44例隐匿性乳腺癌临床分析

目的 分析隐匿性乳腺癌的诊断、治疗及预后情况,总结其诊断和治疗经验.方法 回顾性分析44例隐匿性乳腺癌患者的临床资料,44例隐匿性乳腺癌患者中,16例行乳腺癌根治术,19例行乳腺癌改良根治术,1例行保留乳腺的腋下淋巴结清扫,8例仅行腋下肿物切除.结果 在接受乳腺癌根治术的35例患者中,有4例(11.4%)在术后病理切片中发现原发灶,原发灶的最大直径为0.6～2.5 cm,其中3例为浸润性导管癌,1例为黏液腺癌;另有3例可在标本中见不典型增生.全组有38例患者获得随访,随访时间为12～132个月.32例行手术治疗且获得随访的患者中,2例死亡,3例术后局部复发并带瘤生存;未接受进一步手术治疗患者中,有2例分别于确诊后16和41个月后因浸润性导管癌行乳腺根治术;其余患者均无病生存.结论 对以腋下淋巴结肿大为惟一临床表现、经肿物活检确认为转移性腺癌的女性患者,应高度怀疑隐匿性乳腺癌的可能性.隐匿性乳腺癌的治疗方式可采用腋窝淋巴结清扫后全乳放疗或乳腺癌根治术.

Abstract：

Objective To summarize the experience of diagnosis and treatment of occult breast cancer in 44 cases. Methods Clinicopathological data of 44 cases of occult breast cancer initially presenting axillary mass alone treated in our department during Jan 1997 to Dec 2008 were retrospectively analyzed. Results The 44 patients with occult breast cancer accounted for 0.42% of all breast cancer patients admitted to our hospital and institute in the same period. The surgery included radical mastectomy in 16 cases, modified radical mastectomy in 19 cases, axillary clearance in 1 case, and simple axillary node excision in 8 cases. Follow-up, ranging from 12-132 months, was available in 38 cases. Among 32 cases who underwent mastectomy or axillary clearance, 2 cases died of distant metastases and 3 cases were still alive with local recurrence at the time of analysis. In two out of six cases who refused further surgical treatment received mastectomy 16 months and 41 months after the primary diagnosis of occult breast cancer, respectively. Others were alive without evidence of recurrence or metastases at the time of analysis. Conclusions Occult breast cancer should be taken into consideration in cases presenting with axillary metastasis of unknown primary origin. The treatment of occult breast cancer should include modified radical mastectomy/radical mastectomy or breast conserving surgery combined with breast irradiation.     

Breast cancer outcomes in South Asian population of West Yorkshire

OBJECTIVE: To examine tumour stage at diagnosis, treatment, patient and provider delays to diagnosis/treatment and survival of South Asian patients with breast cancer in Yorkshire in comparison with the general population. DESIGN: Retrospective study, using Yorkshire Cancer Registry population-based data on breast cancer. Data on 16,879 women with breast cancer diagnosed between 1986 and 1994 was available, of which 120 patients were South Asian. All-cause survival, controlling for age, socio-economic profile, tumour stage and treatment was examined. Effects of ethnicity on tumour stage at diagnosis, treatment, patient and provider delays to diagnosis and treatment were described. Over the period 1986-1994, an increase in the number of registered South Asian patients with breast cancer was observed. South Asian patients were significantly younger at the time of diagnosis and presented with larger primary tumours. They received similar treatment to non-Asian patients, but a higher mastectomy rate was noted. South Asian patients' survival, after controlling for age differences was similar to non-South Asian patients. South Asian patients had a significantly longer patient-related delay between initial symptoms and presentation to GP and a slightly longer provider-related delay in time to diagnosis and treatment. In conclusion, outcomes of breast cancer treatment in South Asian patients were similar to non-Asian patients. Asian patients presented later to their GPs, with larger primary tumours and more frequently had mastectomy.     

咸阳地区女性乳腺癌患者临床特点及预后分析

目的:了解咸阳地区女性乳腺癌患者临床特点和预后情况,为乳腺癌防治及个体化治疗提供依据。方法:本研究纳入472例咸阳市2所三级甲等医院于2008年3月至2015年1月期间收治的乳腺癌患者,入组患者均为女性且行外科手术治疗。收集入组患者的临床特征并分析患者影响复发转移和生存的相关因素。结果:本研究中位随访时间56个月,随访过程中失访9例;肿块大小、是否有淋巴结转移、组织学分级、是否三阴性乳腺癌是预测肿瘤复发转移及预后的独立影响因子。结论:咸阳地区乳腺癌生存情况较国内生活水平高的地区差,复发转移率高,早期诊断能够改善患者预后。     

Analysis of the indicence and Survival of Female Breast Cancer Patients in Beijing Over a 20-Year Period

A bout 30-years of information concerning cancer morbidity and mortality has been collected by the Cancer Registration Office of Beijing since its establishment in 1976. The information suggested that lung cancer and female breast cancer (FBC) are relativ…     

The role of surgery in the management of solitary pulmonary nodule in breast cancer patients.

AIMS: To assess the role of surgery in the diagnosis and treatment of a solitary pulmonary nodule (SPN) in patients who had received previous surgery for breast cancer. METHODS: A series of 79 consecutive patients who underwent surgery for an SPN between 1990 and 2003 after a curative resection for breast cancer were reviewed. RESULTS: Surgical diagnosis was obtained by open procedure before 1996 (37 cases), and by video-assisted thoracoscopic surgery (VATS) after 1996 (33 out of 42 cases, 9 open procedures) and intraoperative evaluation. Histology of SPN was primary lung cancer in 38 patients, pulmonary metastasis of breast cancer in 27, and benign condition in 14. VATS was converted to open procedure for anatomical resection in primary lung cancer and for the palpation of the lung in metastatic disease. Average disease-free interval from the initial mastectomy was significantly longer in primary lung cancer than in metastatic patients (179+/-107 vs 51+/-27 moths). Manual palpation identified multiple pulmonary nodules in 3 out of 27 metastatic patients. Five-year survival rate after pulmonary metastasectomy was 38% and was significantly influenced by disease-free interval; 5-year survival rate after resection of primary lung cancer was 43% and was significantly influenced by the pathological stage. CONCLUSIONS: VATS is a good procedure for diagnostic management of peripheral SPN. As SPN in breast cancer patients is primary lung cancer in half cases, it deserves confirmation of pathological diagnosis and appropriate surgical treatment. When breast cancer metastasis is demonstrated, open procedure must be performed to palpate the entire lung to exclude previously unknown nodules.     

淋巴结阴性结肠癌伴同时性肝转移患者的临床病理因素分析*

目的:分析淋巴结阴性结肠癌患者发生同时性肝转移的危险因素,提高高危患者随访的效率和早诊率。方法:回顾性分析2008年1 月至2012年12月就诊北京肿瘤医院胃肠肿瘤中心并且行手术治疗的140 例淋巴结阴性结肠癌患者临床病理资料,通过单因素和多因素分析,研究淋巴结阴性结肠癌同期肝转移的高危因素。结果:140 例淋巴结阴性结肠癌患者同期肝转移13例（9.2%）,61.5%（8/ 13例）的患者伴有不全性结肠梗阻,6 例患者接受原发灶和肝转移灶同期手术治疗。单因素分析和多因素分析均提示脉管浸润（P = 0.010）和术前CEA 水平异常（P = 0.004）是淋巴结阴性结肠癌患者发生同时性肝转移的独立危险因素。结论:淋巴结阴性结肠癌存在较高的同时性肝转移风险,脉管浸润和术前CEA 水平异常是这类患者发生同期肝脏转移的高危因素,对具有该特征的患者在就诊时或根治术后应该针对性地检查肝脏情况,避免漏诊。      

乳腺癌合并肺孤立性结节外科治疗的临床分析

为了探讨外科治疗在乳腺癌合并肺孤立性结节诊断及治疗中的作用,对13例乳腺癌根治术同期行肺孤立性结节手术切除的临床资料进行回顾性分析。结果:手术治疗的13例患者中,肺孤立性病灶的病理结果6例为原发性肺癌,5例为乳腺癌肺转移,2例为良性病变;手术方式:1998年以前患者采用小切口开胸手术(4例),之后的患者采用胸腔镜辅助小切口手术(9例)。术后并发症为皮下气肿和支气管胸膜瘘,无手术死亡。初步研究结果提示,乳腺癌合并的肺孤立性结节并不都是肺转移瘤,乳腺癌合并肺孤立性结节应该尽可能取得病理诊断,得到正确的治疗。     

隐性乳腺癌的诊治(附68例报告)

目的：探讨隐性乳腺癌的发病特点、检诊规范和治疗方法.方法：回顾性分析68例隐性乳腺癌临床病理资料和治疗效果.结果：全组均经腋窝淋巴结活检及免疫组化M4G33检测明确诊断,65例行根治术或改良根治术,3例行腋窝肿块切除,术后全部辅助放、化疗,全组5、10年生存率分别为77.9%和58.12%;术后常规病检原发灶检出率33.8%（22/65）,结合全乳腺次连续大切片检查,病理原发灶总检出率达86.2%（56/65）.结论：对女性腋窝肿块同时排除全身其它部位癌转移者应高度考虑隐性乳腺癌,腋窝淋巴结活检和免疫组化M4G3检测对确诊有重要意义;根治术标本宜行全乳腺次连续大切片检查以提高原发癌灶检出率,治疗宜选择根治术或改良根治术并辅助放疗、化疗以及内分泌治疗.     

多原发恶性肿瘤—乳腺肺四重癌1例报告并文献复习

目的:探讨多原发恶性肿瘤的发病特点,提高对该肿瘤的认识,减少临床漏诊误诊,延误治疗。方法:分析我院1例乳腺肺四原发恶性肿瘤的诊治经过,并结合文献进行回顾总结。结果:该例首患乳腺癌,17年后再同时患肺乳腺三重癌,最终确诊为乳腺肺四原发恶性肿瘤。结论:多原发恶性肿瘤发病与宿主自身状况、环境、遗传、治疗等多因素有关,临床容易漏诊或误诊为复发癌和转移癌,治疗和预后与单原发肿瘤一样,异时性好于同时性。     

不同年龄女性乳腺癌患者的临床特征及预后分析

目的分析不同年龄段女性乳腺癌患者的5年净生存率以及发病年龄与乳腺癌死亡风险的关系。方法回顾性收集2006—2010年北京市4所医院北京户籍的乳腺癌患者首诊病例资料。共纳入浸润性、原发性女性乳腺癌患者3470例,随访截至2018年12月31日,获取全部患者的生存信息。采用寿命表法分析各年龄组乳腺癌患者的5年净生存率,采用Cox比例风险模型分析不同年龄组乳腺癌患者发生乳腺癌死亡的风险,采用限制性立方样条模型分析发病年龄与乳腺癌死亡风险之间的剂量反应关系。结果3470例女性乳腺癌患者的平均年龄为53.2岁,其中45~54岁年龄组发病人数最多(1289例),占37.15%;<35岁年龄组发病人数最少(126例),仅占3.63%。随访期间,死于乳腺癌的患者528例(15.22%),乳腺癌5年净生存率为90.72%(95%CI为89.74%~91.70%);<35岁和≥65岁乳腺癌患者的5年净生存率较低,分别为88.68%(95%CI为83.09%~94.27%)和87.05%(95%CI为84.27%~89.82%)。控制潜在的混杂因素后,以乳腺癌发病年龄为45~54岁为参照,<35岁和≥65岁年龄组发生死亡的HR分别为1.72(95%CI为1.06~2.81)和1.89(95%CI为1.43~2.49),且在Luminal A和Luminal B分子分型中,≥65岁患者具有更高的乳腺癌死亡风险(Luminal A型:HR=1.70,95%CI为1.17~2.46;Luminal B型:HR=3.84,95%CI为1.74~8.49)。限制性立方样条模型分析结果显示,乳腺癌发病年龄与乳腺癌死亡风险的关联呈现非线性的J形剂量反应关系(非线性检验P<0.0001)。结论年龄为影响乳腺癌患者预后的独立因素,年轻和老年乳腺癌患者的预后均较差。     

Bilateral breast masses as initial presentation of widely metastatic melanoma

BACKGROUND AND OBJECTIVES: Malignant melanoma is the most rapidly increasing cancer in the world. Metastatic disease occurs in 20% of patients. Metastatic cancer to the breast is rare, but primary breast cancer is one of the leading causes of death in women. In the present study, a large personal series of breast biopsies is reviewed, and 2 cases of metastatic malignant melanoma to both breasts are reported. METHODS: A personal series of 1,200 breast biopsies from 1975 to 1998 were reviewed. In this series, 2 cases of metastatic melanoma to both breasts were identified. RESULTS: Two female patients, ages 31 and 34 years, were evaluated for bilateral breast masses. Both were treated with simple excision of the breast tumor. Postoperatively, both patients were found to have widespread metastatic disease to the brain, lung, and liver. Despite aggressive treatment with chemotherapy and radiation, the patients died at 6 and 22 months, respectively, after the initial presentation. CONCLUSION: Bilateral breast metastasis from malignant melanoma is rare. Care must be taken to make a correct diagnosis of metastatic melanoma rather than of primary breast cancer. An incorrect diagnosis of anaplastic carcinoma can lead to major surgical procedures that are of no value. The long-term prognosis of patients with bilateral breast metastasis from malignant melanoma is poor.     

Challenges in the Management of Breast Cancer in a Low Resource Setting in South East Asia

Background: Breast cancer is the second most common cancer in women in Cambodia, a low income country in SouthEast Asia. The Sihanouk Hospital Centre of Hope (SHCH) is a charity hospital set up by an international nongovernmental organisation, HOPE Worldwide. In 2008, SHCH partnered with AmeriCares, a global health organisation to set up and deliver a breast cancer programme to provide education, diagnosis and treatment for women with breast cancer. The objective of this study is to characterise the presentation, diagnosis, treatment and outcomes of women treated under this program. Materials and Methods: A total of 215 women newly diagnosed with breast cancer from 1 March 2008 until 31 March 2011 were studied. Age at diagnosis, tumour size, histological type, tumour grade, ER, lymph node involvement, treatment modalities (surgery, radiotherapy, chemotherapy, hormone therapy) were recorded. Data on mortality at 3 years were obtained whenever possible. Results: The median age was 47 years old. Some 77.8% were diagnosed with stage 3 and 4 lesions, and 78.5% underwent mastectomy, of which 28.4% the intent was palliative. Of those whose ER status were known, only 48.3% were ER positive. Only 6 patients could afford chemotherapy while only 1 patient had radiotherapy. Hormone therapy was provided free for those who were ER positive. The overall survival rate at 3 years was 39.1%. Conclusions: Breast cancer presents at a late stage, and because treatment is suboptimal, survival is poor in Cambodia. A more aggressive approach to early detection and treatment needs to be developed to improve outcome from this potentially curable disease.     

Age at diagnosis and multiple primary cancers of the breast and ovary

Summary This nested case-control study assessed the relationship between a woman's age at the time of her initial primary breast or ovarian cancer diagnosis and the risk of a second primary cancer at the other of these two sites. Multiple primary breast and ovarian cancer cases whose initial breast or ovarian diagnosis occurred in 1970–1989 and a random sample of single primary breast or ovarian cancer controls diagnosed in the same years were identified through tumor registries at Duke University Medical Center and the University of North Carolina. Women diagnosed with an initial primary breast cancer at age 50 years were 4.3 times (95% CI: 1.8–10.6) more likely to have developed a subsequent ovarian cancer compared to those diagnosed after age 50. A relationship between an early age at diagnosis ( 50) of ovarian cancer and subsequent diagnosis of breast cancer was not found (odds ratio (OR) = 0.6; 95% CI: 0.2–2.0). Adjustment for stage at diagnosis, treatment, year of diagnosis and length of follow-up using Cox Proportional Hazards modeling techniques supported these relationships, yielding a hazard ratio (HR) for the development of a second primary cancer at the alternate site of 4.6 (95% CI: 1.8–11.5) for women with an initial breast cancer diagnosis and 0.6 (95% CI: 0.2–2.2) for women with an initial ovarian cancer diagnosis. Multiple primary breast and ovarian cancer patients diagnosed with an initial breast cancer at or prior to age 50 may represent a distinct subgroup of women with a germline mutation that confers susceptibility to both breast and ovarian cancers.     

北京城区女性乳腺癌发病死亡和生存情况20年监测分析

目的 探讨北京城区乳腺癌发病率、死亡率及生存率的变化特点,为乳腺癌的预防与控制提供依据。方法 利用1982-2001年北京城区肿瘤登记报告资料,并结合1982年1月1日至1983年12月30日和1987年1月1日至1988年12月30日两个时期新发病例的随访资料,对北京城区女性乳腺癌的发病率、死亡率、生存率进行比较分析。结果 1982-2001年北京城区女性乳腺癌发病率及世界标准人口标化率呈逐年上升趋势,平均每年递增4．6％和4．9％。其流行特征：（1）年龄别发病率呈现一条由低到高的双峰曲线;（2）20年间各年龄组发病率均呈增高趋势;（3）35～64岁截缩发病率高达95．3／10万;（4）1982-1983年和1987-1988年两个时期相比,5年观察生存率（OSR）从62．0％上升到68．7％,相对生存率（RSR）由66．3％增长到74．2％;（5）20年间,死亡率一直在8／10万～10／10万的水平上波动。结论 北京城区女性乳腺癌发病率呈逐年上升的流行趋势,死亡率呈平稳状态,5年生存率在不断提高。北京市乳腺癌的二级预防是有效果的。     

Influence of comorbidity on the effect of adjuvant treatment and age in patients with early-stage breast cancer

Background:

Prevalence of comorbidity at breast cancer diagnosis increases with age and is likely to influence the likelihood of receiving treatment according to guidelines. The aim of this study was to examine the effect of breast cancer treatment on mortality, taking age at diagnosis and comorbidity into account.

Methods:

Four nationwide population registries in Denmark: the Danish Civil Registration System, the Danish Breast Cancer Cooperative Group, the Danish National Patient Register, and the Danish Register of Causes of Death provided information on 62 591 women diagnosed with early-stage breast cancer, 1990–2008, of whom data on treatment were available for 39 943. Comorbidity was measured using the Charlson Comorbidity Index. Adjuvant treatment were categorised as none, chemotherapy, endocrine therapy, and unknown. Multivariable Cox modelling assessed the effect of comorbidity on breast cancer-specific mortality and other cause mortality according to treatment, adjusting for age at diagnosis and other clinical prognostic factors.

Results:

The impact of comorbidity on mortality was most pronounced in patients aged 50–79 years. Patients receiving chemotherapy with mild to moderate comorbidity had HR 0.99 (95% confidence interval (CI); 0.82–1.19) and 1.06 (95% CI; 0.77–1.46) for breast cancer-specific mortality, respectively, compared with patients without comorbidity.

Conclusion:

Comorbidity at breast cancer diagnosis is an independent adverse prognostic factor for death after breast cancer. We identified a subgroup of patients with mild to moderate comorbidity receiving chemotherapy who had similar breast cancer mortality as patients with no comorbidity.     

Genetic implications of bilateral breast cancer: a population based cohort study

BACKGROUND: Women with breast cancer are at high risk of bilateral breast cancer. We aimed to assess the incidence of bilateral breast cancer in relation to age and time since diagnosis of first cancer. METHODS: We analysed a population-based cohort of 123757 women with a first primary breast cancer diagnosed in Sweden from 1970 to 2000 for frequency of bilateral breast cancers and deaths by means of record linkage. Second primary breast cancers were categorised as synchronous bilateral breast cancers if diagnosed within 3 months of the first primary cancer or as metachronous if diagnosed more than 3 months after diagnosis of first primary cancer. FINDINGS: We identified 6550 women who had developed bilateral breast cancer. Age-incidence patterns of synchronous and unilateral breast cancer were similar, although the absolute rates of synchronous bilateral cancer were 50-100 times lower than those of unilateral cancer. A woman aged 80 years or older is at least twice as likely to be diagnosed with synchronous bilateral breast cancer than is a woman younger than 40 years. In the first 20 years after diagnosis of primary breast cancer, incidence of metachronous bilateral cancer decreased from about 800 per 10(5) person-years to 400 per 10(5) person-years in patients diagnosed with primary breast cancer before the age of 45 years, whereas incidence remained at 500-600 per 10(5) person-years in those age 45 years or older at diagnosis. After 30 years' follow-up, cumulative risk of metachronous bilateral breast cancer was about 15% irrespective of age at first primary breast cancer. INTERPRETATION: The higher than expected risk of synchronous bilateral breast cancer could be explained by non-genetic factors. By contrast, incidence of metachronous bilateral cancer fits neither a model of highly penetrant genes nor aggregation of environmental risk factors.     

宫颈鳞状细胞癌乳腺转移3例报道并文献复习

目的:探讨宫颈鳞状细胞癌乳腺转移的临床病理特征,以期提高对该病的认识。方法:回顾性分析我院3例宫颈鳞状细胞癌乳腺转移患者的临床资料、影像学特征、病理学特征及预后,并复习国内外相关文献。结果:宫颈鳞状细胞癌乳腺转移非常罕见,本文报道3例患者以乳腺肿块就诊,影像学检查无法与原发性乳腺癌相鉴别,通过肿块病理学检查及免疫组化染色确诊为宫颈鳞状细胞癌转移。虽经积极的抗肿瘤综合治疗,但患者生存期仍然极短。结论:乳腺转移性鳞状细胞癌极易误诊为原发性乳腺癌,需结合病史、组织形态学特征及免疫表型等进行诊断和鉴别诊断,避免误诊。宫颈鳞状细胞癌患者一旦出现乳腺转移,生存期短、预后差。     

筛查与非筛查乳腺癌病理特征的比较

目的:探讨乳腺癌筛查在乳腺癌早期诊断和早期治疗中的作用,为中国开展乳腺癌筛查项目提供参考依据.方法:2008年7月-2009年9月在天津、南昌、肥城和沈阳这4个城市开展了横断面多中心乳腺癌筛查项目.在22 960例无临床症状妇女中最终确诊67例乳腺癌病例,并收集同期同年龄段至天津医科大学附属肿瘤医院就诊并确诊的1 547例乳腺癌患者的资料.结果:在筛查出的乳腺癌患者中,原位癌占11.9％;而在临床就诊而确诊的乳腺癌患者中,原位癌占6.8％(P=0.136).与临床就诊而确诊的乳腺癌患者相比,筛查出的浸润性乳癌癌患者中,早期、低病理分级、肿瘤较小、淋巴结阴性和无远处转移者更多(P=0.003,P=0.010,P=0.008,P=0.000和P=0.004).结论:与非筛查的乳腺癌患者相比,通过开展乳腺癌筛查项目检查出的乳腺癌患者具有较好的病理特征.     

Second primary cancers of the breast: incidence and risk factors.

Between 1946 and 1976 over 9,000 women with breast cancer were seen within one year of diagnosis at the A. Maxwell Evans Clinic (AMEC) in Vancouver, British Columbia. By 1978, 275 had a subsequent diagnosis of a second primary in the contralateral breast: 100 were diagnosed within 1 year, and 175 after 1 year of the first primary. Two separate comparison groups of AMEC patients with unilateral breast cancer were selected to identify risk factors for bilateral breast cancer and to determine the incidence. The average annual incidence rates for a second primary in the contralateral breast were 5.0, 4.1 and 3.0 per 1,000 women for women less than 45 years, 45-54 years, and over 55 years of age at diagnosis of first primary breast cancer, respectively. These rates remained stable for at least 15 years after the diagnosis of the first primary. Two risk factors were found for bilateral cancer within 1 year of the first primary, histologic diagnosis of lobular carcinoma and absence of pathologic involvement of axillary nodes; one risk factor was found for bilateral breast cancer after 1 year of the first primary, family history of breast cancer.     

乳腺癌脑转移67例临床分析

背景与目的:随着乳腺癌全身治疗疗效的提高和患者生存期的延长,乳腺癌脑转移在临床上越来越常见。本研究通过分析乳腺癌脑转移的临床特点,探讨其治疗方式及预后因素。方法:67例患者出现脑转移距离确诊乳腺癌的时间为0～15年,中位时间为2.5年。治疗方式为手术加放疗3例,单纯放疗30例,单纯化疗3例,放疗加化疗26例,未治疗5例。采用SPSS10.0统计软件进行生存分析,采用Kaplan-Meier分析和log-rank检验进行生存预后分析。结果:乳腺癌脑转移最常见的症状是头痛,脑实质为最常受累部位。全组患者中位生存期为4年,出现脑转移后的中位生存时间为11个月。月经状况、脑转移数目、合并全身转移情况及治疗方式对患者的生存时间均无明显影响。结论:乳腺癌脑转移预后差,目前治疗仍以全脑放疗为主,化疗的作用还需进一步研究。