晚期乳腺癌脑转移危险因素分析

目的 分析晚期乳腺癌脑转移危险因素,指导临床筛选脑转移高危患者。方法 应用卡方检验及t检验进行单变量分析,对筛选出的脑转移危险因素进行多变量Logistic回归分析。结果 单变量分析显示,肿瘤最长径、阳性淋巴结数目、分子分型、人类表皮生长因子受体2（human epidermalgrowth factor receptor 2,HER2）、辅助化疗、无病生存时间、肺转移、局部复发、淋巴结转移9项因素有统计学意义（P<0.05）。多变量Logistic回归分析显示,术后辅助化疗不标准（P<0.001）、存在肺转移（P=0.003）及HER2阳性（P=0.003）为晚期乳腺癌脑转移的高危因素;所得Logistic回归方程对脑转移的预测正确率为73.9%。结论 晚期乳腺癌脑转移高危因素为术后辅助化疗不标准、存在肺转移及HER2阳性。     

Prognostic Factors for Patients With Advanced Colorectal Cancer and Symptomatic Brain Metastases

BackgroundIncreased rates of long-term survival after CRC diagnosis are accompanied by increases in the incidence of BMs. Here, we retrospectively evaluated the outcomes of patients with BMs from CRC.Materials and MethodsWe reviewed the records of 1364 patients with CRC treated between January 1999 and December 2010 at Kinki University Hospital in Japan. Twenty-five of these patients developed BMs. Log-rank tests and Cox regression analyses were used to assess potential prognostic factors for survival.ResultsAmong the patients with BMs, BMs developed a median of 25.3 (range, 11.4-111) months after primary CRC surgery. There was a median of 2 BMs per patient. Eleven patients had solitary BMs. Concomitant extracerebral metastases, particularly lung metastases, were found in 23 patients. Twenty-three patients were receiving systemic chemotherapy at the time of diagnosis with BMs. After the development of BMs, the median survival time (MST) was 2.8 months. The MST was 4.8 months among patients who underwent neurosurgical resection (n = 6) or stereotactic surgery (n = 9, including combined therapy in 2 patients) and 1.5 months among patients who underwent whole-brain radiotherapy only or best supportive care (n = 12). In multivariate analysis, single BMs and additional systemic chemotherapy after BMs diagnosis were significantly associated with overall survival (P = .022 and .023, respectively).ConclusionOur results suggest that advancements in continuing systemic chemotherapy prolong survival among patients with BMs from CRC. Clinicians should be especially aware of BMs in patients with lung metastases.     

男性结直肠癌超额发病风险中已知危险因素的解释效果分析

摘 要：［目的］ 结直肠癌发病性别差异较大,但原因不明,该研究拟评价男性结直肠癌发病超额风险中已知危险因素的解释比例。［方法］ 针对我国4个省参加结直肠癌筛查项目的参与者,开展结直肠癌危险因素分析。采用Logistic回归和超额风险解释度分析(explained share of excess risk,ERR）评价男性超额风险的危险因素解释比例。［结果］ 男性结直肠癌发病风险是女性的1.8倍(OR=1.80,95%CI：1.62～1.99,P<0.01);该部分超额风险可以被烟草暴露、酒精摄入、蔬菜摄入、水果摄入、畜肉摄入、粗粮摄入、体育锻炼、家族史等因素解释31.3%。［结论］ 男性结直肠癌超额发病风险仅有部分可被已知危险因素解释,进一步探索包括遗传易感性等在内更多的结直肠癌危险因素,对于结直肠癌一、二级预防意义重大。     

Clinicopathological Characteristics and Prognostic Factors in Ovarian Metastases from Right- and Left-Sided Colorectal Cancer

Background: Secondary tumors of the ovary (STOs) account for 10–25% of all ovarian malignancies, including metastases from primary gynecological tumors. Colorectal cancer (CRC) has been recognized as one of the most common causes of STOs in Western countries. Despite it being well-known that CRC originating from the right versus left side of the colon/rectum differ substantially, there is a paucity of information regarding the effect of the primary tumor sidedness on the clinicopathological characteristics of STOs. Methods: This retrospective, observational chart review study included patients with histologically confirmed STOs of CRC origin diagnosed between January 2000 and December 2019. The clinicopathological characteristics of STOs originating from left-sided and right-sided CRC were compared. Univariable and multivariable analyses employing elastic net Cox proportional hazard models were used to evaluate potential prognostic factors. Further, the role of imaging methods in STOs diagnostics was evaluated. Results: Fifty-one patients with STOs of colorectal origin were identified. The primary tumor originated in the right and left colon/rectum in 39% and 61% of the cases, respectively. STOs originating from right-sided primary tumors were more frequently bilateral, associated with peritoneal carcinomatosis, had the ovarian surface affected by the tumor, and contained a mucinous component. The independent prognostic factors for overall survival in the whole cohort included: the presence of macroscopic residual disease after cytoreductive surgery, menopausal status, the application of systemic therapy, and the application of targeted therapy. In 54% of cases, the imaging methods failed to determine the laterality of the STOs correctly as compared to pathological reports and/or intraoperative findings. Conclusion: STOs originating from left-sided and right-sided CRC show distinct clinicopathological characteristics. Moreover, different metastatic pathways might be employed according to the primary tumor sidedness. Considering the discrepancies between radiological assessment and histopathological findings regarding the laterality of STOs, bilateral adnexectomy should be advised whenever feasible.     

Risk Factors for Colorectal Cancer in Thailand

Background: Colorectal cancer (CRC) is one of the most common cancers worldwide. This study aimed toinvestigate the risk factors for colorectal cancer in the Thai population. Materials and Methods: A cohort studywas carried out in Khon Kaen, Thailand, including 71 cases of histologically confirmed CRC patients among 19,861participants, aged 30-69 years, who were recruited for a cohort study during the period 1990-2001. Participantswere followed-up until 31 December, 2013. To identify factors associated with the incidence of colorectal cancer,hazard ratios were evaluated using Cox proportional hazard regression. Results: No environmental variablescould be shown to be significantly related to the risk of CRC. Although in our sample, CRC was more prevalentamong males, ex-smokers, and those who drank alcohol beverages ≥ 50 gram/day, but we could not demonstratesignificantly associations (HRmale= 1.67, 95% CI, 0.80-3.49, HR ex-smokers = 1.34, 95% CI, 0.52-3.46, andHRalc≥ 50 = 1.08, 95% CI, 0.43-2.71). Individuals within the sample with a family history of cancer, workinghour >8 hours per day, and current-smokers appeared to have decrease risk of CRC, but again these relationshipcould not be shown to be significantly associated (HRfam cancer= 0.96, 95% CI, 0.85-1.09, HRwork>8= 0.84,95% CI, 0.36-1.93, and HRcurrent-smoker = 0.51, 95% CI, 0.18-1.38). Conclusions: We found no evidence ofenvironmental factors effecting the risk of CRC. There is a need for further research to determine why factorsidentified risk in other populations appear to not be associated with CRC risk in Thais.     

Perceptions of Risk Factors for Colorectal Cancer and Colorectal Cancer Risk-Related Behaviors Among Current, ex-, and Nonsmokers

Smoking significantly increases risk for colorectal cancer (CRC). We examined smokers’ and nonsmokers’ perceptions of behavioral factors for the increased risk of CRC and evaluated how these related to CRC screening. Self-reported questionnaire data were obtained from a random, average CRC risk sample of women and men (aged 50–75 years) during 2004. Smokers less frequently reported recent CRC screening than nonsmokers (p?=?0.03). Smokers not adherent to screening less frequently agreed that smoking and alcohol consumption (both strongly linked to CRC) increased the risk for CRC (p values?<?0.05) than nonsmokers. Notably, the number of concurrent CRC risk behaviors reported by smokers not adherent to CRC screening increased with the number of cigarettes smoked per day, identifying heavy smokers who do not screen as a subgroup most in need of intervention. Findings extend current understanding on processes underlying smokers’ perceptions of risk for CRC and how these relate to screening utilization, which can guide provider efforts to improve CRC screening among smokers and reduce their CRC risk-related behaviors.     

The Role of Lifestyle Risk Factors on Mortality from Colorectal Cancer in Populations of the Asia Pacific Region

Although colorectal cancer is one of the leading malignancies worldwide, there are few data on aetiologicalrelationships from the Asia-Pacific region. Therefore, a collaborative study was conducted involving over half amillion subjects from 33 cohort studies in the region. Age-adjusted death rates from colorectal cancer, over anaverage of 6.8 years follow-up, were 12 and 14 per 100,000 person-years among Asian women and men,respectively; corresponding values in Australasia were 31 and 41. Height was strongly associated with deathfrom colorectal cancer: an extra 5cm of height was associated with 10% (95% confidence interval, 3% - 18%)additional risk, after adjustment for other factors. Smoking increased risk by 43% (9% - 88%), although nosignificant dose-response relationship was discerned (p >0.05). Other significant (p <0.05) risk factors werebody mass index and lack of physical activity. There was no significant effect on colorectal cancer mortality foralcohol consumption, waist circumference, fasting blood glucose or diabetes, although the latter conferred anotable 26% additional risk. Height may be a biomarker for some currently unknown genetic, or environmental,risk factors that are related both to skeletal growth and mutanogenesis. Understanding such mechanisms couldprovide opportunities for novel preventive and therapeutic intervention.     

结直肠癌肝转移的外科综合治疗

文章阐述了当前外科综合治疗结直肠癌肝转移的临床和实验研究的进展，重点介绍了对肝叶切除术后再复发癌的手术效果，经肝区域性化疗和间质疗法等方法，为临床上更合理地选择结直肠癌肝转移的治疗方法提供参考。     

Folate-Related Nutrients,Genetic Polymorphisms,and Colorectal Cancer Risk: the Fukuoka Colorectal Cancer Study

One-carbon metabolism plays an important role in colorectal carcinogenesis. Meta-analyses have suggestedprotective associations of folate and vitamin B6 intakes with colorectal cancer primarily based on studies inCaucasians, and genetic polymorphisms pertaining to the folate metabolism have been a matter of interest.Less investigated are the roles of methionine synthase (MTR) and thymidylate synthetase (TS) polymorphismsin colorectal carcinogenesis. In a study of 816 cases and 815 community controls in Japan, we investigatedassociations of dietary intakes of folate, methionine, vitamin B2, vitamin B6, and vitamin B12 with colorectal cancerrisk. The associations with MTR 2756A>G, MTRR 66A>G, and TSER repeat polymorphism were examined in685 cases and 778 controls. Methionine and vitamin B12 intakes were inversely associated with colorectal cancerrisk, but the associations were totally confounded by dietary calcium and n-3 fatty acids. The other nutrientsshowed no association with the risk even without adjustment for calcium and n-3 fatty acids. The TSER 2R allelewas dose-dependently associated with an increased risk. The MTR and MTRR polymorphisms were unrelatedto colorectal cancer risk. There was no measurable gene-gene or gene-nutrient interaction, but increased riskassociated with the TSER 2R allele seemed to be confined to individuals with high folate status. This study doesnot support protective associations for folate and vitamin B6. The TSER 2R allele may confer an increased riskof colorectal cancer. The role of the TSER polymorphism in colorectal carcinogenesis may differ by ethnicity.     

肺癌脑转移的治疗进展

脑是肺癌常见的远处转移部位之一,脑转移是导致治疗失败的主要原因.随着肺癌发病率的上升,先进影像设备的使用、优化的系统治疗延长了总的生存期,肺癌脑转移的发生率呈现明显增高趋势[1].     

Breast Cancer in Australian Indigenous Women: Incidence,Mortality, and Risk Factors

The Indigenous people of Australia face significant health gaps compared with the general population, with lower life expectancies, higher rates of death, and chronic illness occurring more often than in non-indigenous Australians. Cancer is the second largest contributor to the burden of disease with breast cancer being the most common invasive cancer diagnosed for females. Despite a lower breast cancer incidence compared with non-indigenous women, fatalities occur at an elevated rate and breast cancers have an earlier age of onset. For indigenous women there are also more advanced and distant tumours at diagnosis, fewer hospitalisations for breast cancer, and lower participation in breast screening. Concomitantly there are demographic, socio-economic and lifestyle factors associated with breast cancer risks that are heavily represented within Indigenous communities. The aim of this two-part narrative review is to examine the available evidence on breast cancer and its risk factors in Australian Indigenous women. Part One presents a summary of the latest incidence, survival and mortality data. Part Two presents the risk factors most strongly associated with breast cancer including age, place of residence, family risk, genetics, reproductive history, tobacco use, alcohol intake, physical activity, participation in screening and breast density. With increasing emphasis on personalized health care, a clear understanding of breast cancer incidence, survival, mortality, and causal agents within the Indigenous population is required if breast cancer prevention and management is to be optimized for Indigenous Australians.     

Brain Metastases among Cancer Patients Diagnosed from 2010–2017 in Canada: Incidence Proportion at Diagnosis and Estimated Lifetime Incidence

The incidence of BM among Canadian cancer patients is unknown. We aimed to estimate IP of BM at the time of cancer diagnosis and during the lifetime of patients with selected primary cancers. Data on BM at diagnosis from 2010–2017 was obtained from the CCR. Site-specific IPs of BM were estimated from provincial registries containing ≥90% complete data on BM. The CCR IP estimates and the IP estimates from literature were applied to the total diagnosed primary cancers to estimate the number of concurrent BM and lifetime BM from 2010–2017 in Canada, respectively. The annual average number of patients with BM at diagnosis from all cancer sites was approximately 3227. The site-specific IPs of BM at diagnosis were: lung (9.42%; 95% CI: 9.16–9.68%), esophageal (1.58%; 95% CI: 1.15–2.02%), kidney/renal pelvis (1.33%; 95% CI: 1.12–1.54%), skin melanoma (0.73%; 95% CI: 0.61–0.84%), colorectal (0.22%; 95% CI: 0.18–0.26%), and breast (0.21%; 95% CI: 0.17–0.24%). Approximately 76,546 lifetime BM cases (or 5.70% of selected fifteen primary cancers sites) were estimated to have occurred from the 2010–2017 cancer patient cohort. These findings reflect results of population analyses in the US and Denmark. We recommend improved standardization of the collection of BM data within the CCR.