TK1和Ki-67在三阴性乳腺癌中的表达及其临床意义

目的 探讨胸苷激酶1(TK1)、增殖细胞核抗原Ki-67在三阴性乳腺癌(TNBC)中的表达及其临床意义.方法 选取2009年6月至2010年12月在青岛大学医学院第二附属医院行保乳根治术或改良根治术的乳腺癌患者的肿瘤组织切片120例,其中TNBC60例,非TNBC60例.应用免疫组织化学法检测乳腺癌组织中TK1、Ki-67的表达,并分析二者在TNBC中的表达与患者临床病理特征的关系.结果 TK1在TNBC和非TNBC中的阳性表达率分别为83.33％、51.67％,差异有统计学意义(x2=13.713,P=0.000).Ki-67在TNBC和非TNBC中的阳性表达率分别为68.33％、31.67％,差异有统计学意义(x2=16.133,P=0.000).TNBC患者TK1的表达与组织学分级(x2=6.125,P=0.013)相关,与发病年龄(x2=0.809,P=0.369)、绝经状态(x2=1.615,P=0.204)、肿瘤大小(x2=0.054,P=0.816)、淋巴结转移(x2=0.672,P=0.412)无关.TNBC患者Ki-67的表达与组织学分级(x2=13.145,P=0.000)、淋巴结转移(x2=6.182,P=0.013)相关,与绝经状态(x2=1.018,P=0.313)、发病年龄(x2=2.377,P=0.123)、肿瘤大小(x2=2.401,P=0.121)无关.TNBC患者TK1阳性表达与Ki-67阳性表达呈正相关(r =0.369,P=0.023).生存分析显示,TK1阳性和阴性者的5年无瘤生存率分别为28.20％和66.70％,Ki-67阳性和阴性者的5年无瘤生存率分别为24.30％和64.30％,差异均有统计学意义(x2=4.194,P=0.041;x2 =4.540,P=0.033).结论 TK1、Ki-67在TNBC中均高表达,且其表达与组织学分级和患者生存期相关,可作为判断预后的参考指标.     

早期HER2过表达型乳腺癌术后放疗的作用

目的 探讨T1～2 N1 M0期人表皮生长因子受体-2(HER2)过表达型乳腺癌患者行改良根治术后放疗与否对局部控制和生存的影响,为指导临床决策提供参考.方法 回顾性分析2000-01-22-2018-12-13接受改良根治术的277例T1～2 N1 M0期HER2过表达型乳腺癌患者的临床资料,其中63例行术后放疗,2...     

术后放疗对T1-2N1M0期三阴乳腺癌患者预后的影响

目的 分析T1-2N1M0期三阴性乳腺癌（TNBC）患者行改良根治术后放疗与否对生存的影响。方法 回顾性分析2004年1月至2010年9月接受改良根治术后129例T1-2N1M0期TNBC患者的临床资料,其中61例行术后常规放疗（放疗组）,68例未行放疗（未放疗组）。分析两组5年总生存率、5年无局部复发生存率和5年无病生存率以及影响局部复发的因素。结果 中位随访时间为67个月,全组患者中27例（20.9％）出现局部区域复发。放疗组较未放疗组提高了5年无局部复发生存率（88.5％ vs. 70.6％,P=0.017）和5年无病生存率（78.7％ vs.63.2％, P=0.068）。放疗组和未放疗组的5年生存率分别为88.5％和82.4％（P=0.341）。单因素分析显示年龄、T分期、淋巴结阳性数、是否放疗是影响无局部复发生存的预后因素（P＜0.05）。多因素分析显示未放疗（HR=3.432,P=0.010）和淋巴结3枚阳性（HR=2.915,P=0.020）是影响局部区域复发的独立预后因素。结论 术后放疗可明显改善T1-2N1M0期TNBC患者的无局部复发生存。淋巴结3枚阳性者局部控制更差,增加区域淋巴结照射是可行的。     

乳腺癌改良根治术后T1-2N1期患者局部区域复发的部位分析

目的 分析乳腺癌改良根治术后T1-2N1患者的局部区域复发(LRR)部位分布,探讨放疗的照射范围。方法 1997年9月至2015年4月中国医学科学院肿瘤医院收治2472例改良根治术后T1-2N1女性乳腺癌患者,均未行新辅助治疗。1898例未行术后放疗的患者纳入本研究,分析患者的局部和区域复发部位。采用Kaplan-Meier法进行局部复发率和区域复发率计算,采用Log-Rank法对影响患者局部复发和区域复发的各因素分别进行单因素分析,纳入单因素分析P值小于0.05的因素进行Cox回归法多因素分析。结果 中位随访时间71.3个月,164例(8.6%)患者发生局部和(或)区域复发。其中复发在锁骨上106例(65%),胸壁69例(42%),腋窝39例(24%),内乳19例(12%)。多因素分析显示年龄(>45岁/≤45岁)、肿瘤位置(其他象限/内象限)、T分期(T1/T2)、腋窝阳性淋巴结数(1个/2~3个)、激素受体(阳性/阴性)是局部复发和区域复发共同的影响因素。结论 乳腺癌改良根治术后T1-2N1期患者的LRR部位主要是锁骨上,其次是胸壁,腋窝和内乳少见。影响局部和区域复发的高危因素基本相似,放疗患者建议照射锁骨上区和胸壁。     

乳腺癌改良根治术后T1-2N1期患者局部区域复发的部位分析

目的 分析乳腺癌改良根治术后T1-2N1患者的局部区域复发(LRR)部位分布,探讨放疗的照射范围。方法 1997年9月至2015年4月中国医学科学院肿瘤医院收治2472例改良根治术后T1-2N1女性乳腺癌患者,均未行新辅助治疗。1898例未行术后放疗的患者纳入本研究,分析患者的局部和区域复发部位。采用Kaplan-Meier法进行局部复发率和区域复发率计算,采用Log-Rank法对影响患者局部复发和区域复发的各因素分别进行单因素分析,纳入单因素分析P值小于0.05的因素进行Cox回归法多因素分析。结果 中位随访时间71.3个月,164例(8.6%)患者发生局部和(或)区域复发。其中复发在锁骨上106例(65%),胸壁69例(42%),腋窝39例(24%),内乳19例(12%)。多因素分析显示年龄(>45岁/≤45岁)、肿瘤位置(其他象限/内象限)、T分期(T1/T2)、腋窝阳性淋巴结数(1个/2~3个)、激素受体(阳性/阴性)是局部复发和区域复发共同的影响因素。结论 乳腺癌改良根治术后T1-2N1期患者的LRR部位主要是锁骨上,其次是胸壁,腋窝和内乳少见。影响局部和区域复发的高危因素基本相似,放疗患者建议照射锁骨上区和胸壁。     

乳腺癌合并皮肌炎1例

患者,女,45岁,于2003年12月无意发现右乳外上象限3cm×4cm肿块,质硬,无痛,活动度差.在当地医院行右乳腺癌根治术,术后病理示:右乳腺实体癌.淋巴结转移2/14,ER( ),PR(-),CerbB2( ).临床分期T2N1M0.行术后辅助化疗7周期(紫杉醇 阿霉素).     

三阴性乳腺癌化疗后前瞻性记忆损害特征分析

目的 有关不同分子分型的乳腺癌患者化疗后前瞻性记忆(prospective memory,PM)损害是否存在差异,目前尚不清楚.本研究探讨三阴性乳腺癌(triple negative breast cancer,TNBC)患者化疗后基于事件的PM(event-based prospective memory,EBPM)与基于时间的PM(time-based prospective memory,TBPM)损害特征.方法 收集2013-01-01-2015-09-30安徽医科大学第二附属医院肿瘤中心接受化疗的乳腺癌化疗后患者244例.其中TNBC 80例,非三阴性乳腺癌(non-triple negative breast cancer,NTNBC) 164例.建立EBPM与TBPM的认知神经心理学试验范式,分别进行化疗前后的PM测查.结果 与NTNBC患者相比,TNBC患者化疗后EBPM得分0.89±0.86,明显低于NTNBC组的2.59±0.90,差异有统计学意义,Z=-10.61,P＜0.01;TNBC和NTNBC患者化疗后TBPM得分别为4.65±0.83和4.80±0.92,差异无统计学意义,Z=-1.48,P＞0.05.结论 乳腺癌患者化疗后存在不同程度的PM障碍,且TN-BC较NTNBC患者EBPM损害更为显著.     

pT1-2N0期乳腺癌保乳术加放疗疗效优于改良根治术：倾向性评分分析研究

目的 研究pT1-2N0乳腺癌保乳术+放疗和改良根治术的疗效差异。方法 回顾分析1999-2014年治疗的6137例pT1-2N0期的乳腺癌患者资料,其中1296例患者接受保乳术+放疗(保乳术组),4841例患者接受改良根治术但未做放疗(改良根治组)。采用Kaplan-Meier法生存分析,Logrank检验和单因素分析,采用Cox模型多因素分析,最后采用倾向性评分比较进一步确认。     

HER2表达水平对三阴性乳腺癌新辅助化疗疗效及预后的影响

目的 探讨人表皮生长因子受体2(HER2)表达水平(0、1+、2+且FISH无扩增)对三阴性乳腺癌(TNBC)患者新辅助化疗(NAC)疗效的影响以及预后价值.方法 回顾性分析郑州大学附属肿瘤医院2014-01-01-2018-12-31接受NAC治疗的221例TNBC患者临床病理资料,并通过门诊就诊系统进行随访.采用双...     

早期乳腺癌患者行乳腺癌根治术和保乳术后放疗的生存比较

目的 探讨乳腺癌根治术和保乳术后放疗对早期乳腺癌患者生存情况的影响.方法 选择早期乳腺癌379例,分为根治术组(341例)和保乳术后放疗组(38例).分别观察两组患者的Karnofsky评分和复发情况.结果 随访5年时保乳术后放疗组患者Karnofsky评分显著高于根治术组(P＜0.05);保乳术后放疗组患者1、3、5...     

三阴性对小肿块乳腺癌患者预后的影响

  目的  分析小肿块（直径≤1 cm）乳腺癌患者的临床及病理学特征,了解其生存状态,探讨三阴性对其预后的影响。  方法  收集本院收治的312例直径≤1 cm乳腺癌患者的临床病理学资料,比较三阴性乳腺癌及非三阴性乳腺癌的临床病理学特征、复发转移及生存情况。  结果  312例直径≤1 cm乳腺癌患者纳入研究,三阴组及非三阴组5年DFS分别为81.4%及90.5%（P= 0.038）,5年BCSS分别为84.7%及93.7%（P=0.047）。以淋巴结状态分组比较,淋巴结阴性患者中,三阴组及非三阴组5年DFS分别为82.8%及94.1%（P=0.033）,5年BCSS分别为85.0%及96.1%（P=0.019）。Cox比例风险模型多因素分析显示,淋巴结阳性患者复发转移风险增高（HR=3.721,95%CI:1.743~7.941,P=0.001）,死亡风险亦增高（HR=3.560,95%CI:1.521~8.330,P=0.003）,三阴性患者复发转移风险增高（HR=2.208,95%CI:1.028~4.742,P=0.042）。  结论  淋巴结阳性及三阴性是影响直径≤1 cm乳腺癌患者DFS的独立危险因素,淋巴结阳性是影响BCSS的唯一独立危险因素。淋巴结阴性三阴性乳腺癌组较非三阴组预后差。      

腋窝淋巴结1～3个转移的早期乳腺癌根治术后放疗的临床价值

Background and Objective:The role of postmastectomy radiotherapy (PMRT) in breast cancer patients with T1-T2 tumors and 1-3 positive axillary nodes is still uncertain. This study investigated the value of PMRT for these patients. Methods:In the retrospective data of 488 eligible patients, survival analysis was performed using the KaplanMeier method. Univariate and multivariate analyses were performed using a log-rank test and the Cox proportional hazards model, respectively. Results:The median observation time was 54 months. The 5- and 10-year Iocoregional recurrencefree survival (LRFS) rates were 90.8% and 86.9%, respectively. The 5- and 10-year disease-free survival (DFS) rates were 82.0% and 74.3%, respectively. The 5- and 10-year overall survival (OS) rates were 90.7% and 82.7%, respectively. For the 412 patients without PMRT, T2 classification, 2-3 positive nodes, and hormone (estrogen and progeeterone) receptornegative were risk factors for locoregional recurrence in the multivariate analysis. On the basis of these 3 risk factors, the group with 2-3 factors had a 10-year LRFS rate of 63.1% compared with 96.1% for the group with 0-1 factors (P<0.001＝.For the group with 2-3 risk factors, LRFS and DFS were significantly improved by PMRT, with the 5- and 10-year LRFS rates without PMRT of 82.4% and 63.1%, respectively, and, with PMRT, of 98.1% at both 5 years and 10 years (P =0.002). The 5- and 10-year DFS rates without PMRT were 72.0% and 57.6%, respectively, and, with PMRT, the 5- and 10-year DFS rates were 89.4% and 81.7%, respectively (P = 0.007). There was no significant difference in the 10-year OS rates between patients with and without PMRT. However, there is the potential benefit of 15.3% (87.1% vs. 71.8%, P =0.072). Conversely, the group with 0-1 factors of PMRT had no effect on prognosis. Conclusions:In patients receiving mastectomy with T1-T2 breast cancer with 1-3 positive nodes, for the group with 2-3 risk factors, PMRT significantly improved LRFS and DFS and has potential benefit in OS.     

中高危老年乳腺癌患者改良根治术后放疗的意义

目的 探讨中高危老年(≥65岁)乳腺癌患者改良根治术后放疗(PMRT)的意义.方法 收集874例改良根治术后中高危乳腺癌患者的临床资料,回顾性分析不同年龄组患者接受PMRT的情况和PMRT的作用,其中T3～T4和(或)N2～N3为高危组,T1～T2N1为中危组.结果 ≥65岁的患者108例,占12.4%.与＜65岁的患者相比,≥65岁的患者中,病理学分级为Ⅲ级、N3、高危和化疗患者所占的比例低,而合并其他疾病和有恶性肿瘤史者所占的比例高.≥65岁的患者中,中危组和高危组患者接受放疗的比例分别为15.3%和52.2%;＜65岁的患者中,中危组和高危组患者接受放疗的比例分别为18.1%和82.7%.≥65岁的患者中,中危组放疗和未放疗者的5年局部区域复发率分别为0和14.2%(P=0.242),5年总生存率分别为100%和75.2%(P=0.159);高危组放疗和未放疗者的5年局部区域复发率分别为0和14.1%(P=0.061),5年总生存率分别为84.6%和77.4%(P=0.597).＜65岁的患者中.中危组放疗和未放疗者的5年局部区域复发率分别为0和9.9%(P=0.035),5年总生存率分别为87.0%和82.1%(P=0.739);高危组放疗和未放疗者的5年局部区域复发率分别为7.2%和26.1%(P=0.000),5年总生存率分别为79.2%和57.7%(P=0.000).结论 不同年龄的中危组患者实施PMRT的比例相仿,但对于高危组患者,接受PMRT的比例随着患者年龄的增长而降低.高危老年乳腺癌患者实施PMRT可能可以降低局部区域复发率,应支持放疗.     

T1-2N0M0 Triple-Negative Breast Cancer Treated With Breast-Conserving Therapy Has Better Survival Compared to Mastectomy: A SEER Population-Based Retrospective Analysis

BackgroundFor early-stage breast cancer, the two current mainstay treatments are breast-conserving therapy (BCT; lumpectomy followed by radiotherapy [RT] and BCT) and mastectomy. Generally, triple-negative breast cancer (TNBC) is more aggressive compared to hormone receptor–positive breast cancer. We sought to investigate the effect of BCT compared to mastectomy on overall survival (OS) and breast cancer–specific survival (BCSS) in T1-2N0M0 TNBC.Patients and MethodsA population-based retrospective analysis was performed using the Surveillance, Epidemiology, and End Results (SEER) database. Patients included in the analysis were divided into 3 groups according to surgical modality and RT: BCT, mastectomy alone, and mastectomy with RT. The survival end points were OS and BCSS, and survival analysis was performed by the Kaplan-Meier method and the log-rank test among treatment types.ResultsA total of 14,910 female subjects with T1-2N0M0 TNBC diagnosed between 2010 and 2014 were included. A total of 7381 patients had BCT; 6967 had mastectomy alone, and 562 had mastectomy with RT. Patients treated with BCT had better OS (log-rank P < .05) and BCSS (log-rank P < .05) than those receiving mastectomy with or without RT. The 5-year OS was 88.6% for BCT, 83.0% for mastectomy alone, and 79.6% for mastectomy with RT. The 5-year BCSS was 94.3% for BCT, 93.3% for mastectomy alone, and 83.7% for mastectomy with RT.ConclusionIn patients with T1-2N0M0 TNBC, BCT was associated with superior OS and BCSS compared to mastectomy with or without RT. After mastectomy, there was no evidence of survival benefit of RT.     

The Association Between Survival and Receipt of Post-mastectomy Radiotherapy According to Age at Diagnosis Among Women With Early Invasive Breast Cancer: A Population-Based Cohort Study

AimsClinical trials of post-mastectomy radiotherapy (PMRT) for early invasive breast cancer (EIBC) have included few older women. This study examined whether the association between overall survival or breast cancer-specific survival (BCSS) and receipt of PMRT for EIBC altered with age.Materials and methodsThe study used patient-level linked cancer registration, routine hospital and radiotherapy data for England and Wales. It included 31 243 women aged ≥50 years diagnosed between 2014 and 2018 with low- (T1-2N0), intermediate- (T3N0/T1-2N1) or high-risk (T1-2N2/T3N1-2) EIBC who received a mastectomy within 12 months from diagnosis. Patterns of survival were analysed using a landmark approach. Associations between overall survival/BCSS and PMRT in each risk group were analysed with flexible parametric survival models, which included patient and tumour factors; whether the association between PMRT and overall survival/BCSS varied by age was assessed using interaction terms.ResultsAmong 4711 women with high-risk EIBC, 86% had PMRT. Five-year overall survival was 70.5% and BCSS was 79.3%. Receipt of PMRT was associated with improved overall survival [adjusted hazard ratio (aHR) 0.75, 95% confidence interval 0.64–0.87] and BCSS (aHR 0.78, 95% confidence interval 0.65–0.95) compared with women who did not have PMRT; associations did not vary by age (overall survival, P-value for interaction term = 0.141; BCSS, P = 0.077). Among 10 814 women with intermediate-risk EIBC, 59% had PMRT; 5-year overall survival was 78.4% and BCSS was 88.0%. No association was found between overall survival (aHR 1.01, 95% confidence interval 0.92–1.11) or BCSS (aHR 1.16, 95% confidence interval 1.01–1.32) and PMRT. There was statistical evidence of a small change in the association with age for overall survival (P = 0.007), although differences in relative survival were minimal, but not for BCSS (P = 0.362).ConclusionsThe association between PMRT and overall survival/BCSS does not appear to be modified by age among women with high- or intermediate-risk EIBC and, thus, treatment recommendations should not be modified on the basis of age alone.     

362例早期鼻咽癌单纯放疗疗效分析

目的 分析早期鼻咽癌患者单纯放疗的长期疗效及不同T与N分期对预后影响.方法 搜集接受单纯放疗的362例早期(T1～T2 N0～1M0期,1992年福州分期)鼻咽癌初治患者的临床资料做回顾分析.结果 中位随访70个月,全组病例5年总生存率为85.0%.T1N0、T2N0和T1N1期5年总生存率分别为96.6%、91.3%和85.8%(χ2=3.83,P＞0.05),T2N1期的(73.1%)比前3个期别明显减低(χ2=30.0,P＜0.05),而4个期别的5年无局部复发生存率和无区域复发生存率均无差异.T1N0、T2N0和T1N1期5年无远处转移生存率分别为94.9%、97.5%和95.6%(χ2=0.53,P＞0.05),T2N1期的(81.2%)比前3个期的明显减低(χ2=26.6,P＜0.05).结论 单纯常规放疗对T1N0、T2N0和T1N1期患者可获得满意疗效.T2N1M0期的疗效明显差于前3个期别,其治疗失败的主要原因是远处转移.针对T2N1M0期筛选容易发生远处转移的个体给予放化综合治疗是下一步研究方向.     

78例乳腺癌改良根治术后pT3N0M0期患者放疗价值探讨

目的 探讨乳腺癌改良根治术后病理分期为T₃N₀期患者的术后放疗价值。方法 回顾分析1997-2014年收治的乳腺癌改良根治术后患者资料,筛选标准为女性、术后病理提示浸润性癌、肿瘤最大径>5 cm且腋窝淋巴结未见转移、未接受新辅助化疗及内分泌治疗,且无远处转移及其他第二原发癌。78例符合条件。40例(51%)接受术后放疗,67例(86%)接受辅助化疗。Kaplan-Meier法计算DFS、OS及LRR率,组间差异用Logrank法检验。结果 中位随访时间79个月(6~232个月),5年OS、DFS和LRR分别为89%、87%和2%。放疗组与未放疗组患者5年DFS分别为84%与91%(P=0.641),5年OS分别为84%与96%(P=0.126),5年LRR分别为0%和5%。仅ER/PR状态、分子分型影响患者DFS (P=0.002、0.031)。未放疗组有1例患者出现胸壁复发。结论 乳腺癌改良根治术后T₃N₀M₀期患者LRR率较低,仅ER/PR状态及分子分型影响患者DFS。在有效系统全身治疗基础上术后病理T₃N₀患者可能不需全部接受胸壁+锁骨上野放疗,但仍需大样本病例证实。     

Neck observation versus elective neck dissection in management of clinical T1/2NO oral squamous cell carcinoma: a retrospective study of 232 patients

Objective:The management of early-stage (cT1/2N0) oral squamous cell carcinoma (OSCC) remains a controversial issue.The aim of this study was to compare the clinical outcomes of neck observation (OBS) and elective neck dissection (END) in treating patients with cT1/2N0OSCC.Methods:A total of 232 patients with cT1/2N0OSCC were included in this retrospective study.Of these patients,181 were treated with END and 51 with OBS.The survival curves of 5-year overall survival (OS),diseasespecific survival (DSS),and recurrence-free survival (RFS) rates were plotted using the Kaplan-Meier method for each group,and compared using the Log-rank test.Results:There was no significant difference in 5-year OS and DSS rates between END and OBS groups (OS:89.0％ vs.88.2％,P=0.906;DSS:92.3％ vs.92.2％,P=0.998).However,the END group had a higher 5-year RFS rate than the OBS group (90.1％ vs.76.5％,P=0.009).Patients with occult metastases in OBS group (7/51) had similar 5-year OS rate (57.1％ vs.64.1％,P=0.839) and DSS rate (71.4％ vs.74.4％,P=0.982) to those in END group (39/181).In the regional recurrence patients,the 5-year O S rate (57.1％ vs.11.1％,P=0.011) and D SS rate (71.4％ vs.22.2％,P=0.022) in OBS group (7/51) were higher than those in END group (9/181).Conclusions:The results indicated that OBS policy could obtain the same 5-year OS and DSS as END.Under close follow-up,OBS policy may be an available treatment option for patients with clinical T1/2N0OSCC.     

Outcome of treatment for breast cancer patients with chest wall recurrence according to initial stage: implications for post-mastectomy radiation therapy

PURPOSE: The impact of postmastectomy radiation therapy (PMRT) on overall survival (OS) for patients with Stage II breast cancer with 1-3 positive lymph nodes is controversial. We sought to compare the outcome of salvage treatment for patients with chest wall recurrence (CWR) according to initial disease stage to shed light on the potential benefit of PMRT in specific subgroups of patients. METHODS: We retrospectively reviewed information concerning 96 patients with CWR who were not previously treated with PMRT. The patients were divided according to their initial extent of disease: T1-T2N0 (Group 1), T1-T2 with 1-3 positive lymph nodes (Group 2), and T3-T4 or > or =4 positive lymph nodes (Group 3). The OS and distant metastasis-free survival (DMFS) from the time of CWR were compared using the method of Kaplan and Meier, and a Cox regression model was used for a multivariate analysis. RESULTS: Group 1 had an improved OS and DMFS compared with Group 2 and Group 3 (p < 0.001), but there were no differences in OS or DMFS between Group 2 and Group 3 (p = 0.250 and p = 0.492, respectively). The respective 5-year rates for the three groups were as follows: OS 79.9% vs. 41.9% vs. 29.1%; DMFS 75.2% vs. 33.6% vs. 25.9%. CONCLUSIONS: Breast cancer patients with T1-T2N0 breast cancer who develop a CWR have a significantly better outcome than those with lymph node-positive disease. Patients with T1-T2 tumors and one to three positive lymph nodes have a similar outcome after CWR as those with larger tumors or more than four positive lymph nodes. These data should be considered when weighing the risks and benefits of PMRT for patients with Stage II breast cancer with one to three positive lymph nodes.