Expressions Of ER, PR, Nm23, P53 And Clinically Pathological Analysis In 55 Cases With Bilateral Primary Breast Cancers

Objective: To study the clinical significances of expressions of ER,PR,nm23 and P53 in bilateral primary breast cancer(BPBC) and clinically and pathologically analyse 55 cases with the lesions.Methods: The clinical data of 55 patients with BPBC admitted in the General Surgery Department of our hospital from 1963 to 2001, were collected and the patients were followed up; the expressions of ER,PR,nm23 and P53 in the preserved paraffin imbedded specimens of 48 BPBCs were immunohistochemically deteted. All data were statistically analysed.Results: 1.The overall 5-year,10-year survival rates ( life table method) of the whole group, the synchronous BPBC group were 71.4%,50.9%; 56.7% , 44.4%, respectively. The first tumor's survival rate of asynchronous BPBC were obviously higher than the second(5-year survival rate :87.0%vs 58.7%, p<0.01;10-year survival rate:69.6%vs34.8% ,p<0.01), similarly, the infiltrative special cancer's higher than the infiltrative nonspecial cancer's,histological classification I's higher than Ⅱ's, the group's of tumors≤3cm higher than the group's>3cm, the negative axillary lymph node group's higher than the positive group's. 2.The rates of positive expressions of ER,PR,nm23 and P53 were 57.3%,44.8%,51.0% and 49.0%, respectively;and their expression uniformities in the paired tumors were 58.3%,35.4%,43.8%,43.8%,respectively;the 5-year ,10-year survival rates of the positive ER,PR,nm23 groups and negative P53 group weresignificantly higher than that of the negative ER,PR,nm23 groups and positive P53 group,respectively; a higher rate of axillary metastasis was observed in negative nm23 group than in positive group. 3. The expression of ER was positively correlated with that of PR and nm23 (rs=0.312,P<0.01; rs=0.208, P<0.05) and the expression of P53 had a negative relationship with that of ER and nm23 (rs=-0.25, P<0.05; rs=-0.208, P<0.05,respectively). 4. Those with familial history of breast cancer or genital organ cancer accounted for 16.4%; those beginning mensis under the age of 13 appeared in 23.6%; 52.2% of the second tumors occurred within 3 years after the first operations; there were more tumors of stage 0～I in the second cancers than in the first (27.3% VS 10.9%, P<0.05). 5. The first cancers treated with tamoxifen (TAM) or ovariectomy had a higher 10- year survival rate than those without, and the intervals between the paired cancer had an average increase of 1.5 years.Conclusions: 1. The main risk factors of BPBC may be once having breast cancer,familial history of breast cancers, etc. 2. The survival rates of the first cancers, the group of tumors≤3cm and the group of non axi11ary metastasis are obviously higher than that of the second cancers ,the group of tumors>3cm and the group of axillary metastasis, respectively. The pathologic types and histologic classifications of tumors also have an important effect on the prognosis of BPBC,treatment adding TAM or ovariectomy may benefit the prognosis and delay or prevent the second cancer. 3. The positive expressions of ER,PR,nm23 and negative expression of P53 have a good effect on the survival of patients with BPBC. 4. The expressions of ER in the paired tumors are mostly uniform; the expressions of PR,nm23 and P53 are not concordant at large; the expression of ER is associated positively with that of PR and nm23; the expression of P53 is negatively correlated with that of ER and nm23. 5. Most of the second cancers developwithin 3 years after the first operations and there are more early stage cases in the second tumors than in the first.