| Objectives1.Both thyroid cancer and breast cancer are most common malignant tumors in Chinese women,which seriously threaten people's life and health,and all have significant gender differences.Whether there are similarities in the pathogenesis of thyroid cancer and breast cancer,there is no clear conclusion so far.This study aimed to investigate the correlation between the two diseases,and provide a theoretical basis for further study of specific pathogenesis and search for new therapeutic targets.2.During clinical practice,thyroid cancer and breast cancer are often found in the same patients at the same time or in succession.The data reported in the literature also indicates that the incidence of the two malignancies has certain correlation.Study of the clinicopathological features of both thyroid and breast cancer patients can help us to find a common pathogenesis of these two malignant tumors,help to achieve early recognition of multiple primary malignant tumor patients and explore new therapeutic strategies and targets.Methods1.We searched patients who underwent thyroid or breast cancer surgery in inpatients from Peking Union Medical College Hospital from April 2011 to June 2018.A total of 153 patients were retrieved with thyroid cancer or breast cancer at the same time or in succession.Of these,48 patients with thyroid cancer and breast surgery both were performed in our hospital.The data of the 48 patients were systematically collected.At the same time,data of 50 randomly selected patients with only breast cancer admitted to our hospital were collected.2.Inclusion and exclusion criteria:Inclusion criteria:1)Both thyroid cancer and breast cancer are treated surgically in our hospital.2)Patients with complete clinical and pathological data.Exclusion criteria:1)Thyroid or breast tumors were not treated in our hospital.2)Patients with clinical and pathological data are incomplete.3.Statistical methods:This study used SPSS 23.0 software for statistical analysis,in which the normal distribution of measurement data,using t test;the count data using chi-square test,multivariate analysis using logistic regression analysis,with P<0.05 as the difference was statistically significant;4.We searched the SEER database for the epidemiological and clinical case characteristics of patients with both breast cancer and thyroid cancer in the United States from 1976 to 2016,and then conducted bioinformatics analysis.We searched KEGG database to find common signaling pathways of these two malignancies.ResultsFrom April 2011 to June 2018,Peking Union Medical College Hospital treated a total of 16973 cases of thyroid cancer,10886 cases of breast cancer,including 153 cases with both breast cancer and thyroid cancer,accounting for 0.9014%of all thyroid cancer patients,and 1.405%of all breast cancer patients.Among the 48 patients with both thyroid cancer and breast cancer,all of them were female.The average age of diagnosis was 51.56±9.057 years old,the oldest was 71 years old,and the youngest was 30 years old.34 patients had thyroid cancer after a history of breast cancer,accounting for 70.83%of them,with an average interval of 32.5 months.The longest interval was 182 months,and the shortest was 2 months.Nine patients had breast cancer with a history of thyroid cancer,accounting for 18.75%of them,the average interval of 24.66 months,the longest is 65 months,and the shortest is 2 months.The remaining 4 patients were diagnosed with thyroid cancer and breast cancer at the same time,accounting for 8.33%of the total.In other respects,25 patients had menopause when they found the first malignant tumor,accounting for 52.08%of the total.Of the 48 patients,8(16.6%)patients had showing thyroiditis diagnosed by pathological and thyroid function tests,44(91.66%)patients had normal thyroid function,3(6.25%)patients had hypothyroidism,and only 1(2.08%)patient has hyperthyroidism.In the surgical treatment of thyroid cancer,12 patients(25%)underwent total thyroidectomy,36(75%)patients underwent unilateral thyroidectomy.And 38(79.16%)patients underwent central node(VI group)lymph node dissection,7 patients(14.5%)had lateral lymph node dissection;As for breast cancer surgery,22 patients(45.89%)underwent breast-conserving surgery,and 26 patients(54.1%)underwent modified radical mastectomy.In terms of pathological features,in co-cancer patients,all 48 cases(100%)of thyroid cancer were papillary thyroid carcinoma,41 cases(85.41%)were invasive breast carcinoma,and 7 cases(14.58%)were in situ cancer.Four patients(8.33%)showed multifocal thyroid cancer,and 5 patients(10.41%)had multifocal features in breast cancer.As for lymph nodes,35 cases(72.91%)had no lymph nodes in thyroid cancer,10 cases(20.83%)and 3 cases(6.25%)had central lymph node metastasis and lateral lymph node metastasis,respectively.Of the 11 patients who detected the BRAFV600E gene mutation,10 patients detected BRAFV600E gene mutation,and only 1 gene mutation was negative.Comparing 48 patients with 50 only breast cancer patients randomly selected,the results showed that there were significant differences in lymph node metastasis status between the two groups,and whether the tumor size was greater than 2 cm,or in sexual and family history,there were no statistical differences.There were no statistically significant differences in pathological features between them in ER,PR and Her-2 expression.Compared with the clinical pathological data of breast cancer in the general population in China,there were significant differences in ER expression,PR expression,and lymph node metastasis between the two groups.Conclusions1.Breast cancer is associated with the onset of thyroid cancer,and the likelihood of another cancer in thyroid cancer patients and breast cancer patients is significantly higher than in the general population.2.Breast cancer patients have an increased risk of primary papillary thyroid cancer,especially in postmenopausal women.During the follow-up treatment of breast cancer,screening of thyroid nodules should be strengthened.For suspected malignant thyroid nodules,we should treat them properly.3.The risk of recurrent primary breast cancer is increased in patients with thyroid cancer.Such patients should actively perform breast examination regularly.For suspected malignant lesions,early detection,early diagnosis and early treatment should be achieved.In particular,patients with BRAFV600E gene mutation should strengthen the test,but whether the gene mutation is a high risk factor for breast cancer,due to the small sample size,it is still uncertain.4.Among breast cancer patients,pathological results suggest that ER positive,PR positive and no lymph node metastasis are risk factors for recurrence of primary papillary thyroid carcinoma in breast cancer.For such patients,thyroid ultrasound should be checked regularly to detect possible thyroid cancer.5.Among breast cancer patients,Her-2 positive,breast tumor size greater than 2cm,and other clinicopathological features are not high risk factors for recurrent thyroid cancer.For such patients,there is no need to over-examine thyroid nodules due to breast cancer history.6.Surgeons should cooperate with the Department of Ultrasound and Pathology to take the advantage MDT and establish a system for detecting secondary thyroid and breast cancer. |
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