复旦发现乳腺癌与甲状腺癌相关性

　　甲状腺癌是乳腺癌存活者最常见的其他恶性肿瘤之一。

　　2018年11月27日，美国癌症学会和国际抗癌联盟《癌症医学》在线发表复旦大学附属肿瘤医院黄乃思、莫淼、吴炅、嵇庆海、郭小毛、柳光宇、邵志敏、王宇等学者的研究报告，回顾分析了乳腺癌与甲状腺癌的相关性。

　　该单中心回顾研究对1999～2013年复旦大学附属肿瘤医院1万3978例乳腺癌患者（其中男性56例，占0.4%）进行分析，将患者分为乳腺癌和甲状腺癌组、单纯乳腺癌组。

　　结果发现，1万3978例乳腺癌患者之中，有甲状腺癌247例，发病率高达1.8%，与中国女性标准化人口甲状腺癌总发病率相比，高4.48倍，并且其中甲状腺乳头状癌占98.0%。多因素比例风险回归模型分析结果表明，恶性肿瘤家族史是乳腺癌患者发生甲状腺癌的唯一独立风险因素（风险比：1.457，P=0.025）。

　　此外，同时与先后发生乳腺癌和甲状腺癌的患者相比，无复发生存率显著较低（91.0%比96.8%，P=0.016）。多因素比例风险回归模型分析结果表明，无复发生存率较低的唯二独立风险因素：

• 同时发生两癌（风险比：5.597，P=0.018）

• 肿瘤分级较高（风险比：5.476，P=0.022）

　　因此，该研究结果表明，乳腺癌患者的甲状腺癌发生率较高，同时与先后发生乳腺癌和甲状腺癌的结局不同，可能存在不同机制。

Cancer Med. 2018 Nov 27. [Epub ahead of print]

Association between breast cancer and thyroid cancer: A study based on 13 978 patients with breast cancer.

Huang NS, Chen XX, Wei WJ, Mo M, Chen JY, Ma B, Yang SW, Xu WB, Wu J, Ji QH, Guo XM, Liu GY, Shao ZM, Wang Y.

Fudan University Shanghai Cancer Center, Shanghai, China; Shanghai Medical College, Fudan University, Shanghai, China.

BACKGROUND: Thyroid cancer (TC) is one of the most commonly seen secondary malignancy in breast cancer (BC) survivors.

MATERIALS AND METHODS: A retrospective study was conducted in BC patients in our center from 1999 to 2013. Patients were divided into BC-TC group and BC-alone group.

RESULTS: In total, 13 978 BC patients were identified, among whom 247 (1.8%) had TC. The standardized incidence ratio (SIR) of TC was 4.48 compared with Chinese females, and up to 98.0% of cases were thyroid papillary carcinomas. A family history of malignancy was the only independent risk factor (odds ratio = 1.457, P = 0.025) for development of TC in patients with BC. We also identified inferior survival in patients with synchronous versus metachronous BC-TC (P = 0.016). Synchronous BC-TC (risk ratio = 5.597, P = 0.018) was an independent prognostic factor for inferior RFS.

CONCLUSIONS: We observed high co-occurrence of TC in patients with BC. There might be different mechanisms behind synchronous and metachronous BC-TC.

KEYWORDS: breast cancer; prognosis; second primary malignancy; synchronous cancer; thyroid cancer

PMID: 30480382

DOI: 10.1002/cam4.1856