6 Multivariate Cox regression analysis (omitted)
According to multivariate analysis (1) the results of the
survival of patients with BPBC fitting model: h (t, x) = H0 (t) exp (0.281X1 1.301X2); X1: second lateral size of the tumor; X2: 2nd Side histological grade.
According to multivariate analysis (2), the results of the survival of patients with BPBC fitting model: h (t, x) = H0 (t) exp (0.666X1 0.167X2 +1.007 X3); X1: second lateral lymph node-positive; X2: The second side of tumor size; X3: first side of node-positive. Reposted elsewhere in the paper for free download http://
3 Discussion
3.1 survival
Recalling the published literature in China, five-year
survival rate from 28.4% ~ 86.6%, 10-year survival rate from
21.40% ~ 69.7%, table 7. Such a large gap and take samples of the regional, age, income group standards, mining samples
obtained state the length of follow-up time, statistical
methods, as well as the starting point is based on first side BPBC cancer or the diagnosis or surgery as a starting point or in The second side of a relationship as a starting point.
With regard to the method of calculating survival BPBC the views of non-uniform, many scholars are from the second side of cancer, when the calculation, while others think that the first side from the diagnosis of cancer, the survival rate, when calculated taking into account the extension of survival increased risk of contralateral cancer This factor is more appropriate [19]. We believe that the prognosis in the study BPBC, such as when taking the first side of the date of diagnosis the survival rate, due to mBPBC a longer interval of time, it may cause results to bias, it is suggested that a second side of the date of cancer diagnosis survival time is more reasonable. Furthermore, only when the second cancer occurred only in patients with mBPBC classified from UBC to
BPBC. Therefore, calculation of a second cancer as a starting point in order to truly reflect the BPBC survival prognosis. In this paper, the second side starting point for calculating the date of surgery, using Kaplan Miere method to get the
5-year survival rate was 78.73%, 10-year survival rate was
69.09%. Table 7, five or ten years survival rate literature comparison (omitted)
3.2 sBPBC and mBPBC survival rate
sBPBC and the survival rate mBPBC comparison, sBPBC and mBPBC the definition of what is the starting point by comparing the two. How long interval that occurred on the second side of breast cancer was diagnosed as mBPBC, clinically there is no generally accepted standard, the present dispute is relatively large. Safal such as breast
cancer, found that time intervals on both sides of Zeng Yi 3 months or less is called simultaneous bilateral breast cancer [20]. At present the vast majority of the literature in order to 6 months as the standard. That is, simultaneously or in
less than 6 months have occurred, classified as sBPBC; 6 months or more took place when the second side of cancer, for mBPBC. From the tumor biological characteristics of view, the
clinical manifestations of breast cancer in a pre-existing for
some time, if the interval of time-bound short, it is possible
some mBPBC essentially simultaneous, only the first side in the diagnosis of contralateral breast cancer has not found cancer only. Thus some people will mBPBC set interval is greater than one year [16,19,21]. The growth of breast cancer cells from a large tumor 1cm in diameter be 2.5 to 3 years, according to tumor doubling theoretical speculation as to the definition of a years time, simultaneous bilateral breast cancer is still the short side. The division of time was
difficult to accurately reflect the true biological characteristics of tumors, so the same time, or metachronous is only relative in terms of [22].
For sBPBC and the survival rate reported in mBPBC at home and abroad, there are two inconsistent results. One is that the survival rate similar to sBPBC and mBPBC. Kollias, etc. [23], Singletary et al [24] reported that, sBPBC and mBPBC overall survival in patients with similar or the two groups no significant difference in overall survival. At home, has also
been reported in patients with no significant difference in survival [16,18]. Another view was that sBPBC worse than mBPBC [11]. Heron, etc. The study found, mBPBC the survival rate is similar to UBC and is superior to sBPBC, simultaneous
bilateral compared with unilateral breast cancer and breast metachronous bilateral breast high risk of distant metastasis [19]. Theory sBPBC or in a relatively short time interval mBPBC occurred or may be a factor in causing a strong immune defense function poorly, so the prognosis may be poor [18].
The group study of 6 months mBPBC and sBPBC defined criteria, the overall survival rate was found sBPBC more mBPBC difference, but no statistical significance. This is consistent with many reports, and also and this group of
researchers found in a single factor analysis of survival prognosis independent of the time interval consistent with the results.
3.3 Analysis of prognostic factors
Currently on the prognostic factors of bilateral breast
cancer have not yet achieved consistent recognition, probably because of the heterogeneity of the design (from the medical reports to the strict epidemiological investigations have) as well as methodological differences. Pairs found so far the
impact of breast cancer prognostic factors are: whether the early diagnosis and proper treatment in time; in particular on the second side of breast cancer treatment; interval between the occurrence of bilateral breast cancer; early or late stage of disease and tumor biological characteristics and so on.
This study found that single-factor analysis, and proven
unilateral breast cancer prognostic factors, the second side of the tumor size and bilateral axillary lymph node metastasis is also a major factor affecting the prognosis BPBC. Bilateral axillary lymph node-positive, and the second side of patients with tumors ? 5cm lower survival rate, the average survival time is short, and poor prognosis.
In this study, all single-factor analysis, statistically
significant factor in the introduction of Cox model multivariate analysis, we found that the second side of tumor size, histological grade is the second side-impact survival in
patients with major prognostic factors. However, due to histological grade examination so that this factor is not the lack of universality of the value of more, eventually leading to an effective multi-factor analysis of the small number of cases, only 87 cases, which will seriously affect directly the accuracy of the results of multivariate analysis. If you are doing multi-factor analysis is not brought into the second side of the results of histological grade, effective cases of 206 cases by multi-factor analysis of the results: first, the two side of node-positive, and the second side of the size of
tumor affecting the survival of patients the outcome of a major prognostic factors. The research results also prompt us from another angle, the second side of the early detection and early diagnosis and prognosis for BPBC importance. The author
is more inclined to accept the results of this analysis.
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