BCSG1基因在乳腺癌新辅助化疗疗效评估中的价值

目的:探讨乳腺癌特异基因（BCSG1）在乳腺癌新辅助化疗疗效评估中的价值。方法:采用免疫组化S P法和荧光定量PCR方法检测36例乳腺癌患者新辅助化疗(CEF方案)前后乳腺癌组织BCSG1的表达，比较化疗前后肿瘤体积的变化情况，分析新辅助化疗前后BCSG1蛋白表达与肿瘤形态学变化的关系。结果:36例乳腺癌患者新辅助化疗后肿瘤体积均有明显缩小（P<0.01），病灶缓解率(CR+PR)为85.6%；新辅助化疗后BCSG1 mRNA表达水平亦明显低于化疗前（P<0.05），BCSG1蛋白高表达率低于新辅助化疗前（P<0.01）。结论:乳腺癌新辅助化疗后BCSG1在分子和蛋白水平表达均明显降低，与新辅助化疗后疗效呈负相关（r=-0.539,P<0.01），提示BCSG1可作为乳腺癌新辅助化疗疗效的预测因子。     

表阿霉素联合多西紫杉醇新辅助化疗治疗三阴、非三阴乳腺癌的疗效及预后评价

目的比较表阿霉素联合多西紫杉醇新辅助化疗方案(ET方案)对三阴乳腺癌(TNBC)和非三阴乳腺癌(non-TNBC)的临床疗效及预后差别。方法回顾性分析接受ET新辅助化疗方案治疗的198例乳腺癌患者的临床资料,依据免疫组化结果将乳腺癌分为TNBC及non-TNBC两组,对两类乳腺患者接受ET新辅助化疗方案后的病理疗效及预后的差别进行分析比较。结果 198例乳腺癌患者中,TNBC43例,non-TNBC155例。所有患者的临床总有效率(cOR)为76.8%,其中完全缓解率24.7%,部分缓解率48.5%;TNBC患者的临床有效率84.2%,病理完全缓解率(pCR)27.9%;non-TNBC患者临床有效率70.4%,病理完全缓解率12.9%。TNBC患者与非TNBC患者5年无病生存率(DFS)分别为52.9%和70.9%(P<0.05);TNBC患者与非TNBC患者5年总体生存率分别为59.1%和80.5%(P<0.05)。结论表阿霉素联合多西紫杉醇新辅助化疗方案治疗三阴乳腺癌患者能够获得较好的临床效果。     

表阿霉素联合多西紫杉醇新辅助化疗治疗三阴乳腺癌的疗效及预后评价

目的探讨三阴乳腺癌(TNBC)与非三阴乳腺癌(non-TNBC)接受表阿霉素联合多西紫杉醇方案(ET方案)的化疗敏感性及预后方面的差别。方法对接受ET新辅助化疗方案治疗的249例乳腺癌患者进行回顾性分析。依据免疫组化雌激素受体(ER)、孕激素受体(PR)、表皮生长因子受体2(HER2)表达水平将乳腺癌分为三阴乳腺癌及非三阴乳腺癌两类,分析三阴与非三阴乳腺患者接受ET新辅助化疗方案后,二者病理疗效及远期生存的差别。结果 249例患者中,54(21.7%)例为三阴乳腺癌,195(78.3%)例为非三阴乳腺癌。三阴乳腺癌的病理完全缓解(pCR)率为25.9%,明显高于非三阴乳腺癌的12.3%(P=0.019)。三阴乳腺癌患者,特别是新辅助化疗后仍有癌残留的患者,其5年无病生存率(DFS)及5年的总生存率(OS)均明显低于非三阴乳腺癌(P值均<0.05)。获得pCR的乳腺癌患者5年的DFS和OS均明显高于化疗后仍有癌残留的患者(P值均<0.05)。获得pCR的三阴乳腺癌与非三阴乳腺癌患者的DFS(P=0.837)及OS(P=0.398)均无统计学差异。结论本研究结果表明,相比于非三阴乳腺癌患者,三阴乳腺癌患者具有更高的病理完全缓解率,但预后却较差。     

乳腺癌的新辅助化疗

随着临床和基础研究的不断深入,乳腺癌新辅助化疗逐渐成为乳腺癌临床研究中十分活跃的领域.理论上,新辅助化疗较辅助化疗有诸多优势,但多个大型临床试验结果表明,新辅助化疗并不能显著改善患者生存.许多因素可能与之有关,例如,以往的研究在最初设计时多仅根据患者临床分期来决定患者是否需要新辅助化疗,而忽视了重要生物学指标雌激素受体(ER)、Her-2等对疗效的影响,且不同研究中生物学指标的检测方法及使用的化疗方案也不一致.本文结合最近的文献资料,就生物学指标对乳腺癌新辅助化疗的影响及其他几个临床上十分关注的问题谈一些个人的体会和看法,与同行探讨.     

乳腺癌的新辅助化疗

本文回顾了有关乳腺癌新辅助化疗的临床研究，认为可使大部分原发性乳腺癌体积明显缩小，进而使80％的可手术治疗的患者能选择保留乳房术式。虽然理论上可更大程度地杀灭亚临床的微小转移灶，减少耐药细胞株的产生，但在提高这部分患者的无复发生存率及总体生存率方面尚无临床定论。     

乳腺癌新辅助化疗的研究进展

近年来,新辅助化疗治疗乳腺癌的概念引起了肿瘤学界极大的兴趣。一系列正在进行的临床研究都希望这一新疗法能够从总体上增加疗效。新的化疗药物、新的影像学检查工具及某些生物学因子正日益引起广大学者的密切关注。基因表达谱也有望对新辅助化疗反应作出预测。本文对以上诸方面分别作了介绍。     

乳腺癌新辅助化疗的研究进展

目的探讨乳腺癌新辅助化疗的研究进展。方法从乳腺癌新辅助化疗的理论基础、临床意义、适用范围、常用药物及方案、疗效预测因子及其与保乳手术、前哨淋巴结活检的关系等方面总结乳腺癌新辅助化疗的研究进展。结果新辅助化疗可降低临床分期,增加保乳手术机会,了解化疗药物敏感性,防止远处转移,但对前哨淋巴结活检的影响存在争议。结论新辅助化疗是乳腺癌全身治疗重要的部分,但在如何选择高效的化疗药物、制订个体化方案、预测治疗效果等方面仍需进一步研究。     

新辅助化疗对晚期乳腺癌的作用

晚期乳腺癌的治疗在临床上是较为棘手的，尤其是肿瘤巨大、广泛侵犯皮肤和胸壁的情况出现时，难以施行外科手术。近十年来新辅助化疗在临床上的应用越来越广泛，其对晚期乳癌的治疗作用也得到肯定。但对采用何种化疗方案和剂量目前尚无统一的意见。我们近三年来对晚期乳腺癌患者开展了新辅助化疗，现报告如下。     

乳腺癌新辅助化疗应注意的几个问题

乳腺癌新辅助化疗,从最初用于手术切除困难的局部晚期 乳腺癌(LABC)和炎性乳腺癌(IBC),其后扩展到对肿瘤较大 (直径>3cm)的可手术的乳腺癌,经化疗后肿瘤缩小、降低分 期,使本不适合保乳的病例能成功实施保乳。新辅助化疗历经 30余年,随着临床和基础研究的不断深入,迄今其临床价值和 意义已远愈其初衷,成为当今乳腺癌临床十分活跃的领域。我国这项工作起步较晚,但面对乳腺癌发病率越来越高及目前临 床就诊病例普遍偏晚的现状,新辅助化疗应为从事治疗乳腺癌 的外科医生必备的基本技能。从临床实用角度,就乳腺…     

乳腺癌新辅助化疗后腋窝淋巴结的变化

目的评价新辅助化疗对乳腺癌腋窝淋巴结的影响。方法45例Ⅱ、Ⅲ期乳腺癌接受新辅助化疗后手术(新辅助化疗联合手术组),根据体检、B超及钼靶像计数腋窝淋巴结总数和阳性、阴性淋巴结数,与未行新辅助化疗直接手术治疗的79例乳腺癌(直接手术组)比较,观察腋窝淋巴结的变化。结果新辅助化疗联合手术组检出腋窝总淋巴结和阳性淋巴结为(16.9±5.9)枚和(2.5±2.2)枚,显著低于直接手术组的(20.8±8.0)枚和(3.9±3.0)枚(t=-2.856,P=0.005;t=2.790,P=0.006),2组阴性淋巴结分别为(14.4±5.4)枚和(16.7±7.0)枚,无统计学差异(t=-1.904,P=0.055)。新辅助化疗联合手术组40例随访6~19个月,平均10个月;直接手术组67例随访7~21个月,平均12个月,2组各有4例复发。结论乳腺癌经新辅助化疗后行腋窝淋巴结清扫所检出的淋巴结总数和阳性淋巴结数减少。     

Selection of local therapy after neoadjuvant chemotherapy in patients with stage IIIA,B breast cancer

Background: Stage IIIA,B breast cancer is commonly treated with neoadjuvant chemotherapy because of high objective response rates and improved operability. Criteria for subsequent selection of local therapy—mastectomy, radiotherapy, or both—are not well defined. We adopted a policy of selective local therapy based on rebiopsy of the breast and clinical axillary lymph node status at the time of best response to chemotherapy. Methods: Between 1980 and 1993, 126 patients with stage IIIA,B breast cancer were treated with neoadjuvant chemotherapy and definitive local therapy. The long-term incidence of locoregional failure (in-breast, chest wall, axilla, supraclavicular, neck), relapse-free survival, and overall survival was determined. Results: The overall clinical objective response rate to chemotherapy was 95.2%. Eighty-three patients underwent mastectomy, with negative margins achieved in 91.6%. Forty-two patients had breast preservation; the overall in-breast recurrence rate was 19.0% (8 of 42 patients). The overall locoregional recurrence rate by site was: chest wall—8.7% (11 of 126 patients), axilla—8.7% (11 of 126 patients), supraclavicular—5.6% (7 of 126 patients), and neck—4.0% (5 of 126 patients). The axillary recurrence rate was 6.6% (5 of 76 patients) for clinically negative axilla treated with radiotherapy only, and 12.0% (6 of 50 patients) for clinically positive axilla treated with surgery only. The overall long-term survival probabilities (6 years) according to stage were: stage IIIA—58.0%, stage IIIB_noninflam—58.0%, stage IIIB_inflam—36.0%. Conclusions: These findings support a selective approach to local therapy in patients with stage IIIA,B breast cancer. This approach provides local control in most patients, and allows for breast preservation and elimination of axillary dissection in selected patients. Presented at the 49th Annual Cancer Symposium of the Society of Surgical Oncology, Atlanta, Georgia, March 21–24, 1996.     

乳腺癌新辅助化疗后前哨淋巴结活检术的研究

目的 探讨乳腺癌病人新辅助化疗后前哨淋巴结活检的可行性。方法对2003年11月至2004年10月住院治疗中的57例Ⅱ、Ⅲ期乳腺癌病人行新辅助化疗后，临床检查腋窝淋巴结阴性行前哨淋巴结活检术（SLNB）。结果57例中检出前哨淋巴结（SLN）53例，检出率93．0％。SLN对腋窝淋巴结状况预测的敏感性为89．7％，特异性为100．0％，准确性为94．3％，阳性预测值为100．0％，阴性预测值为88．9％，假阴性率为5．7％。肿瘤对化疗反应为CR（完全缓解）、PR（部分缓解）和SD（稳定）的SLN检出率分别为100．0％、96．7％和70．0％（P〈0．01）。SLN假阴性3例均为腋窝淋巴结转移数〉4个者。结论Ⅱ、Ⅲ期乳腺癌实施新辅助化疗后。行SLNB可获得与早期乳腺癌SLNB相似的效果。     

FTO基因在乳腺癌组织的表达及新辅助化疗对其表达的影响

目的：探讨FTO基因在原发性乳腺癌组织中的表达及新辅助化疗对其表达的影响。 方法：应用RT-PCR方法检测28例乳腺增生病组织和24例乳腺癌组织及10例乳腺癌新辅助化疗前后组织中FTO mRNA的表达水平,并分析FTO基因表达水平与乳腺癌患者临床病理参数的关系。 结果：FTO基因在乳腺增生组织及乳腺癌组织均有表达,而在乳腺癌表达高于乳腺增生组织（P<0.05）;新辅助化疗后乳腺癌组织FTO mRNA的表达水平低于化疗前（P<0.05）;乳腺癌组织FTO mRNA表达水平与淋巴结转移有关,FTO mRNA的表达量在淋巴结转移组高于未转移组（P<0.05）,而与ER,PR受体,CerbB-2基因状态及肥胖无关（均P>0.05）。 结论：FTO基因在乳腺癌组织中表达增加,且可能与乳腺癌发生发展有关;新辅助化疗可以下调乳腺癌组织FTO基因的表达。     

Breast-conserving surgery using supine magnetic resonance imaging in breast cancer patients receiving neoadjuvant chemotherapy

BACKGROUND: Success of breast-conserving surgery (BCS) following neoadjuvant chemotherapy (NAC) depends on accurate assessment of the initial lesion. We developed a new procedure (NIPR) in which initial naked magnetic resonance images are projected onto the skin before BCS. METHODS: Thirty-five breast cancer patients underwent supine oblique MRI of the operative area. In 20 DCIS patients, the metallic clips were reproduced by projection on the skin using NIPR, and discrepancies between the projection site and clip were measured on X-rays. Fifteen patients (T1;3,T2;8,T3;4 cases) treated with NIPR were compared to 20 (T1;5 , T2;15 cases) treated using the conventional method with regard to excision area and additional excision rate of BCS after NAC. RESULTS: The median discrepancy (linear distance) was 2.6 mm. NIPR significantly reduced the excision area and additional excision rate in T1 and T2 compared to the conventional method (P<0.05). CONCLUSIONS: NIPR is a reliable technique for BCS following NAC with significant reductions in excision area and additional excision rate and superior cosmetic results.     

The effect of neoadjuvant chemotherapy on estrogen and progesterone receptor expression and hormone receptor status in breast cancer

BACKGROUND: Neoadjuvant chemotherapy may decrease tumor volume to allow breast conservation surgery. Its effect on estrogen and progesterone receptor (ER/PR) expression and hormone receptor (HR) status is controversial. METHODS: From February 2001 to July 2002, 56 breast cancer patients treated with neoadjuvant chemotherapy and 56 non-neoadjuvant therapy (control) patients with adequate tissue samples were identified. Quantitative ER/PR expression was analyzed in preneoadjuvant or preoperative core biopsies and final surgical specimens. Changes between the two groups were compared to determine if alterations were due to neoadjuvant chemotherapy or tissue sampling. RESULTS: The ER/PR expression changed in 34 (61%) neoadjuvant chemotherapy patients and 27 (48%) control patients. These expression changes resulted in HR status (positive/negative) alterations in 3 patients (5%) in both groups. Age, histology, chemotherapy regimen, and neoadjuvant response did not predict change. CONCLUSIONS: Hormone receptor status changed in 5% of neoadjuvant chemotherapy and control groups due to tissue sampling. As these changes may impact treatment, HR expression reanalysis in final surgical specimens is recommended.     

High-resolution axillary ultrasound is a poor prognostic test for determining pathologic lymph node status in patients undergoing neoadjuvant chemotherapy for locally advanced breast cancer

BACKGROUND: The purpose of this study was to evaluate the efficacy of high-resolution axillary ultrasound in detecting axillary lymph node metastases after neoadjuvant chemotherapy in patients with locally advanced breast cancer. METHODS: Fifty-three patients with stage II or III breast cancer undergoing neoadjuvant chemotherapy who had a physical examination, high-resolution axillary ultrasound, and axillary lymph node dissection from January 1999 to September 2003 were included in this study. RESULTS: The positive predictive value of the postchemotherapy ultrasound for predicting pathologic nodal involvement was 83%, but the negative predictive value was only 52%. Postchemotherapy physical examination was also poor at predicting pathologic nodal involvement with a positive predictive value of 93% and a negative predictive value of only 58%. CONCLUSIONS: A negative post-neoadjuvant chemotherapy high-resolution axillary ultrasound or physical examination does not predict pathologic node status, and this test has limited value in this setting.     

ER、PR、HER2和Ki-67在乳腺癌新辅助化疗前后表达变化的临床意义

【摘要】 目的 探讨新辅助化疗前后ER、PR、HER2、Ki-67表达的改变与乳腺癌新辅助化疗疗效的关系。方法 收集广东省妇幼保健院乳腺外科2007年1月1日至2012年12月31日收治的72例接受新辅助化疗的ⅡA~ⅢC期的乳腺癌资料,回顾性分析临床特征、ER、PR、HER2及Ki-67表达水平与新辅助化疗疗效的关系。结果 72例乳腺癌患者新辅助化疗总有效率(RR)为76.4%(55/72),其中有16.7%(12/72) 病例达临床完全缓解(CR),59.7%(43/72)病例达临床部分缓解(PR)。23.6%(17/72)的病例为病情稳定(SD),无患者获得疾病进展(PD),病理完全缓解(pCR)7例(9.72%)。原发肿瘤大小、ER、PR、Ki-67表达与新辅助化疗的临床有效率相关(P<0.05);病理完全缓解率(pCR)与ER、PR状态相关(P<0.05);ER新辅助前后发生改变的约22.2%,PR发生改变的约25.0%,HER2发生改变的约15.3%,Ki-67发生改变的约55.6%;新辅助化疗疗效与ER、PR、Ki-67化疗前后的改变相关(P<0.05),与HER2的改变无关(P>0.05)。结论 乳腺癌新辅助化疗后ER、PR、HER2和Ki-67的表达可发生改变,并且ER、PR和Ki-67表达的改变可预测新辅助化疗的疗效。