Amelioration of postmenopausal primary hyperparathyroidism during adjuvant tamoxifen for breast cancer

The effects of adjuvant treatment with tamoxifen on bone metabolism in a postmenopausal woman with primary hyperparathyroidism is presented. A 69-year-old woman with increased serum ionized calcium, parathyroid hormone, and 1,25-(OH)2 vitamin D levels and a normal bone scan received tamoxifen 10 mg three times daily for 1 year. During treatment bone turnover decreased whereas parathyroid hormone increased further. After cessation of treatment the calcium metabolic variables returned to pretreatment levels. The antiestrogen tamoxifen seems to behave as an estrogen on bone metabolism in primary hyperparathyroidism.     

Management of elderly patients with primary breast cancer

From 1974 through 1983, three hundred forty-three patients aged 70 years or older at diagnosis received comprehensive post-operative radiation therapy for localized (Stage I-III) breast cancer following surgical procedures ranging from incisional biopsies to classical radical mastectomy. The 5- and 10-year overall survival rates for this series of elderly patients are 67% and 33%. The respective disease-free survival rates are 67% and 42%. Over one-half of these women were treated by less than total mastectomy. No differences were seen in survival, disease-free survival, or local regional control rates comparing similarly staged patients treated by radical mastectomy, modified radical mastectomy, or tylectomy. Complications were few and seen primarily in those patients subjected to axillary dissection prior to irradiation. Long term survival appears to be achievable in the majority of elderly patients with regionally confined disease at presentation and aggressive treatment with curative intent is warranted. These elderly patients are often poor candidates for radical surgery. In this patient population, conservative surgery with post-operative radiation therapy is well tolerated and provides equivalent results to more radical surgical procedures.     

Second primary malignancies in patients with male breast cancer

An international multicentre study of first and second primary neoplasms associated with male breast cancer was carried out by pooling data from 13 cancer registries. Among a total of 3409 men with primary breast cancer, 426 (12.5%) developed a second neoplasia; other than breast cancer, a 34% overall excess risk of second primary neoplasia, affecting the small intestine (standardised incidence ratio, 4.95, 95% confidence interval, 1.35-12.7), rectum (1.78, 1.20-2.54), pancreas (1.93, 1.14-3.05), skin (nonmelanoma, 1.65, 1.16-2.29), prostate (1.61, 1.34-1.93) and lymphohaematopoietic system (1.63, 1.12-2.29). A total of 225 male breast cancers was recorded after cancers other than breast cancer, but an increase was found only after lymphohaematopoietic neoplasms. BRCA2 (and to some extent BRCA1) mutations may explain the findings for pancreatic and prostate cancers. Increases at other sites may be related to unknown factors or to chance. This large study shows that the risks for second discordant tumours after male breast cancer pose only a moderate excess risk.     

不同年龄段乳腺癌患者的临床病理特点

目的找出不同年龄段之间乳腺癌患者的临床病理生物学特点,为临床乳腺癌患者个体化治疗提供更多的理论基础。方法回顾性分析总结2001～2008年入住本院并经病理证实且有手术指征的1131例乳腺癌患者的临床病理资料,根据患者年龄分成青年患者、中年患者和老年患者3个组。对3个不同年龄段乳腺癌患者的临床病理生物学指标进行比较分析。统计分析采用卡方检验或秩和检验(Kruskal-WallisH检验)。结果病灶大小和Ki67在3组间存在微弱的统计学意义上的差异(P=0.047,P=0.048)。淋巴结转移、雌激素受体(ER)、孕激素受体(PR)、人表皮生长因子受体2(HER-2)、上皮细胞钙黏蛋白(E-cadherin)、多重耐药基因1(MDR1)、DNA拓扑异构酶Ⅱ(TOPO-Ⅱ)以及组织学类型的分布在3组间差异均有统计学意义(P0.050)。老年患者病灶最大,发生其他组织学类型癌的比例最高,并且ER、PR和E-cadherin的阳性率也最高。青年组发生淋巴结转移的比例最高,HER-2、Ki67、TOPO-Ⅱ以及MDR1的阳性率最高。结论老年乳腺癌的生物学行为最好,青年乳腺癌的生物学行为最差。青年乳腺癌淋巴结转移的风险高。     

骨科首诊原发性甲状旁腺功能亢进症的临床特征分析

目的探讨骨科首诊原发性甲状旁腺功能亢进症（PHPT）患者的临床特征,提高对此类患者的诊断水平。方法回顾性分析骨科首诊并经组织学证实的32例PHPT患者的临床、影像、病理资料。结果所有患者均证实患有甲状旁腺腺瘤并行腺瘤切除术。所有患者骨骼X线片均表现为广泛性骨密度减低,不同程度的局灶性溶骨性改变,15例（46．88％）合并病理性骨折并经手术治疗。实验室检查显示所有患者血钙、碱性磷酸酶（ALP）、骨钙素（BGP）和甲状旁腺激素（FFH）明显高于正常,血磷明显低于正常。患者甲状旁腺腺瘤切除术后第一天血钙即恢复正常,术后7d内PTH恢复正常。长期随诊12例患者骨骼状况恢复良好。结论部分以骨科症状首诊的PHPT患者,如能正确认识PHPT造成的骨损害,及时行甲状旁腺外科治疗可治愈此病。     

Bilateral primary breast cancer in patients treated with adjuvant therapy

Between 1974 and 1986, 1036 patients with operable breast cancer were treated with doxorubicin-containing combination chemotherapy regimens. Of these, 44 patients had bilateral breast cancer prior to initiation of adjuvant therapy (prechemotherapy) and 17 patients developed primary breast cancer on the contralateral side during or after completion of adjuvant therapy (postchemotherapy). The objectives of the study were twofold: to determine the incidence of bilateral primary breast cancer and to determine the effect of second primary breast cancer on prognosis of patients treated for disease in the contralateral breast. The estimated disease-free and overall survival of patients with prechemotherapy bilateral disease was similar to the patients with unilateral breast cancer. Four hundred eight patients received tamoxifen in addition to combination chemotherapy during adjuvant therapy. The incidence of contralateral breast cancer at 2 years in patients treated with tamoxifen was 0.4% in comparison to 0.8% in patients treated with chemotherapy alone. Time to development of second breast cancer in patients treated with or without tamoxifen was not significantly different (p = 0.41). We conclude that patients with bilateral breast cancer have a prognosis similar to that of patients with comparably staged unilateral disease. Although the rate of bilateral disease observed among patients treated with adjuvant chemotherapy and tamoxifen was somewhat lower than for those receiving chemotherapy only, the difference was not statistically significant.     

140 例原发性甲状旁腺功能亢进患者临床资料分析

目的：探讨不同病理类型的原发性甲状旁腺功能亢进（primary hyperparathyroidism,PHPT）的临床待征。方法：回顾性分析2010年1 月至2016年6 月首都医科大学附属北京世纪坛医院行手术治疗并经病理学检查确诊的140 例PHPT患者的临床资料。结果：术后经病理学检查证实,分为甲状旁腺癌组（parathyroidcarcinoma ,PC）13例（9.29%）,增生组（parathyroid hyperplasia,PH）27例（19.29%）,甲状旁腺瘤组（parathyroid adenoma,PA）100 例（71.43%）。 PC组的病程长,PH组的病程>PA 组（P < 0.05）;PC组年轻患者所占比例较高（P = 0.003）;PC组病变的直径>PA 组,且PA组>PH 组（P < 0.05）;PC组的血钙、甲状旁腺激素（parathyroidhormone,PTH ）、碱性磷酸酶（alkaline phosphatase,AKP ）、空腹血糖（fasting blood-glucose ,FPG ）、谷丙转氨酶（alanine aminotransferase ,ALT）、谷草转氨酶（aspartate aminotransferase ,AST）、谷氨酸转肽酶（glutametet ranspeptidase ,GGT ）、尿素氮（blood urine nitrogen,BUN ）、血肌酐（creatine,CRE ）最高（P < 0.05）,且尿钙和尿磷最高（P < 0.05）;PH组血钙、PTH 、AKP 、尿钙均 0.05）;PC组在泌尿系统、消化系统、精神神经系统的表现的比例分别为76.92%（10/ 13）、76.92%（10/ 13）、15.38%（2/ 13）,高于PH组和PA组（P < 0.05）,其中PH组在泌尿系统表现的比例>PA 组,PC组病理性骨折、便秘的比例最高30.77%（4/ 13）、38.46%（5/ 13）（P < 0.05）。 结论：PC组的病程较长,发病年龄较年轻;PC组的病变组织最大,PH组病变组织>PA 组,术后PC组的血钙最低,而PTH 水平最高。PC组的生化和临床表现更为明显。     

乳腺与肺双原发性癌的临床病理特征分析

目的:探讨乳腺癌合并原发性肺癌患者的临床病理特征及同时手术的安全性。方法:回顾性收集1999 年1月至2017年12月中国医学科学院肿瘤医院收治的乳腺癌合并肺癌患者共计94例,经病例筛选后共71例纳入本研究,对纳入研究的双原发性癌患者临床病理特点进行分析。结果:71例患者中,乳腺癌作为首发癌合并肺癌 63例,肺癌作为首发癌合并乳腺癌 8例,两组患者在乳腺肿瘤大小、淋巴结转移数目、临床分期、病理类型、ER表达、Ki-67指数、HER-2表达、手术方式及有无放化疗史方面的差异均无统计学意义（均P>0.05）,但乳腺癌首发组患者无进展生存期优于肺癌首发组（P<0.05）。在同时性双原发性癌 28 例中,6 例患者（21.4%）同时接受乳腺癌及肺癌手术,围手术期无并发症发生,术后病情平稳。以乳腺癌作为首发癌的41例异时性双原发性癌中,中位间隔为57.3个月,肺结节平均观察时间为10个月。肺癌临床分期Ⅰ期以下占82.9%,病理类型中93%为腺癌。发现肺结节的早晚与乳腺癌术后复查及随访有关。结论:乳腺癌首发的双原发性癌患者预后较好;同时手术治疗乳腺癌及肺癌是安全可行的;在异时性双原发性癌中,肺癌一般是在乳腺癌术后 5 年内发现的,乳腺癌术后规律及时的随访有助于肺癌早期发现。     

Biological features of breast cancer in patients under 35

The study was concerned with biological features of inoperable breast cancer and their prognostic significance for patients under 35. That age was identified as a prognosticator for breast cancer: high-grade (G3) malignancies, vascular invasion and EIC+component were relatively more frequent in such patients. Also, those with HER2/neu hyperexpression had worst prognosis.     

男性乳腺癌125例患者的临床病理特征与生存分析

目的:探讨男性乳腺癌患者的临床病理特征以及治疗和生存情况,并进行预后相关因素的分析.方法:回顾性分析1961年1月-2011年12月共125例男性乳腺癌患者的病历资料和随访资料.采用log-rank检验和COX回归模型分析与男性乳腺癌患者预后相关的因素.结果:125例男性乳腺癌患者的5年总生存率为60.5％,5年无病生存率为54.8％.单因素分析结果显示,是否有恶性肿瘤家族史(P=0.041)、肿瘤大小(P＝0.005)、临床TNM分期(P=0.005)、腋窝淋巴结是否转移(P=0.013)和是否行乳腺癌根治术(P=0.016)是与男性乳腺癌患者总生存率相关的预后因素,而是否有恶性肿瘤家族史(P=0.015)、肿瘤大小(P=0.000)、临床TNM分期(P=0.002)和腋窝淋巴结是否转移(P=0.010)是与男性乳腺癌患者无病生存率相关的预后因素.COX回归模型分析结果显示,肿瘤大小(P=0.045)、腋窝淋巴结是否转移(P=0.026)和是否行乳腺癌根治术(P=0.000)是与总生存率相关的独立预后因素,而肿瘤大小(P=0.010)和是否行乳腺癌根治术(P=0.001)是与无病生存率相关的独立预后因素.结论:肿瘤大小、腋窝淋巴结是否转移和是否行乳腺癌根治术是影响男性乳腺癌患者预后的独立危险因素,早期诊断以及以乳腺癌根治术为主的综合治疗措施是提高男性乳腺癌患者生存率的关键.     

乳腺癌患者肺内孤立性结节CT征象：肺原发性腺癌和转移性乳腺癌的鉴别

背景与目的：乳腺癌患者CT上表现为孤立性的肺结节（solitary pulmonary nodule,SPN）可能是原发性肺癌（primary lung cancer,PLC）也可能是乳腺癌肺转移（metastatic pulmonary breast cancer,MBC）,明确诊断对于患者的个性化诊疗具有重要意义。该研究回顾性分析CT上表现为SPN的PLC和MBC的高分辨率CT（high resolution CT,HRCT）特征,探讨其诊断价值。方法：回顾性分析2007年10月—2013年9月经胸外科手术获得病理证实的116例乳腺癌患者的孤立性肺结节,通过Logistic回归模型和受试者工作特征（receiver operating characteristic,ROC）曲线分析结节CT征象鉴别MBC和PLC。结果：116例结节中,PLC为77例（66.4%）,MBC为39例（33.6%）。MBCs与PLCs在圆形或椭圆形、亚实性结节、分叶征、毛刺征、空泡征、支气管充气征、胸膜凹陷征、结节最大径及实性成分体积比等征象上差异有统计学意义。多变量分析显示,毛刺征、支气管充气征和非实性成分体积比≥24%是PLC的独立预测因子,相应的比值比（odds ratio,OR）分别为0.219（95%CI：0.069~0.638）、0.061（95%CI：0.009~0.240）和0.972（95%CI：0.951~0.990）。该多因素回归模型对PLC与MBC的鉴别具有良好的性能,ROC曲线的曲线下面积（area under curve,AUC）为0.903（95%CI：0.838~0.969）,准确率为86.2%,灵敏度为88.3%,特异度为82.1%。结论：乳腺癌患者孤立性肺结节中原发性肺腺癌概率高。实性成份体积比＜24%、有支气管充气征和有毛刺征等CT征象提示原发性肺癌的可能大。     

三阴性乳腺癌的临床病理学特征及预后分析

目的分析三阴性乳腺癌临床病理学特征及预后。方法收集2004年1月至2005年1月本院收治的1264例可手术乳腺癌患者的临床病理资料,并回顾性分析其中246例三阴性乳腺癌患者的临床病理学特征、复发转移及生存情况。采用SPSS13．0软件进行统计学处理,频数资料组间比较采用x^2检验或Mann-Whitney U检验,生存分析采用Kaplan-Meier法,组间曲线比较用Log—Rank检验。结果三阴性乳腺癌患者占总患者数的19．46％（246／1264）。与非三阴性乳腺癌患者比较,三阴性乳腺癌患者小于35岁的患者所占比例大[8．54％（21／246）,Z=-3．58,P=0．000],有乳腺癌家族史者多[8．13％（20／246）,x^2=5．98,P=0．014],肿瘤直径≥5cm者多[11．79％（29／246）,Z=-2．70,P=0．007],腋窝淋巴结阳性者多[58．13％（143／246）,x^2=6．16,P=0．013],组织学分级较高,Ⅲ级占20．73％（51／246,x^2=13．55,P=0．000）。其复发、转移发生率高,占20．33％（50／246,x^2=8．70,P=0．003）。三阴性乳腺癌患者的5年无瘤生存率和总生存率分别为79．67％（196／246）、89．84％（221／246）,均明显低于非三阴性乳腺癌患者（x^2=8．70,P=0．003;x^2=15．07,P=0．000）,其中骨、肺、脑、锁骨上淋巴结转移发生率明显高于非三阴性乳腺癌患者（P〈0．050）。亚组分析中,三阴组5年无瘤生存率明显低于HR（＋）HER-2（-）组（x^2=7．55,P=0．006）,且5年总生存率明显低于HR（＋）HER-2（-）及HR（-）HER-2（＋）组（x^2=15．31,P=0．000;x^2=5．77,P=0．016）。结论三阴性乳腺癌可以作为一种独特的乳腺癌亚型．复发、转移发生率高,临床预后差。     

Clinical features and managements of breast cancer patients with pulmonary metastasis

One hundred-thirty-nine patients with advanced breast cancer were treated during five years since 1977 in our Department. Treatments consisted of chemotherapy (ACF and ACFM), hormone therapy (tamoxifen) and their combination (ACFT). Seventy patients had lung metastases at the initiation of these therapies. An overall response rate was 41%, whereas a response rate for metastatic lung lesions was 26% (18/69). Breast cancer is known as a systemic disease, thus other therapies such as pulmonary resection or irradiation had a limited indication to control the lung metastasis. Our result indicates that favorable responses to advanced breast cancer with systemic therapies will improve the prognosis of breast cancer patients with lung metastasis.     

循环肿瘤干细胞与原发性乳腺癌患者生存时间的相关性

目的探讨循环肿瘤干细胞与原发性乳腺癌患者生存时间的相关性。方法对50例乳腺癌患者的外周血进行免疫组化检测,对患者进行随访,分析两者之间的关系。结果 50例患者中,CK19+/CD44+/CD24-/LOW阳性36例,阴性14例。乳腺癌组织上皮细胞的CK19+/CD44+/CD24-/LOW表达率明显高于癌旁组织,差异有统计学意义(P<0.05)。50例乳腺癌外周血标本中,Cerb B-2高表达患者癌组织中CK19+/CD44+/CD24-/LOW阳性表达率为85.2%(23/27),C-erb B-2低表达患者癌组织中CK19+/CD44+/CD24-/LOW阳性表达率为39.1%(9/23),且C-erb B-2表达强度随CK19+/CD44+/CD24-/LOW阳性率增加而增高,两组差异有统计学意义(P<0.05)。随CK19+/CD44+/CD24-/LOW表达的增高,患者发生远处转移及死亡率增高。结论动态监测循环肿瘤干细胞变化,有利于及时了解乳腺癌患者病情及治疗效果。     

乳腺癌保乳治疗近期观察

目的探讨乳腺癌保乳治疗的方法与疗效。方法19例Ⅰ～Ⅱ期原发性乳腺癌施行局部扩大切除并腋窝淋巴结清扫,手术后患侧乳房接受放射治疗。结果手术后6个月随访,患者本人对保留乳房的满意率100%,十分满意者占90%。经随访2～26个月,平均随访12个月,无局部复发,无远处转移和死亡病例。结论Ⅰ～Ⅱ期乳腺癌实施保乳治疗,近期疗效满意,远期效果有待长期随访观察。     

Adjuvant aminoglutethimide therapy for postmenopausal patients with primary breast cancer

Three hundred and twenty-two postmenopausal patients with primary breast cancer and ipsilateral axillary node involvement were randomized to receive aminoglutethimide and hydrocortisone or placebo for 2 years in a double blind randomized trial between April 1980 and March 1985. Two hundred and eighty-six patients were eligible for the study of whom 145 received active drug and 141 received placebo. At the present time significantly fewer patients have relapsed or died without previous relapse in the treatment arm (P = 0.002); 43 of 145 (30%) patients receiving aminoglutethimide have relapsed or died compared with 63 of 141 (40%) of those receiving placebo. Local recurrence is also significantly reduced (P = 0.002) since only 6 patients receiving active treatment developed local recurrence compared to 21 receiving placebo. Side effects were severe enough to necessitate complete withdrawal or reduction of therapy in 27 of 145 (19%) in the treatment arm of the study compared with 21 of 141 (15%) in the placebo arm. A single treatment-related death occurred, due to agranulocytosis. Aminoglutethimide and hydrocortisone therefore delay relapse after surgery for primary breast cancer in postmenopausal women. It is too early to assess any effect on overall survival.     

Changes of biological features in breast cancer cells determined by primary chemotherapy

Background. To evaluate the changes in the biological features of breast cancer cells induced by primary chemotherapy (PCT) and their possible relationship with the response to therapy, we performed an extensive immunohistochemical study before and after PCT. Patients and methods. PCT was administered to 29 women with breast cancer. On specimens obtained by tru-cut and post-chemotherapy surgery we analyzed the following parameters: histology, histologic grade, apoptotic index, hormone receptor levels, Ki67, PCNA, EGFr, bcl-2, p53, p170. The significance of the changes induced by PCT and their correlations with the type of response were evaluated. Results. Twelve patients achieved a partial response with PCT. No baseline biological parameter correlated with the type of response. After PCT we observed a significant increase in the apoptotic index (p = 0.000), PCNA (p=0.036), EGFr (p = 0.005), and p170 expression (p=0.001), regardless of the type of chemotherapy administered (anthracyclines, 25 cases, or CMF, 4 cases). Responder patients displayed a significant decrease in ER levels (p = 0.015), whereas in non responders there was an increase in PCNA (p=0.008) and EGFr expression (p=0.002). The apoptotic index and p170 expression rose after PCT regardless of the type of response. Conclusions. PCT induced significant variations in the phenotype of breast cancer cells. These changes might reflect the selection of new neoplastic clones with different biological properties and so could facilitate the choice of appropriate chemotherapy agents.     

CLINICOPATHOLOGIC FEATURES AND HEPATECTOMY IN THE ELDERLY PATIENTS WITH PRIMARY LIVER CANCER

ＣＬＩＮＩＣＯＰＡＴＨＯＬＯＧＩＣＦＥＡＴＵＲＥＳＡＮＤＨＥＰＡＴＥＣＴＯＭＹＩＮＴＨＥＥＬＤＥＲＬＹＰＡＴＩＥＮＴＳＷＩＴＨＰＲＩＭＡＲＹＬＩＶＥＲＣＡＮＣＥＲＺｈｏｕＸｉｎｄａ周信达ＴａｎｇＺｈａｏｙｏｕ汤钊猷ＹｕＹｅｑｉｎ余业勤ＭａＺｅｎｇｃｈ...     

The fate of bone marrow micrometastases in patients with primary breast cancer

Using an immunocytochemical technique, micrometastases have been found in the bone marrow of approximately 26% of patients with primary breast cancer at the time of initial surgery. To determine the fate of these cells, both in patients receiving and not receiving adjuvant therapy, multiple bone marrow aspirates were repeated in 82 patients at a median time of 18 months after surgery but prior to overt relapse. In both treated and untreated patients micrometastases were only found in one of 45 (2%) and one of 37 (3%) patients, respectively. However, when multiple marrow aspirates were taken from patients with local recurrence the incidence of micrometastases was 19% (three of 16), and this increased to 30% (three of ten) in patients with disease at distant sites other than bone, and 100% (ten of ten) in patients with radiologically proven bony disease. Three of 11 (27%) patients in whom the primary tumor remained in situ while receiving adjuvant therapy before definitive surgery had micrometastases at the time of diagnosis and at follow-up 3 months later. These results suggest that many of the micrometastases from breast cancer patients are the result of "shedding" of cells from the primary carcinoma and that a proportion are not viable. The technique is currently insufficiently sensitive to accurately monitor adjuvant therapy in breast cancer patients.