乳腺癌临床特征与预后分析

目的：总结经综合治疗的233例乳腺癌患者的临床病理特征及生存情况,探讨影响乳腺癌预后的因素。方法：建立乳腺癌患者的临床资料库,采用SPSS8.0统计软件对临床数据进行单因素及多因素生存分析,以发现影响乳腺癌长期生存的因素。结果：所有患者1、2、3、5和8年生存率分别为95.71%（223/233）、82.83%（193/233）、61.37%（143/233）、37.34%（87/233）和6.87%（16/233）。单因素分析显示腋淋巴结转移数目;原发肿瘤大小与生存呈负相关（P均〈0.001）;TNM晚期患者复发转移的患者中位生存明显缩短（P均〈0.0001）;术后辅助化疗方案选择含有蒽环类的方案组生存期优于不含有蒽环类的方案组（P〈0.05,X^2=9.99）;病理类型治疗方式与生存时间相关（P均〈0.01）。COX比例风险模型分析显示治疗方式、术后辅助性化疗方案和复发转移具有独立预后意义（P〈0.05）。Logistic分析结果显示,原发肿瘤大小、腋窝淋巴结转移状态、病理类型、综合治疗方式是影响乳腺癌复发转移的主要因素,其影响程度的排序依次是腋窝淋巴结转移、原发肿瘤大小、病理类型、综合治疗方式（P〈0.0001）。结论：乳腺癌患者的远期生存及复发转移与原发肿瘤大小、腋窝淋巴结转移状态、病理类型、术后化疗方案的选择及个体化综合治疗方式密切相关。     

pN1期甲状腺乳头状癌术后复发危险因素分析

摘 要：［目的］ 探讨pN1期甲状腺乳头状癌术后复发的危险因素。［方法］回顾性分析380例手术pN1期甲状腺乳头状癌患者的临床病理特征,及其与术后复发的关系。［结果］380例患者中术后20例（5.3%）出现肿瘤复发,复发时间10.9±5.2个月。单因素分析显示多发病灶、被膜外侵犯、转移淋巴结数＞5个以及淋巴结转移率≥0.4与肿瘤复发有关（P＜0.05）,而年龄、性别、原发肿瘤大小、是否为双侧病变、是否合并慢性淋巴细胞性甲状腺炎以及BRAFV600E基因突变与肿瘤复发无关（P＞0.05）。多因素分析显示,被膜外侵犯和淋巴结转移率≥0.4是肿瘤复发的独立危险因素（P＜0.05）。复发患者中,复发部位以Ⅱ区淋巴结最为常见,Ⅵ区淋巴结和残余腺体少见。［结论］被膜外侵犯、淋巴结转移率≥0.4与肿瘤复发有关,此类患者术后需加强随访。术前需要加强对Ⅱ区淋巴结的评估。     

霍奇金淋巴瘤患者外周血尿激酶型纤溶酶原激活物受体水平检测的临床意义

 目的　研究霍奇金淋巴瘤（HL）患者外周血中尿激酶型纤溶酶原激活物受体（uPAR）的浓度与HL预后关系。方法　30例HL患者为均经淋巴结病理活组织检查确诊的初治病例,健康对照者30名。采用ELISA方法检测HL初治患者和健康对照组外周血中uPAR 的浓度。比较HL患者与健康对照者、不同临床分期、治疗效果HL患者间外周血uPAR水平。结果　HL患者较健康对照者外周血uPAR水平分别为（1.1235±0.8725）、（0.5843±0.4002）μg／L,差异有统计学意义（t＝2.21,P＝0.015）。Ⅰ+Ⅱ期与Ⅲ+Ⅳ期患者外周血uPAR 水平分别为（0.8022±0.5876）、（1.3120±0.7982）μg／L,差异有统计学意义（t＝2.42,P＝0.01）。达完全缓解（CR）组与未达CR组uPAR水平分别为（0.9843±0.8574）、（1.1243±0.6969）μg／L,差异无统计学意义（t＝2.71,P＝0.06）。结论　外周血uPAR 的浓度可作为HL的预后指标。     

左胸单切口和颈-右胸-腹三切口在食管癌淋巴结清扫中的应用

 目的　比较左胸单切口和颈-右胸-腹三切口在食管癌根治手术中的淋巴结清扫情况,探讨食管癌手术中合理的淋巴结切除范围。方法　回顾性分析2006年1月至2008年1月行食管癌根治手术的95例患者的临床资料,根据手术方式分为左胸切口组62例和三切口组33例,对淋巴结清扫状况和术后并发症进行分析。结果　95例患者共切除1322枚淋巴结,平均每例切除13.9枚。95例中有43例（45.3 %）出现淋巴结转移。左胸切口组和三切口组淋巴结转移率分别为40.3 %（25／62）和54.5 %（18／33）。上段和中段食管癌的颈部淋巴结转移率分别为25.0 %（2／8）和40.0 %（4／10）,下段食管癌的腹部淋巴结转移率为53.8 %（7／13）。食管癌的浸润深度（r＝0.315,P＝0.007）和分化程度（r＝0.239,P＝0.017）与淋巴结转移显著相关。肿瘤长度＞2 cm时淋巴结转移率明显增高（χ2＝34.2,P＜0.001）。左胸切口组和三切口组患者术后并发症发生率分别为25.8 %（16／62）和4.2 %（8／33）,差异无统计学意义（χ2＝0.017,P＝0.869）。围手术期死亡率分别为1.6 %（1／62）和3.0 %（1／33）,差异无统计学意义（χ2＝0.047,P＝0.651）。结论　食管癌根治手术应综合考虑肿瘤浸润深度、分化程度和长度对淋巴结转移的影响。对于上、中段食管癌宜选择三切口利于行术野淋巴结切除,下段食管癌应重视腹腔淋巴结的切除。     

淋巴结阳性腮腺癌16例临床病理特征及预后因素分析

摘 要：［目的］ 探讨淋巴结阳性腮腺原发性癌的临床病理特征及预后因素。［方法］ 回顾性分析16例淋巴结阳性腮腺原发性癌患者的临床病理特点,总结病理类型和淋巴结分期对预后的影响。［结果］ 16例淋巴结阳性（pN+）腮腺癌中,涎腺导管癌8例,颈部淋巴结隐匿性转移率为56.3%。颈部淋巴结隐匿性转移的位置主要在同侧腮腺区（88.9%）,其次为同侧颈部Ⅱ区（11.1%）。pN+腮腺癌的5年生存率和5年无复发生存率分别为66.7%和60.0%。涎腺导管癌和非涎腺导管癌的5年生存率分别为42.9%和87.5%（χ2=3.355,P=0.067）;5年无复发生存率分别为28.6%和87.5%（χ2=4.604,P=0.032）。8th AJCC pN1、pN2和pN3的5年生存率分别为75.0%、66.7%和50.0%（χ2=1.052,P=0.591）,5年无复发生存率分别为75.0%、33.3%和50.0%（χ2=1.469,P=0.480）。［结论］ pN+腮腺癌中涎腺导管癌的比例较大。腮腺癌颈部淋巴结隐匿性转移的位置主要位于同侧腮腺区和Ⅱ区。涎腺导管癌是pN+腮腺癌的不良预后因素,较8th AJCC pN分期能更好地评估pN+腮腺癌预后。     

早期霍奇金淋巴瘤的预后多因素分析

目的：目前对于早期霍奇金淋巴瘤（Hodgkin’s lymphoma，HL）的预后因素仍存有争议，本研究旨在探讨早期HL的预后因素。方法：回顾性分析188例早期HL患者，其中100例（53．2％）接受单纯放疗，88例（46．8％）接受联合放化疗。采用Kaplan-Meier生存分析并log—rank检验，估计5年、10年总生存（overall survival，OS）率和无病生存（disease—free survival，DFS）率，用COX比例风险模型确定早期HL的预后因素。结果：单纯放疗和联合放化疗的5年、10年0S率分别为84．5％、76．3％和96．2％、96．2％（P=0．340），5年、10年DFS率分别为84．7％、76．9％和93．4％、71．8％（P=0．015）。单因素分析表明肿瘤大小、年龄（以40岁为分界点）预测OS和DFS差异有统计学意义，其P值分别为0．002和0．001、0．033和0．019；病理类型预测OS接近有统计学意义（P=0．072）；有无B症状预测DFS接近有统计学意义（P=0．072）。多因素分析表明年龄（P=0．022）、性别（P=0．036）、肿瘤大小（P=0．024）、淋巴结受侵区域数目（受侵数目≥3个）（P=0．060）和临床分期（P=0．028）共5个因素有统计学意义或接近有统计学意义。结论：年龄≥40岁、男性、临床Ⅱ期、肿瘤体积较大或大纵隔、淋巴结区域受侵数目≥3个为早期HL独立的不良预后因素。     

影响肝癌切除术预后的多因素分析

目的：回顾性研究肝硬化、Child-Pugh分级、肿瘤大小、门脉癌栓、术中输血、肝门阻断时间等与肝癌切除术预后的关系。方法回顾性分析2007—2009年华中科技大学同济医学院附属同济医院进行肝癌切除术的123例原发性肝癌患者临床资料,用Log-Rank检验和Cox风险比例模型分析肝癌切除术预后的相关危险因素。结果患者术后1、2、3、5年复发率分别为54.17%、66.67%、81.40%、87.50%,平均复发时间为19.5个月。1、2、3、5年生存率分别为93.50%、73.17%、58.54%、27.64%,平均生存时间为42.9个月。单因素分析显示肝硬化（χ2＝11.159,P ＝0.005）、Child-Pugh 分级（χ2＝7.715,P＝0.028）、肿瘤≥5 cm（χ2＝11.483,P＝0.004）、门脉癌栓（χ2＝22.271,P＝0.001）与肝癌复发有关;多因素分析显示肝硬化（χ2＝8.993,P＝0.003）、肿瘤≥5 cm（χ2＝4.022,P＝0.039）、门脉癌栓（χ2＝5.023,P＝0.027）与肿瘤复发有关。单因素分析显示肝硬化（χ2＝7.339,P＝0.025）、血清甲胎蛋白AFP﹥400 ng/ml（χ2＝5.431,P＝0.042）、Child-Pugh分级（χ2＝13.389,P＝0.002）、肿瘤≥5 cm（χ2＝11.342,P＝0.003）、门脉癌栓（χ2＝52.167,P﹤0.001）、肝门阻断（χ2＝5.801,P ＝0.037）、术中输血（χ2＝14.959,P＝0.001）等与患者术后生存率有关;多因素分析显示肝硬化（χ2＝9.133,P＝0.003）、Child-Pugh分级（χ2＝4.799,P＝0.028）、肿瘤≥5 cm（χ2＝9.101,P＝0.004）、门脉癌栓（χ2＝11.126,P＝0.001）、肝门阻断（χ2＝3.985,P＝0.046）与患者术后生存率相关。结论肝硬化、Child-Pugh分级、肿瘤大小≥5 cm、门脉癌栓、肝门阻断是影响肝癌患者切除术预后的独立因素。     

肥胖对异基因造血干细胞移植效果的影响

目的:探讨肥胖对异基因造血干细胞移植效果的影响。方法:回顾性分析南京医科大学第一附属医院2017年8月至2020年9月行异基因造血干细胞移植的81例患者临床资料。根据体质量指数（BMI）分为肥胖组（BMI≥28 kg/m 2，11例）和非肥胖组（BMI<28 kg/m 2，70例），比较两组患者临床病理特征、造血干细胞植入、移植后并发症、生存及复发等情况。采用Cox比例风险回归模型进行单因素、多因素生存分析。 结果:81例患者中位随访时间280 d（8~1 218 d），1年总生存（OS）率77.9%，1年无进展生存（PFS）率73.8%。非肥胖组与肥胖组1年OS率分别为82.6%和46.2%（ χ2＝15.54， P<0.01），1年PFS率分别为82.1%和36.4%（ χ2＝15.56， P<0.01），非复发死亡（NRM）率分别为7.1%和32.7%（ χ2＝6.463， P＝0.01），累积复发率分别为11.5%和42.9%（ χ2＝8.146， P＝0.004）。非肥胖组和肥胖组中性粒细胞植入时间、血小板植入时间、急性移植物抗宿主病、慢性移植物抗宿主病、出血性膀胱炎、巨细胞病毒感染及EB病毒感染发生情况比较，差异均无统计学意义（均 P>0.05）。多因素分析结果显示，肥胖是异基因造血干细胞移植患者OS的独立不良影响因素（ HR＝3.814，95% CI 1.343~10.827， P＝0.012）。 结论:肥胖是异基因造血干细胞移植后患者生存的重要不良影响因素，改善这部分患者的疗效及生存值得进一步研究探讨。     

早期乳腺癌根治术后放射治疗靶区的确定

目的：确定早期乳腺癌根治术后放射治疗的靶区。方法：回顾分析本院行乳腺切除和腋窝淋巴结清扫的605例T1－2N0－1M0期乳腺癌患者。所有得接受乳腺癌根治术,343例接受术后放射治疗,其中,135例接受胸壁放射治疗,270例锁骨上腋顶放射治疗,98例腋窝放射治疗,340例内乳放射治疗。生存分析采用Kaplan-Meier法,局部区域复发率的差别用Logrank检验。结果：全组患者的10年胸壁复发率为5．2％,10年锁骨上淋巴结复发率为6．5％,10年腋窝淋巴结复发率为2．9％,10年内乳淋巴结复发率为0．2％。未做胸壁放射治疗时,腋窝淋巴结转移数为0,1－3和≥4个的10年胸壁复发率分别为4．9％,5．3％和11．8％,腋窝淋巴结转移数≥4个的复发率比腋窝淋巴结转移数为0和1－3个有增高的趋势（P＝0．062）,放射治疗有降低这组患者胸壁复发率的趋势（2．9％和11．8％,P＝0．089）,未做锁骨上放射治疗时,腋窝淋巴结转移数≥4个的10年锁骨上复发率明显高于腋窝淋巴结转移数为0和1－3个者（42．4％和3．1％和9．1％,P＝0．000）,放射治疗可使这组患者的锁骨上淋巴结复发率明显降低（5．3％和42．4％,P＝0．000）,腋窝淋巴结转移数≥4个的患者,做和不做腋窝放射治疗的10年腋窝淋巴结复发率分别为0％和6．5％,差别无显著性意义（P＝0．142）。全组患者只有1例出现内乳淋巴结复发,10年内乳淋巴结复发率为0．2％,结论：腋窝和内乳淋巴结复发少见,对腋窝淋巴结转移数≥4个的患者,建议行胸壁和锁骨上淋巴结照射,放射治疗有降低胸壁复发率的趋势,并能显著降低锁骨上淋巴结复发率。     

盆腔淋巴结清扫对评估膀胱癌预后的价值

目的:评价规范化盆腔淋巴结清扫对膀胱癌患者预后的影响作用,分析影响淋巴结转移的相关因素及淋巴结肿大与淋巴结转移两者的关系。方法:回顾性分析2008年1 月至2013年7 月天津医科大学肿瘤医院120 例膀胱癌患者临床资料,分为盆腔淋巴结规范化清扫组58例,未规范化清扫组62例。分析淋巴结转移与病理分期、分级及术中触及肿大淋巴结的关系,探讨盆腔淋巴结清扫对预后的影响。结果:120 例膀胱癌患者术后1、3、5 年总生存率分别为84.0% 、69.9% 、57.9% 。规范化盆腔淋巴结清扫组与未规范化清扫组的3 年生存率分别为78.4% 与46.2%（χ2= 5.487,P = 0.019）。 淋巴结阳性与阴性患者术后3 年生存率分别为50.0% 与86.4% ,（χ2= 9.303,P = 0.002）。 术中触及肿大淋巴结与淋巴结转移具有相关性（P < 0.001）,病理分期、病理类型（尿路上皮癌及非尿路上皮癌）及年龄是患者预后的影响因素（P < 0.05）。 结论:术中触及肿大淋巴结与淋巴结转移相关,可预测淋巴结转移的发生,盆腔淋巴结清扫影响膀胱癌患者预后,阳性淋巴结是膀胱癌患者预后的独立危险因素,规范盆腔淋巴结清扫术可延长患者术后生存时间。      

High-dose chemotherapy followed by autologous stem cell transplantation for relapsed or refractory Hodgkin lymphoma: prognostic features and outcomes

Between January 1990 and April 2001, 115 patients received high-dose chemotherapy (HDT) followed by autologous stem cell transplantation (ASCT) for relapsed or refractory Hodgkin lymphoma (HL). With a median follow-up of 58 months (range, 1 - 175 months), 5-year progression-free survival (PFS) and overall survival (OS) were 46% and 58%, respectively. Twelve patients with primary refractory disease had a 5-year PFS of 41% and OS of 58%, not significantly different from those of the remaining cohort. Early and overall regimen related mortality were 7% and 16%, respectively. Male gender (P = 0.04) and a time to relapse (TTR) < 12 months (P = 0.03) were associated with decreased OS by univariate analysis. In multivariate analysis, TTR < 12 months remained statistically significant (P = 0.04). We have confirmed that HDT and ASCT result in long-term survival for a proportion of patients with relapsed or refractory HL. All patients, including those with primary refractory disease, benefited from HDT and ASCT.     

High‐dose chemotherapy in relapsed or refractory Hodgkin lymphoma patients: a reappraisal of prognostic factors

High‐dose chemotherapy (HDCT) has a consolidated role in the treatment of patients with refractory or relapsed Hodgkin lymphoma (HL). We report clinical results of 97 HL patients who underwent HDCT for refractory (62 patients) or relapsed (35 patients) diseases in Istituto Europeo di Oncologia, from 1995 to 2009. Treatment included high‐dose carmustine, etoposide, cytarabine and melphalan in 84 patients and high‐dose idarubicin and melphalan in 13 patients with subsequent peripheral hemopoietic stem cells transplant. Outcomes were evaluated in terms of progression‐free survival (PFS) and overall survival (OS). In order to identify prognostic factors for outcome, a multivariate analysis for age, sex, disease status (refractory/relapsed), disease stage, B symptoms, presence of extranodal involvement, bulky disease, elevated lactate dehydrogenase, number of previous chemotherapy lines, remission status before transplant, 18F‐fluoro‐deoxy‐d ‐glucose positron emission tomography (¹⁸FDG‐PET) status before and after transplant was done. A clinical response was achieved in 91% of patients, with complete remissions in 76/97 patients. With a median follow‐up of 45 months (range 1–164 months), 5‐year PFS and OS were 64% and 71%, respectively. Remission status after induction therapy, 18F‐fluoro‐deoxy‐d ‐glucose positron emission tomography status before and after transplant were the most important prognostic factors for PFS and OS in univariate or multivariate analyses. HDCT is able to induce a high remission rate and a prolonged PFS in more than 50% of the patients with refractory and relapsed HL. Copyright © 2012 John Wiley & Sons, Ltd.     

Phase I/II trial of total lymphoid irradiation and high-dose chemotherapy with autologous stem-cell transplantation for relapsed and refractory Hodgkin's lymphoma.

BACKGROUND: The standard approach to treatment of relapsed/refractory Hodgkin's lymphoma (HL) is high-dose chemotherapy conditioning followed by autologous hematopoietic stem-cell transplantation (aHSCT). We report the results of a prospective phase I/II clinical trial of accelerated hyperfractionated total lymphoid irradiation (TLI) immediately followed by high-dose chemotherapy for relapsed/refractory HL. PATIENTS AND METHODS: Forty-eight patients underwent aHSCT with either sequential TLI/chemotherapy (n = 32) or chemotherapy-alone conditioning (n = 16), based on prior radiation exposure. The first 22 patients enrolled on trial received escalating doses of etoposide (1600-2100 mg/m(2)) with high-dose carboplatin and cyclophosphamide. RESULTS: No dose-limiting toxicity was seen and TLI/chemotherapy was well tolerated. The 5-year event-free survival (EFS) estimate for all patients was 44% with overall survival (OS) of 48%. Five-year EFS and OS for the TLI/chemotherapy group was 63% and 61%, respectively, compared with 6% and 27%, respectively, for the chemotherapy-alone group (P < 0.0001 and P = 0.04, respectively). Patients with primary induction failure HL who received TLI/chemotherapy had 5-year EFS and OS rate of 83%. The 100-day treatment-related mortality was 4.2% and two secondary cancers were seen. Significant factors predicting survival by multivariate analysis included TLI/chemotherapy conditioning and B symptoms at relapse. CONCLUSIONS: Sequential TLI/chemotherapy conditioning for relapsed/refractory HL is safe and associated with excellent long-term survival rates.     

复发难治T细胞非霍奇金淋巴瘤患者的疗效及预后分析

背景与目的:复发难治T细胞非霍奇金淋巴瘤(non-Hodgkin's lymphoma,NHL)患者预后差,尚无确定的预后因素,目前仍无标准的治疗方案.本研究探讨复发难治T细胞NHL患者预后相关因素及有效治疗方案.方法:1997年1月至2003年3月中山大学肿瘤防治中心共收治复发难治T细胞NHL 45例.回顾性分析其近期疗效、远期疗效和预后因素.结果:截止2006年7月,中位随访时间30个月(2～70个月),5例仍生存,复发后中位生存时间(MST)为22个月(2～62个月).全组患者中,42例(93.3%)接受挽救化疗,有效率为61.9%(26/42),其中接受二线化疗方案有效率为52.4%(22/42).1年总生存(overall survival,OS)75.6%,3年OS 17.8%,5年OS 4.4%.将二线国际预后指数(international prognostic index,IPI)0～1分和2分合并为低危组,3分和4～5分合并为高危组,进行生存比较,两者MST均未达到,低危组1年、3年和5年OS分别为82.1%、25.0%、5.8%,高危组1年、3年和5年OS分别为64.7%、6.5%、6.5%,有统计学意义(P=0.026).多因素分析表明,血清乳酸脱氢酶(LDH)水平(P=0.010)、二线Ann Arbor分期(P=0.009)、二线IPI评分(P=0.015)、自体造血干细胞移植(P=0.026)、PS状态(P=0.002)和接受IMVP-16方案化疗(P=0.026)与复发难治T细胞NHL患者复发后OS密切相关.结论:二线IPI评分、自体造血干细胞移植等因素是复发难治T细胞NHL独立预后因素;复发难治T细胞NHL预后不佳,常规化疗缓解后应考虑加用如自体造血干细胞移植等治疗方法.     

Ⅱ期上呼吸消化道结外鼻型NK/T细胞淋巴瘤患者受累区域淋巴结水平的预后价值

目的 分析区域淋巴结转移范围在Ⅱ期上呼吸消化道结外鼻型NK/T细胞淋巴瘤(UADT-NKTCL)患者中的预后价值。方法 回顾分析1987—2013年间本院初治的97例Ⅱ期UADT-NKTCL患者资料,分析淋巴结转移范围与预后关系。全组患者52例原发鼻腔,45例原发鼻腔外上呼吸消化道。多数患者接受以放疗为主治疗,65例接受放化疗,27例单纯放疗,5例单纯化疗。Kaplan-Meier法计算生存率,Logrank法检验和单因素预后分析,Cox模型多因素分析。结果 全组患者5年OS、PFS分别为57%、49%。单因素和多因素分析都显示伴有下颈(环状软骨下缘水平以下)淋巴结转移的患者预后更差,其中位生存时间仅19.3个月,2、5年OS分别为28%、11%,而未伴有下颈淋巴结受累的Ⅱ期患者5年OS达68%(P=0.000)。治疗模式明显影响预后,综合治疗患者5年OS、PFS分别为64%、52%,显著优于单纯放疗或化疗患者的40%(P=0.006)和42%(P=0.088)。结论 区域淋巴结受累水平是Ⅱ期UADT-NKTCL的独立预后因素,伴有下颈淋巴结受累患者预后很差。     

181例肺腺鳞癌患者术后预后因素分析

  目的  探讨术后Ⅰ~Ⅲ期肺腺鳞癌患者的预后及其影响因素。  方法  按照2009年国际肺癌研究协会公布的新版肺癌分期标准进行分期, 回顾性分析1994年1月至2008年12月天津医科大学附属肿瘤医院收治181例手术切除的Ⅰ~Ⅲ期肺腺鳞癌患者的临床资料, 对影响其预后的各因素进行了单因素及多因素分析。  结果  全组患者3、5年生存率分别为30.9%、19.0%, 中位生存期23.0个月。单因素分析显示淋巴结清扫方式、T分期、N分期、辅助化疗周期数是影响预后的重要因素(P < 0.05)。多因素分析结果显示淋巴结清扫方式(P=0.046)、T分期(P=0.006)、N分期(P < 0.001)、辅助化疗周期数(P=0.031)是影响预后的独立因素。  结论  肺腺鳞癌整体预后差。系统性淋巴结清扫能显著提高肺腺鳞癌患者生存时间。肿瘤的T分期越高其生存率越低, 无区域淋巴结转移组生存率较高。Ⅲ期肺腺鳞癌患者可从术后辅助化疗中获益, 应至少行4个化疗周期。      

Treatment results and prognostic factors of early breast cancer treated with a breast conserving operation and radiotherapy

BACKGROUND: The purpose of this study was to analyze the prognostic factors affecting local control and survival rates for patients with early breast cancer who received breast conserving treatment (BCT) and to find out the optimal treatment according to their risk factors. METHODS: From October 1994 to December 2001, 605 patients with 611 stage I and II breast cancers received BCT, and the results were analyzed retrospectively. BCT consists of breast conserving surgery and whole breast irradiation. All the patients underwent lumpectomy or quadrantectomy. Axillary lymph node dissection or sentinel lymph node biopsy was performed in 608 cases (99.5%). The radiation dose to the whole breast was 50.4 Gy over 5 weeks with a 1.8 Gy daily fraction and with boost doses of 9-14.4 Gy administered to the tumor bed. Adjuvant chemotherapy was performed in most of the patients with axillary lymph node metastasis or tumors larger than 1 cm. The median follow-up period was 47 months. RESULTS: Local relapse, regional relapse and distant metastasis occurred in 15 (2.5%), 16 (2.6%) and 43 patients (7.1%), respectively. The 5-year overall survival, local-relapse-free survival, distant-metastasis-free survival and disease-free survival rates were 95.3%, 97.2%, 91.3% and 88.5%, respectively. On multivariate analysis, age (P = 0.02), number of involved axillary lymph nodes (P = 0.01) and nuclear grade (P = 0.01) affected the local-relapse-free survival. The factors associated with disease-free survival were the T stage (P = 0.05), number of involved axillary lymph nodes (P = 0.01) and nuclear grade (P = 0.001). Overall survival was associated with the T stage (P = 0.02), number of involved axillary lymph nodes (P = 0.01) and c-erb B2 overexpression (P = 0.05). Patients with more than two factors among (i) age 1 cm, (ii) positive lymph node metastasis and (iii) high nuclear grade showed an inferior 5-year disease-free survival rate compared with others (P = 0.0005). CONCLUSIONS: The most important prognostic factor affecting local control, disease-free survival and overall survival was axillary lymph node metastasis. The nuclear grade influenced local control and disease relapse. Patients with multiple unfavorable risk factors such as positive axillary lymph nodes, high nuclear grade, young age and large tumor showed poorer local control and disease-free survival than patients without any risk factors, and so more aggressive treatment is required for these patients.     

Breast-conserving therapy for stage I-II breast cancer in elderly women

PURPOSE: To assess breast-conserving therapy results in elderly patients with early-stage breast cancer (clinical Stage I-II). METHODS AND MATERIALS: Between 1979 and 1998, 196 women (200 treated breasts) aged > or =70 years (median age, 72.5 years) were treated with breast-conserving therapy (lumpectomy or quadrantectomy with axillary lymph node dissection and radiotherapy). Pathologic axillary node involvement was found in 51 patients (28%). Two-thirds of patients received tamoxifen, and 16% received chemotherapy. RESULTS: At a median follow-up of 59 months, 3 patients (1.5%) had developed local recurrence and 20 (10.2%) distant metastases. The overall survival rate was 81% and 62% at 5 and 10 years, respectively. The corresponding disease-specific survival rates were 92% and 88%. Axillary nodal involvement was the only statistically significant risk factor for the development of metastases (p = 0.0035). Arm mobility impairment and arm lymphedema each occurred in 5 patients. In another 5 patients, a thromboembolic event occurred during tamoxifen treatment. CONCLUSION: Elderly women tolerate breast-conserving therapy, including radiotherapy, well and have excellent rates of locoregional control and disease-specific survival.     

Myeloablative versus reduced intensity allogeneic stem cell transplantation for relapsed/refractory Hodgkin's lymphoma in recent years: a retrospective analysis of the Lymphoma Working Party of the European Group for Blood and Marrow Transplantation

This registry-based analysis highlights the significant reduction of non-relapse mortality associated to myeloablative allogeneic stem cell transplantation for relapsed/refractory Hodgkin's lymphoma in recent years. Intensity of the conditioning regimen should be taken into consideration when designing prospective clinical trials in this setting.BackgroundTo evaluate long-term outcome of myeloablative allogeneic stem cell transplantation (allo-SCT) (MAC) versus reduced-intensity allo-SCT (RIC) in patients with relapsed/refractory Hodgkin's lymphoma (HL) in recent years.Patients and methodsA total of 312 patients (63 MAC and 249 RIC) with relapsed/refractory HL who received allo-SCT between 2006 and 2010 and were reported to the EBMT Database were included in the study.ResultsWith a median follow-up for alive patients of 56 (26–73) months, there were no significant differences in non-relapse mortality (NRM) between MAC and RIC. Relapse rate (RR) was somewhat lower in the MAC group (41% versus 52% at 24 months, P= 0.16). This lower RR translated into a marginal improvement in event-free survival (EFS) for the MAC group (48% versus 36% at 24 months, P= 0.09) with no significant differences in overall survival (73% for MAC and 62% for RIC at 24 months, P= 0.13). Multivariate analysis after adjusting for disease status at the time of allo-SCT showed that the use of MAC was of borderline statistical significance for predicting a lower RR and EFS [HR 0.7, 95% CI (0.5–1.0), P= 0.1] and [HR 0.7, 95% CI (0.5–1.0), P= 0.07], respectively, after allo-SCT.ConclusionsWith modern transplant practices, the NRM associated with MAC for HL has strongly decreased, resulting into non-significant improvement of EFS because of a somewhat better disease control compared with RIC transplants. The intensity of conditioning regimens should be considered when designing individual allo-SCT strategies or clinical trials in patients with relapsed/refractory HL.     

132例三阴性乳腺癌患者的临床特征与预后分析

目的探讨三阴性乳腺癌的临床特征及影响预后的因素。方法采用回顾性方法对我院132例三阴性乳腺癌患者的临床特征进行分析,并根据随访资料分析了患者的生存情况及预后因素。所有患者均经免疫组化证实ER、PR、Her-2为阴性。结果132例三阴性乳腺癌患者占同期乳腺癌患者（774例）的17．1％,绝经前患者（91例）占68．9％,53．8％的患者（71例）发病时肿块大小为T2,39．4％患者（52例）腋窝淋巴结阳性。中位随访时间63个月,共有33例出现复发或转移,其中20例死亡,23例同时出现2个部位以上的转移,5年的无病生存率为73．8％,总生存率为85．7％。淋巴结阳性患者复发转移风险较淋巴结阴性患者明显增加（P=0．001）。结论三阴性乳腺癌患者大多在治疗后2—3年发生多发转移,仅淋巴结状况是影响其预后的重要因素,淋巴结阳性的三阴性乳腺癌患者预后差。