2022 年第 3 期 第 17 卷

基于监测和流行病学及最终结果数据库的双侧原发性三阴性乳腺癌临床病理特征及预后分析

Clinicopathological characteristics and prognosis analysis of bilateral primary triple-negative breast cancer based on Surveillance, Epidemiology, and End Results   database

作者：白燕李俊杰任新瑜吴焕文梁智勇

英文作者：Bai Yan Li Junjie Ren Xinyu Wu Huanwen Liang Zhiyong

单位：中国医学科学院北京协和医学院北京协和医院病理科，北京100730

英文单位：Department of Pathology Peking Union Medical College Hospital Chinese Academy of Medical Sciences & Peking Union Medical College Beijing 100730 China

关键词：三阴性乳腺癌；双侧乳腺癌；监测、流行病学和最终结果（SEER）数据库；临床病理特征

英文关键词：Triple-negativebreastcancer;Bilateralbreastcancer;Surveillance,Epidemiology,andEndResults(SEER)database;Clinicopathologicalcharacteristics

• 摘要：

• 目的 基于监测、流行病学和最终结果（SEER）数据库研究双侧原发性三阴性乳腺癌（BPTNBC）的临床病理特征，并探究影响BPTNBC预后的因素。方法  从SEER数据库中筛选2010年至2017年经病理诊断为BPTNBC的女性患者，并收集其临床病理特征、治疗情况、生存信息等。采用Cox比例风险回归分析法评估影响总生存期和乳腺癌特异性生存期（BCSS）的独立预后因素。结果 本研究共纳入191例BPTNBC患者，其中113例（59.2%）为同时性BPTNBC、78例（40.8%）为异时性BPTNBC。同时性BPTNBC和异时性BPTNBC患者双侧癌灶均以非特殊型、高级别为主。与第一癌相比，同时性BPTNBC及异时性BPTNBC的第二癌的肿瘤直径较小（以0～2.0 cm为主），TNM分期多为Ⅰ期。同时性BPTNBC第一癌的组织学分级较第二癌高（P=0.030）。同时性BPTNBC患者双侧乳房的手术方式选择类似，77.0%（87/113）的同时性BPTNBC患者在诊断时选择了双侧乳房切除术，而61.5%（48/78）的异时性BPTNBC患者在最初诊断时接受了保乳手术。同时性和异时性BPTNBC二者的总生存期和BCSS差异均无统计学意义（总生存期：风险比=1.19，95%置信区间：0.63～2.23，P=0.589；BCSS：风险比=1.24，95%置信区间：0.64～2.38，P=0.530）。第一癌的TNM分期、第二癌的区域淋巴结状态以及第二癌是否进行化疗是BPTNBC预后的独立影响因素（均P<0.05）。结论  同时性BPTNBC的手术方式选择较异时性BPTNBC更积极。同时性BPTNBC与异时性BPTNBC的预后无明显差异。第一癌的TNM分期、第二癌的区域淋巴结状态以及第二癌是否进行化疗等因素都是预后的影响因素，可为BPTNBC的临床诊疗提供参考。

• Objective   To explore the clinicopathological characteristics of bilateral primary triple-negative breast cancer(BPTNBC) based on Surveillance, Epidemiology, and End Results  (SEER) database, and to analyze risk factors of BPTNBC prognosis. Methods   Female patients who were pathologically diagnosed as BPTNBC from 2010 to 2017 from SEER database were selected, and their clinicopathological characteristics, treatment, survival information and other data were collected. Cox proportional hazards regression analysis was used to evaluate the independent prognostic factors affecting overall survival(OS) and breast cancer-specific survival(BCSS). Results  A total of 191 patients with BPTNBC were included in this study, of which 113 cases(59.2%) were synchronous BPTNBC and 78 cases(40.8%) were metachronous BPTNBC. Most of the bilateral lesions in patients with synchronous BPTNBC and metachronous BPTNBC were of no special type and higher grade. Compared with the first tumor, the second tumor of synchronous BPTNBC and metachronous BPTNBC was predominantly smaller in size(mainly 0-2.0 cm), and their TNM stage were mainly stage Ⅰ. The histological grading of the first tumor of synchronous BPTNBC was higher than that of the second tumor(P=0.030). Patients with synchronous BPTNBC had similar surgical approaches of bilateral breasts. Among patients with synchronous BPTNBC, 77.0%(87/113) of them chose bilateral mastectomy at the time of diagnosis, while 61.5%(48/78) of patients with metachronous BPTNBC chose breast-conserving surgery at diagnosis. There were no significant differences in OS and BCSS between synchronous BPTNBC and metachronous BPTNBC(OS: hazard ratio=1.19， 95% confidence interval: 0.63-2.23，P=0.589; BCSS: hazard ratio=1.24，95% confidence interval: 0.64-2.38，P=0.530). The TNM staging of the first tumor, the regional lymph node status of the second tumor, and whether the second tumor underwent chemotherapy were independent prognostic factors affecting BPTNBC(all P<0.05). Conclusions The choice of surgical approaches for synchronous BPTNBC is more radical than that of metachronous BPTNBC. The prognosis of synchronous BPTNBC and metachronous BPTNBC has no significant difference. Factors such as the TNM staging of the first tumor, the regional lymph node status of the second tumor, and whether the second tumor underwent chemotherapy are related to the prognosis, and those can provide references for the clinical diagnosis and treatment of BPTNBC.