Analysis Of Axillary Lymph Node Metastasis Characteristics And Prognosis Of Bilateral Primary Breast Cancer Based On SEER Database

Objective: This research has been conducted to investigate the clinicopathological characteristics of bilateral primary breast cancer(BPBC),to analyze the correlation between its clinicopathology and ipsilateral axillary lymph node metastasis,and improve the understanding of the characteristics of axillary lymph node metastasis in bilateral primary breast cancer;to analyze the prognosis of patients and understand the factors affecting prognosis,so as to provide a reference basis for the clinical treatment plan of this special type of breast cancer.Methods: We retrospectively selected the clinicopathological data of female bilateral primary breast cancer patients admitted to the Second People’s Hospital of Yibin City and the Affiliated Hospital of Southwest Medical University from January 2006 to March 2022,and screened the clinicopathological and prognostic data of female bilateral primary breast cancer patients from 2010-2015 from the SEER database.Clinicopathological characteristics of domestic and foreign patients with simultaneous bilateral breast cancer(SBBC)and heterochronic bilateral breast cancer(MBBC)were analyzed using SPSS software.Logistic regression was used to analyze the factors influencing axillary lymph node metastasis in patients with bilateral primary breast cancer,and the prognostic analysis of patients with bilateral primary breast cancer was performed using univariate and multivariate COX regression models.Results: A total of 96 patients with BPBC were collected from two hospitals in China,53 patients with SBBC,with a median age of first cancer onset of 51 years;43 patients with MBBC,with a median age of first cancer onset of 47 years.6513 patients with BPBC were collected from the SEER database,5519 patients with SBBC,with a median age of first cancer onset of63 years;994 patients with MBBC,with a median age of first cancer onset of63 years.The median age of onset was 63 years.A multi-factor logistic regression analysis of axillary lymph node metastasis in SBBC patients revealed that age at onset of first cancer <60 years,high T stage,high histological grade,and negative PR were independent risk factors for ipsilateral axillary lymph node metastasis(P < 0.05);age at onset of second cancer <60years,high T stage,high histological grade,and negative ER were independent risk factors for ipsilateral axillary lymph node axillary lymph node metastasis.Lymph node metastasis was an independent risk factor(P < 0.05).Multi-factor logistic regression analysis of axillary lymph node metastasis in MBBC patients revealed that age at onset <60 years,high T stage and high histological grade were independent risk factors for ipsilateral axillary lymph node metastasis in the first cancer(P<0.05);high T stage and high histological grade were independent risk factors for ipsilateral axillary lymph node metastasis in the second cancer(P<0.05).When survival analysis was performed for patients with bilateral invasive breast cancer,MBBC had a worse prognosis than SBBC,and the difference was statistically significant(P<0.05).Univariate survival analysis showed that the higher the axillary lymph node stage of the first cancer,the higher the risk of death for SBBC and MBBC patients;the higher the axillary lymph node stage of the second cancer,the higher the risk of death for patients.Multifactorial survival analysis showed that high TNM stage of first and second cancers,high histological grade of first and second cancers,and positive HER-2 expression of first and second cancers were independent risk factors for overall survival in SBBC patients(P<0.05).Chemotherapy for second cancer,positive PR for both first and second cancers were independent protective factors for overall survival(P<0.05).Multifactorial survival analysis showed that high TNM stage for first and second cancer and high histological grade for second cancer were all independent risk factors for overall survival in MBBC patients(P<0.05).Positive chemotherapy for second cancer,PR for first and second cancer were all independent protective factors for overall survival(P<0.05).Conclusion: 1.The age of onset of first cancer in BPBC patients in two hospitals in China is younger than that of BPBC patients in the SEER database.2.For SBBC and MBBC patients,the higher the stage of axillary lymph nodes of first and second cancer,the higher the risk of death of patients.3.SBBC and MBBC patients with prognosis-related risk factors will face a higher risk of death and poor prognosis,and need to be treated aggressively and closely followed up and monitored.4.The second cancer chemotherapy is the same prognostic protective factor for SBBC and MBBC patients.