中性粒细胞与淋巴细胞比值对三阴性乳腺癌临床预后及与Ki - 67表达的影响

目的 探讨中性粒细胞与淋巴细胞比值（neutrophil to lymphocyte ratio，NLR）对三阴性乳腺癌的临床预后影响及与Ki - 67表达的关系。方法 回顾性分析2006年1月 - 2012年12月于我院乳腺外科住院治疗的134例三阴性乳腺癌患者。NLR最佳临床分界值采用ROC曲线确定，并依此分NLR＜2.64组和NLR≥2.64组。临床独立预后因素采用单因素和多因素Cox回归模型分析。术后生存时间和生存曲线比较采用Kaplan - Meier和log - rank方法。Ki - 67的表达采用免疫组织化学方法检测。结果 NLR是三阴性乳腺癌的独立预后因素，最佳临界值为2.64。NLR＜2.64组术后中位DFS为39.10月，中位OS为52.30月；NLR≥2.64组术后中位DFS为27.35月，中位OS为37.35月。2组术后DFS和OS比较，差异具有统计学意义（P＜0.05）。NLR低组伴Ki - 67表达阴性的三阴性患者术后中位DFS和OS生存时间显著高于其他情况。结论 NLR是三阴性乳腺癌的关键影响预后因素，具有重复性强、非侵袭性、方便实用等特性，可用于预测三阴性乳腺癌临床预后。     

Menstrual and reproductive characteristics and breast cancer risk by hormone receptor status and ethnicity: The Breast Cancer Etiology in Minorities study

We pooled multiethnic data from four population-based studies and examined associations of menstrual and reproductive characteristics with breast cancer (BC) risk by tumor hormone receptor (HR) status [defined by estrogen receptor (ER) and progesterone receptor (PR)]. We estimated odds ratios and 95% confidence intervals using multivariable logistic regression, stratified by age (<50, ≥50 years) and ethnicity, for 5,186 HR+ (ER+ or PR+) cases, 1,365 HR− (ER− and PR−) cases and 7,480 controls. For HR+ BC, later menarche and earlier menopause were associated with lower risk in non-Hispanic whites (NHWs) and Hispanics, and higher parity and longer breast-feeding were associated with lower risk in Hispanics and Asian Americans, and suggestively in NHWs. Positive associations with later first full-term pregnancy (FTP), longer interval between menarche and first FTP and shorter time since last FTP were limited to younger Hispanics and Asian Americans. Except for nulliparity, reproductive characteristics were not associated with risk in African Americans. For HR− BC, lower risk was associated with later menarche, except in African Americans and older Asian Americans and with longer breast-feeding in Hispanics and Asian Americans only. In younger African Americans, HR− BC risk associated with higher parity (≥3 vs. 1 FTP) was increased fourfold in women who never breast-fed, but not in those with a breast-feeding history, suggesting that breast-feeding may mitigate the adverse effect of higher parity in younger African American women. Further work needs to evaluate why menstrual and reproductive risk factors vary in importance according to age and ethnicity.     

乳腺癌缺氧诱导因子-1α、Ki-67表达与超声声像特征的关系

目的探讨乳腺癌患者乳腺癌组织中的缺氧诱导因子-1α(HIF-1α)、Ki-67蛋白的表达与超声声像特征的关系。方法对110例乳腺癌患者进行超声检查,观察患者的毛刺征、肿块形态、钙化灶形态和血流显像分级等。取110例乳腺癌患者的乳腺癌组织,免疫组化法检测HIF-1α、Ki-67蛋白的阳性表达率。分析不同超声声像特征乳腺癌患者乳腺癌组织中HIF-1α、Ki-67蛋白的表达情况。结果110例乳腺癌患者中,43例既存在Ki-67蛋白阳性表达又存在HIF-1α蛋白阳性表达,35例仅存在Ki-67蛋白阳性表达,13例仅存在HIF-1α蛋白阳性表达,Ki-67、HIF-1α蛋白阴性表达患者共19例。乳腺癌患者乳腺癌组织中Ki-67蛋白的阳性表达率为70.91%(78/110),HIF-1α蛋白的阳性表达率为50.91%(56/110)。不同肿块形态、钙化灶形态、血流显像分级乳腺癌患者乳腺癌组织中Ki-67蛋白阳性表达率比较,差异均有统计学意义(P﹤0.05)。不同血流显像分级乳腺癌患者乳腺癌组织中HIF-1α蛋白阳性表达率比较,差异有统计学意义(P﹤0.05)。结论乳腺癌患者乳腺癌组织中HIF-1α的表达可能与血流显像分级有关,Ki-67的表达可能与肿块形态、钙化灶形态及血流显像分级有关。     

植入物乳房重建一步法和二步法临床对比研究

目的:探讨即刻乳房假体重建（一步法）和应用扩张器的假体重建（二步法）两种不同手术方式在术后并发症、美容效果和成本效益的差异。方法:回顾性分析我院乳腺外科2015年5月至2018年5月收治的285例乳腺癌植入物重建患者，依据手术方式不同分为一步法组（145例）和二步法组（140例），比较两组患者临床资料的差异。结果:一步法组术后出血发生率（6.8%）高于二步法组（1.4%），差异有统计学意义（P=0.021）。一步法组术后伤口皮瓣坏死率（6.2%）高于二步法组（1.4%），差异有统计学意义（P=0.036）。二步法组乳房满意度评分（81.5±7.1）分高于1步法组（78.6±6.2）分，差异有统计学意义（P=0.035）。二步法组住院总花费（80 334.8±6 149.8）元高于一步法组（60 966.5±5 544.9）元，差异有统计学意义（P=0.049）。二步法组住院天数（34.3±3.2）天多于一步法组（17.5±3.9）天，差异有统计学意义（P=0.014）。结论:在植入物乳房重建两种手术方式中，二步法相较于一步法，其并发症少，美容效果好，但在成本效益上并不优于一步法。     

从“血不利则为水”探讨乳腺癌相关淋巴水肿

导致血不利的原因一是不足,即由于气、血、津、液等物质的缺乏致无源行血;一是不通,即水、湿、痰、饮、瘀、食积、火郁、内风、外伤等病理因素阻滞,致血行不畅。血瘀经脉之内,则水亦瘀积脉中,致脉络胀满,形成水肿。乳腺癌术后患者,金刃本已损伤血脉,术后的放疗、化疗又属祛邪之法,故机体元气受损,气虚无力行血,血运行不畅,导致患侧上肢水肿。故治疗乳腺癌相关淋巴水肿时,应当血水同治,即活血利水之法要贯穿始终。先病血而后病水者,可以活血化瘀为主,利水为辅;先病水后病血者,则以利水消肿为主,酌加活血养血之品。但需要注意的是:①临证时切不可拘泥于单纯的活血利水法,而忽视乳腺癌相关淋巴水肿(breast cancer related lymphedema,BCRL)患者机体本身的状况。②临证勿忽视五脏与血、水的关系,以及肺、脾、肾、三焦与水肿的内在关系。③可多种方法联合运用,审证求因,标本同治。BCRL术后宜补气活血,通脉利水;术后兼化疗者可疏肝健脾、利水消肿;早期可在活血利水基础上,侧重利湿消肿,后期多湿聚为痰,治疗侧重化痰软坚。     

不同影像检查在乳腺结构扭曲中的研究进展

我国乳腺癌的发病率占女性恶性肿瘤疾病的首位,结构扭曲病变(architectural distortion,AD)作为触诊阴性乳腺癌的第三最常见影像学表现,也是乳腺癌最早出现的征象,具有重要的临床价值。AD具有较高的漏诊率及假阳性率。本文通过查阅文献,针对超声、乳腺X线摄影、乳腺数字三维断层摄影技术及核磁共振成像技术在乳腺结构扭曲病变中的研究进展及优缺点进行分析,进一步指导科学研究及临床工作。     

基于蛋白质组学分析色胺酮抑制小鼠乳腺癌的作用机制

目的:采用非标记定量(Label-free)蛋白质组学技术研究色胺酮抗小鼠体内乳腺癌的作用机制。方法:采用超高效液相色谱-质谱联用技术检测色胺酮抗小鼠乳腺癌的表达蛋白,选择Ionoptics nano UPLC C18色谱柱(0.075 mm×250 mm,1.6μm),流动相0.1%甲酸水溶液-0.1%甲酸乙腈溶液梯度洗脱,正离子模式,扫描范围m/z 100～1 700,使用MaxQuant 1.6.5.0进行数据库检索。采用Label-free高分辨质谱的蛋白质组学技术筛选4T1乳腺癌小鼠模型组与色胺酮(100 mg·kg~(-1))口服给药组之间的差异表达蛋白,进行色胺酮抗乳腺癌的蛋白质组学研究。结果:共鉴定出3 997个蛋白质,其中有2 911个蛋白可定量。模型组与色胺酮组共750个差异表达蛋白,其中286个蛋白上调,464个蛋白下调。基因本体分析表明,这些差异表达蛋白主要参与增殖、细胞迁移、凋亡、免疫、血管生成和炎症调节等生物学过程。京都基因与基因组百科全书通路分析进一步表明,这些蛋白主要集中于T细胞受体,B细胞受体,Toll样受体,核转录因子-κB(NF-κB),Ras蛋白,白细胞介素-17,肿瘤坏死因子,磷脂酰肌醇3-激酶/蛋白激酶B(PI3K-Akt)和丝裂原活化蛋白激酶(MAPK)等信号通路。结论:与色胺酮抗4T1乳腺癌作用密切相关的差异表达蛋白包括上调蛋白白细胞分化抗原14(CD14),前列腺素G/H合酶2(PTGS2),泛素蛋白连接酶E3和下调蛋白CD44,70 kDa热休克蛋白1A(HSPA1A),巨噬细胞移动抑制因子(MIF),NF-κB,核糖体蛋白S6激酶α-4(RPS6KA4)和高迁移率族蛋白B1(HMGB1),提示色胺酮主要通过调节肿瘤炎症微环境来达到抑制小鼠乳腺癌的作用。     

Bishonokiol A Induces Multiple Cell Death in Human Breast Cancer MCF-7 Cells

Objective: A dimeric neolignan, bishonokiol A (BHNKA) isolated from Magnolia grandiflora, significantly inhibits the proliferation of human breast cancer cells. However, the exact mechanism of BHNKA induced breast cancer cell death is unknown. In this study, we investigated the pharmacological mechanism underlying BHNKA induced MCF-7 cell death. Methods: Cell viability measurement was performed by the MTT assay. Flow cytometry with PI staining, DAPI staining, and electron microscopy were used to analyze cellular death modes. In addition, western blotting, siRNA transfection, ATP assay, and fluorescence microscopy were used to determine the mechanism of BHNKA induced MCF-7 cell death. Results: BHNKA induced cell death by apoptosis, necroptosis and autophagy at the same concentration and time in MCF-7 cells, and electron microscopy confirmed these results. The mechanism of BHNKA triggered apoptosis and autophagy in MCF-7 cells was primarily due to an increase in the Bax/Bcl-2 ratio and simultaneous up-regulation of LC3-II protein expression, respectively. BHNKA induced necroptosis by activation of the RIP1-RIP3-MLKL necroptosis cascade, up-regulation of cyclophilin D (CypD) protein expression to stimulate ROS generation. We further demonstrated that siRNA-mediated down-regulation of CypD protected against BHNKA induced cell death. Conclusions: These results suggest that BHNKA may be a potential lead compound for development as an anti-breast cancer agent for induction of multiple cell death pathways.