IA期乳腺癌临床病理特征及预后相关因素分析

目的：探讨IA期乳腺癌患者的临床病理特征与预后因素。 方法：回顾性分析2004年1月—2009年12月天津医科大学肿瘤医院收治的156例IA期（T1N0M0,）乳腺癌患者的临床病理资料。 结果：156例患者均为女性;病理类型以浸润性导管癌为主（115例,73.7%）;原发肿瘤大小以T1c居多 （77例,49.4%）;组织学分级以II级（79例,50.6%）及III级（58例,37.2%）为主。5年无进展生存（PFS）为93.3%,5年总生存（OS）为99.1%。单因素分析结果显示,组织学分级、Ki-67表达及淋巴脉管侵犯与患者的PFS有关（均P<0.05）;多因素分析显示,组织学分级及Ki-67表达情况是影响患者PFS的独立预后因素（均P<0.05）。 结论：IA期乳腺癌患者虽然总体预后较好,但对于某些亚组患者而言,预后较差,该类患者的复发转移风险较大。     

Ⅰ_A期乳腺癌临床病理特征及预后相关因素分析

目的:探讨Ⅰ_A期乳腺癌患者的临床病理特征与预后因素。方法:回顾性分析2004年1月—2009年12月天津医科大学肿瘤医院收治的156例IA期(T1N0M0,)乳腺癌患者的临床病理资料。结果:156例患者均为女性;病理类型以浸润性导管癌为主(115例,73.7%);原发肿瘤大小以T1c居多(77例,49.4%);组织学分级以II级(79例,50.6%)及III级(58例,37.2%)为主。5年无进展生存(PFS)为93.3%,5年总生存(OS)为99.1%。单因素分析结果显示,组织学分级、Ki-67表达及淋巴脉管侵犯与患者的PFS有关(均P0.05);多因素分析显示,组织学分级及Ki-67表达情况是影响患者PFS的独立预后因素(均P0.05)。结论:IA期乳腺癌患者虽然总体预后较好,但对于某些亚组患者而言,预后较差,该类患者的复发转移风险较大。     

临床T1期肾癌后腹腔镜根治术的治疗报告

目的 探讨后腹腔镜肾癌根治术治疗临床T1期肾癌的可行性及临床应用价值.方法 2004年7月至2007年11月行后腹腔镜肾癌根治术治疗临床T1期肾癌32例.结果 32例均无中转开放,平均手术时间192 min(100～305 min),平均出血量123 ml(50～500 ml),术后平均肠道恢复时间1 d(1～2 d),术后住院时间平均4.8 d(4～7 d),联合肾上腺切除4例.2例术中腹膜穿孔,1例术后发生皮下气肿.术后分期为T1N0M0 30例,T3aN0M0 2例,T4N0M0 1例.随访1～29个月,平均12个月,31例未发现肿瘤复发或转移,1例T4期患者术后10个月发生肿瘤局部复发和转移.结论 不宜行保留肾单位手术治疗的T1期肾癌患者可推荐后腹腔镜肾癌根治术.     

T1期乳腺癌的临床病理特征及预后危险因素分析

背景与目的：T1期乳腺癌患者总体生存预后良好,但仍有少部分患者具有高度侵袭性,早期容易出现复发转移与死亡等不良生存结局,预后较差。本研究探讨影响T1期乳腺癌的临床病理特征及预后的危险因素,旨在早期识别高风险的T1期乳腺癌患者,为临床决策提供参考。方法：回顾性分析中南大学湘雅医院2011年1月—2015年12月经手术治疗的1 250例T1～T3期原发性浸润性乳腺癌患者资料,分析T1期与非T1期患者的临床病理学特征差异,单因素及多因素Cox风险模型分析影响T1期乳腺癌患者复发转移及死亡的危险因素,Kaplan-Meier法分析不同危险因素下T1期乳腺癌患者总生存（OS）和无病生存（DFS）的差异,Log-rank检验比较组间生存曲线差异。结果：1 250例原发性浸润性乳腺癌患者中,T1期261例（20.88%）,非T1期（T2和T3期） 989例（79.12%）。与非T1期比较,T1期患者BMI值低、腋窝淋巴结转移数目少、不利生物学特性少、生存预后好（均P<0.05）。T1期患者随访期间共15例死亡,40例出现复发转移。中位OS时间为94 (5～132)个月,2、5、10年OS率分别...     

I，II期乳腺癌部分腋窝淋巴结清扫术远期疗效分析

目的探讨I,II期乳腺癌部分腋窝淋巴结清扫术对乳腺癌患者的预后及上肢功能的影响。方法随机选择临床I,II期乳腺癌部分腋窝淋巴结清扫组(PAL)及全腋窝淋巴结清扫组(TAL)各1 1 0例。PAL组行乳腺癌改良根治术加部分腋窝淋巴结(I,II组淋巴结)清扫术,TAL组行乳腺癌改良根治术加全腋窝淋巴结清扫术。比较术后远期复发及上肢功能状况。结果随访5~1 0年,PAL组胸部局部复发4例,占3.8%(4/1 0 6),腋窝淋巴结复发转移1例;TAL组胸部局部复发5例,占4.9%(5/1 0 3),无腋窝淋巴结复发转移;两组差异无显著性(P>0.0 5)。PAL组发生患肢水肿及功能障碍5例,占4.7%(5/1 0 6);TAL组1 2例,占1 1.7%(1 2/1 0 3),差异有极显著性(P<0.01)。两组5年和1 0年生存率均无明显统计学差异。结论I,II期乳腺癌实施使PAL可减少患肢的术后功能障碍,不增加预后风险。     

原发性肾肉瘤的诊治及预后(附6例报告及文献复习)

目的：探讨原发性肾肉瘤的诊断方法、病理学特点、治疗手段及影响预后的因素。方法：回顾性分析1998～2007年期间收治的6例原发性肾肉瘤患者的临床资料：男5例，女1例，年龄39～72岁，平均58岁。左肾肿瘤3例，右肾肿瘤3例。表现为腹痛3例，腹部包块1例，阴囊坠胀1例，无症状1例。肿瘤直径2．5～13cm&#183;平均8．1cm。T1N0M0期2例，T2T0M0期1例，L3bN1M0期1例，T4NxM1期2例。6例患者术前影像学资料均诊断为肾脏恶性肿瘤。2例T1N0M0期、1例T2N0M0期及2例T1N0M1期患者均行肾癌根治术，1例T3bN1M0期患者行肾脏姑息性切除术。4例术后实施化疗。结果：术后病理检查示平滑肌肉瘤5例，癌肉瘤1例。术后3例随访6个月～3年，其中1例（T2N0M0）于术后2年发现腹膜后转移，并于术后3年死亡，1例（T4NxM1）于术后2个月发现双肺转移，1例（T1N0M0）无瘤存活。结论：腹痛及包块是肾肉瘤的常见症状，其恶性程度高，预后差。病理分期是影响预后的重要因素。手术是其主要治疗方式，术后是否化疗尚存在争议。     

乳腺癌患者改良根治术后复发转移的相关危险因素分析

目的探究乳腺癌改良根治术后复发转移的危险因素。方法回顾性选取2014年3月至2015年9月期间三家医院行乳腺癌改良根治术的155例乳腺癌患者临床资料,根据随访结果将其分为复发转移组49例和未复发转移组106例。采用统计软件包SPSS 22.0进行数据处理,术后复发转移单因素分析采用χ~2检验,多因素分析采用Logistic回归模型进行分析。P0.05为差异有统计学意义。结果 155例行乳腺癌改良根治术的患者术后肿瘤复发转移率为31.6%(49/155),其中局部复发11例,远处转移38例。将单因素分析中与术后复发转移显著相关因素进行多因素分析,发现伴有脉管癌栓、原发肿瘤直径≥5 cm、腋淋巴结转移数目≥4枚、TNM分期为Ⅲ期、组织学分级Ⅲ级及激素受体(ER、PR)阴性是影响乳腺癌改良根治术后复发转移的独立危险因素(P0.05),而蒽环类联合紫衫类化疗、术后辅助放化疗及内分泌治疗是乳腺癌患者复发转移的保护因素(P0.05)。结论乳腺癌改良根治术后复发转移的独立危险因素包括脉管癌栓、原发肿瘤大小、腋淋巴结转移数目、TNM分期、组织学分级及激素受体状态等;针对以上因素制定综合的预防、治疗方案,能够降低复发转移风险,改善患者预后生存。     

T2N0M0期结直肠癌根治性术后的生存状况研究

探究外科治疗T2N0M0期结直肠癌患者的生存状况。回顾性分析2012年1月—2014年1月我院收治的108例T2N0M0期结直肠癌患者的临床资料,所有患者均行根治性手术,随访患者术后1年和3年的生存状况。单因素和Logistic多因素分析患者术后死亡相关因素。术后1年和3年生存率分别为94.46%和79.66%,其中腹腔转移、肺部转移、肝脏转移是患者术后死亡的主要原因。Logistic多因素分析显示,年龄≥60岁、病理类型为浸润型、低分化程度为T2N0M0期结直肠癌患者术后死亡的危险因素(P0.05)。T2N0M0期结直肠癌患者根治术后易发腹腔转移、肺部转移、肝脏转移,应加强对年龄≥60岁、病理类型为浸润型、低分化程度患者的管理,以提高生存率。     

II,III期乳腺癌行根治术与扩大根治术的疗效评价:附691例报告

目的　探讨乳腺癌根治术与扩大根治术治疗II ,III期乳腺癌的疗效。方法　回顾性分析691例II ,III期乳腺癌的两种手术方法治疗后的 5年和 10年生存率。 691例乳腺癌中II期行根治术 2 0 6例 ,行扩大根治术 14 2例 ;III期行根治术 193例 ,行扩大根治术 15 0例。结果　癌灶位于中央区及内乳区行扩大根治术的II ,III期患者的 5年生存率和III期的 10年生存率显著高于根治术患者 (均P <0 .0 1)。癌灶位于外上象限行扩大根治术的II ,III期患者 10年生存率和III期患者的 5年生存率亦显著高于根治术患者 (均 P <0 .0 5 )。结论　提示II ,III期乳腺癌病灶位于中央区及内乳区的患者、位于外上象限的III期患者应考虑行扩大根治术。     

乳腺癌改良根治术中部分腋窝淋巴结清扫的远期疗效分析

目的 探讨乳腺癌改良根治术中部分腋窝淋巴结清扫对乳腺癌患者预后及上肢功能的影响.方法 选择98例Ⅰ、Ⅱ期乳腺癌,随机分为部分淋巴结清扫(PALD)组(n＝48)和全腋窝淋巴结清扫(TALD)组(n＝50).PALD组行乳腺癌改良根治术加部分腋窝Ⅰ、Ⅱ站淋巴结清扫术,TALD组行乳腺癌改良根治术加全腋窝Ⅰ、Ⅱ、Ⅲ站淋巴结清扫术.比较术后远期复发及上肢功能状况.结果 随访5～10年,平均4.5年.PALD组胸部局部复发2例(4.2%),腋窝淋巴结复发转移1例(2.1%),锁骨上淋巴结转移1例(2.1%); TALD组胸部局部复发2例(4.0%),无腋窝淋巴结复发转移,锁骨上淋巴结转移1例(2.0%); 2组差异无统计学意义(P>0.05).PALD组发生患肢水肿及功能障碍2例(4.2%),TALD组8例(16.0%),差异有统计学意义(P＜0.01).PALD组和TALD组患者5年生存率(89.6%比88.0%)及10年生存率(79.2%比78.0%)差异均无统计学意义(P＞0.05). 结论 Ⅰ、Ⅱ期乳腺癌实施PALD可减少术后患侧上肢的功能障碍,且不增加预后风险.     

保留乳头乳晕复合体的乳腺癌改良根治术预后的相关因素分析

目的探究影响保留乳头乳晕复合体(NAC)的乳腺癌改良根治术(NSM)预后的相关因素。 方法回顾性分析2011年1月至2014年12月84例早期原发性乳腺癌并接受NAC的NSM患者临床病理资料。使用统计软件SPSS 20.0进行数据分析,采用K-M生存曲线评估术后无病生存(DFS)及总生存(OS),采用单因素分析和Cox多因素分析影响NSM术后患者DFS和OPS的影响因素。P<0.05差异有统计学意义。 结果术后局部复发8例,远处转移6例,术后5年DFS为83.3%,OS为91.7%。多因素分析显示,肿瘤最大径、肿瘤距乳头乳晕距离(TND)、腋窝淋巴结状态、组织学类型及Her-2阳性是影响DFS的独立危险因素(P<0.05);而腋窝淋巴结状态是影响术后OS的独立危险因素(P<0.05)。 结论肿瘤最大径、TND、腋窝淋巴结状态、组织学类型及Her-2阳性是DFS的独立危险因素,腋窝淋巴结状态是OS的独立危险因素;腋窝淋巴结情况同时影响患者术后DFS和OS,术前系统、精准地评估并妥善处理特殊腋窝淋巴结可提高乳腺癌患者预后。     

Impact of multicentricity on clinical outcome in patients with T1-2, N0-1, M0 breast cancer

Background: The objective was to determine the impact of multicentric breast cancer on recurrence and survival and to evaluate the current tumor, node, metastasis staging system recommendations for multicentricity in the breast. Methods: This study included 284 nonpregnant patients with T1-2, N0-1, M0 breast cancer, without previous cancer, who were treated by modified radical mastectomy followed by doxorubicin-based adjuvant chemotherapy. Clinical and pathological data were collected retrospectively and survival was calculated from the date of initial diagnosis using the Kaplan-Meier method. Results: The median follow-up time was 8 years (range, 0.3–24.0), and the median age was 47 years (range, 23–76). The median clinical size of the index tumor was 2.5 cm. In 17% of patients, the clinical nodal status was N1. In 84% of patients, pathology of the index lesion was invasive ductal ± in situ. Multicentric breast cancer was detected in 60 patients (21%): 30 patients with two lesions, 13 patients with three lesions, and 17 patients with four or more lesions. Locoregional recurrence, contralateral breast cancer, distant metastasis, and survival (disease-specific and disease-free) were similar in both groups of multicentric versus unicentric breast tumors. There was a significant difference between groups in estrogen receptor and axillary lymph node positivity, but these did not contribute significantly to outcome on multivariate analysis. Conclusions: Multicentricity does not increase the risk of poor outcomes in patients with early-stage breast cancer. This supports the current recommendations of the tumor, node, metastasis staging system that tumor size should be based on the diameter of the largest lesion in patients with multicentric breast cancer.     

不同术式对T_1乳腺癌病人的疗效评估

目的：探讨不同术式对Ｔ１乳腺癌的疗效。方法：观察Ｈａｌｓｔｅｄ术、改良根治术和乳房象限切除加腋淋巴结清扫术对２７４例Ｔ１乳腺癌病人预后的影响;并分析全部病人的腋淋巴结转移情况。结果：Ｔ１乳腺癌病人１０年生存率为８４．７％;标准根治术与改良根治术后病人的１０年生存率分别为８０．５石％和８４．１％（Ｐ＞０．０５）;乳房象限切除加腋淋巴结清除术与根治术相比,Ｔ１Ｎ０Ｍ０病人的１０年生存率分别为１００％和９０．４％（Ｐ＞０．０５）;全组腋淋巴结转移率为２７．７％;９７．４％的转移淋巴结位于低位组。结论：３种术式治疗Ｔ１乳腺癌病人的效果相同,从美观及心理因素上考虑,提倡行保守性手术;２／３以上Ｔ１病人无腋淋巴结转移,一律行腋淋巴结清除对预后意义不大,前哨淋巴结活检可以解决这一问题;腋淋巴结转移绝大多数在低位组,在不能进行前哨淋巴结活检的情况下,可仅清除低、中位淋巴结。     

TK1、Ki-67、p53在乳腺癌组织中的表达与及其预后的关系

目的：探讨TK1、Ki-67、p53在乳腺癌组织中的表达及其与预后的关系。 方法：2009年3月—2013年5月收治的60例乳腺癌患者,均接受乳腺癌根治术并留取组织标本,用免疫组化法检测乳腺癌组织及其癌旁组织中TK1、Ki-67和p53的表达;根据随访资料分析TK1、Ki-67和p53的表达与患者预后的关系。 结果：乳腺癌组织中TK1、Ki-67、p53阳性率均明显高于癌旁组织（均P<0.05）;TK1、Ki-67、 p53的表达强度明显影响患者的5年生存率,均表现为表达强度越高患者的生存率越低（均P<0.05）;TK1、Ki-67和p53表达的阳性率在术后5年内出现复发或转移的患者中均明显高于无复发或转移的患者（均P<0.05）。 结论：在乳腺癌组织中TK1、Ki-67和p53表达增强,且其表达强度与乳腺癌的不良预后密切相关。     

The content of tumor DNA as an indicator of prognosis in patients with T1N0M0 and T2N0M0 carcinoma of the breast

To determine if the flow cytometric measurement of the content of the tumor DNA could provide prognostic information in T1N0M0 and T2N0M0 carcinoma of the breast, we isolated nuclei from paraffin-embedded tumor specimens from 128 consecutive patients who underwent modified radical mastectomy and were found to have a T1 or T2N0M0 carcinoma of the breast. The content of DNA of the nuclei was determined by flow cytometry. Although the average tumor size was not significantly different, 17 of 56 patients with aneuploid tumors died of cancer compared with 2 of 72 with euploid tumors. The 10-year overall actuarial survival rate of the euploid and aneuploid groups was 72% and 67%, respectively (p less than 0.02). A hazards model of the data shows that the DNA content of the tumor is the most significant indicator of prognosis, with a 2.25-fold increased risk of death for patients with aneuploid tumors. These data show that the tumor DNA content can be used to identify a group of patients with T1 or T2N0M0 carcinoma of the breast with the same prognosis as a group of patients without carcinoma of the breast that would be unlikely to benefit from adjuvant therapy.     

乳腺癌术后局部复发的治疗及预后分析

目的 探讨乳腺癌术后局部复发的治疗方案及影响预后的相关因素.方法回顾性分析天津肿瘤医院2002年7月至2005年2月期间收治的477例乳腺癌术后复发患者的临床资料.结果 477例复发病例中,术后1年内复发占26.2%(125/477),2年内复发占61.2%(292/477).局部复发后远处转移率为65.0%(310/477),复发后5年总生存率48.4%.不同复发部位、临床分型、有无放射治疗、放射治疗范围、有无手术切除或切除活检的亚组之间局部控制率的差异有统计学意义(P<0.05).不同原发肿瘤分期、无病间期、临床分型以及治疗方式的亚组间远处转移率及5年总生存率的差异有统计学意义(P<0.05),多因素分析显示治疗方案单一、原发肿瘤分期晚、三阴型乳腺癌是影响复发性乳腺癌预后的独立危险因素(P<0.05).结论 多部位复发者和三阴型乳腺癌局部控制不佳,局部扩大野放射治疗结合手术治疗是改善局部控制率的必要模式.原发肿瘤分期晚、2年内复发、三阴型的乳腺癌复发后容易发生远处转移,对于复发性乳腺癌采取综合治疗方案可以提高患者的生存率.

Abstract：

Objective To explore an optimal treatment and to study the prognosis related factors of breast cancer patients with local recurrence after mastectomy. Methods From 2002. 7 to 2005. 2, 477female patients with loco-regional recurrence of breast cancer treated in Tianjin Cancer Hospital were analyzed retrospectively. Results In 477 cases, recurrence within 1 year after mastectomy accounted for 26. 2% , recurrence within 2 years accounted for 61. 2%. There were 310 cases with metastasis after local recurrence was diagnosed, accounting for 65.0%. 5-year total survival rate after recurrence is 48.4%.Local control rates varied in subgroups with different recurrence site, clinical subtypes, radiotherapy fields,with or without radiotherapy, surgical resection or excisional biopsy ( P<0. 05 ). There was a statistical difference in distant metastasis rate and 5-year survival rate among subgroups which had different clinical stage of primary tumor, disease-free interval, clinical subtypes or treatment methods ( P<0. 05 ). Simplistic treatment option, late clinical stage of primary tumor and triple-negative breast cancer were the independent factors predicting poor prognosis for recurrent breast cancer ( P<0.05 ). Conclusions Multi-site recurrence and triple-negative breast cancer lead to a poor local control. Local expansion of radiotherapy combined with surgery improves the local control rate. Patients with late clinical stage of primary tumor,recurrence within 2 years, triple-negative breast cancer are likely to have distant metastasis when recurrence is diagnosed. Combined treatment program improves survival rate.     

Prognosis in stage II (T1N1M0) breast cancer.

As part of a detailed study of prognostic factors in breast cancer, we have analyzed the ten year survival rates of 524 patients with primary invasive carcinomas 2.0 cm or less in diameter (T1). This report describes the subset of 142 patients (27%) who had metastases only in axillary lymph nodes (T1N1M0). All the patients were treated initially by at least a modified radical mastectomy. Factors associated with a significantly poorer prognosis were: axillary lymph node metastases suspected on clinical examination; perimenopausal menstrual status at diagnosis; tumor larger than 1.0 cm; prominent lymphoid reaction; infiltrating duct or lobular rather than medullary, colloid and tubular carcinoma; and blood vessel invasion. When compared with those patients with negative nodes (T1N0M0), the patients with one or more lymph node metastases had a significantly poorer prognosis. Generally, survival rates tended to diminish as the number of involved lymph nodes increased. In this respect, comparison of patients with one-three and four or more nodal metastases provided a significant discrimination of prognostic groups in the entire series. However, for patients with disease limited to Level I, the same discrimination was obtained comparing those with one-two and three or more positive nodes. In the subset with a single lymph node metastasis, the size of the metastasis (micro or less than or equal to 2 mm vs macro or greater than 2 mm) was not significantly related to prognosis. Lymph node metastases were significantly less frequent among tumors smaller than 1 cm and special tumor types (medullary, colloid, lobular and tubular). However, no factor proved to be a reliable predictor of the presence of axillary metastases for the single largest group consisting of patients with infiltrating duct carcinoma 1-2 cm in diameter.     

A role of interpectoral (Rotter's) lymph node dissection in modified radical mastectomy for breast cancer]

To study the influence of interpectoral lymph node (IPN) dissection on the prognosis of patients who underwent modified radical mastectomy, IPN was carefully dissected and studied pathologically on 168 cases of our breast cancer patients operated with modified radical mastectomy. There were 1.2 lymph nodes on an average in the interpectoral region, and they were almost 1-2mm in diameter. IPN metastases were found in 10 cases. (Tis: 0%, Stage I: 4.9%, Stage II: 5.7%, Stage III: 13%). Tumors located in outer quadrant in almost all these cases. Positive IPN were found in 6 (16%) of n1 alpha group, 1 (10%) of n1 beta group, and in 3 (50%) of n2 group. All these 3 cases of n2 died of distant metastasis and local recurrence. Two (1.7%) of axillary node (1a, 1b) negative patients had microinvolvement of cancer only in IPN, and are currently disease-free. These data suggest that IPN metastasis may occur even in the early breast cancer patients, and that may be controllable by lymph node excision. Therefore, routine and careful dissection of IPN through wide opening of sulcus interpectoralis is necessary for modified radical mastectomy and even for breast preserving operation.     

Evaluation of various surgical methods in the treatment of breast cancer

The author analyses 5-year results of the treatment of 548 patients with breast cancer according to the type of the operative intervention: Halsted's radical mastectomy, Peity's modified radical mastectomy, and mastectomy with axillary lymphadenectomy. In stages T1-2, N0, M0 the results of all three types of operations were the same. No statistically significant difference was revealed between Halsted's mastectomy and modified radical mastectomy in stages T2-3, N1-3, M0 which allows it to be recommended for wider use.