PROGNOSTIC SIGNIFICANCE OF c-erbB-2 ONCOGENE IN AXILLARY NODE-NEGATIVE BREAST CANCER

Background: With the advent of screening mammography more breast cancer will be detected at an earlier stage, apparently confined to the breast with no nodal involvement. However, 30% of these will recur due to micrometastases present at the time of diagnosis. Chemotherapy and tamoxifen have been shown to improve disease-free survival in axillary node-negative patients but not overall survival. In the search for a useful predictor of breast cancer recurrence the relationship between c-erbB-2 expression and recurrence and survival was examined. Methods: Eighty-eight axillary node-negative breast cancer patients were followed up for at least 5 years. Results: There was a significant relationship between c-erbB-2 expression and both tumour recurrence (P < 0.001) and poorer survival (P = 0.003). In a Cox multiple regression analysis, c-erbB-2 staining remained the only significant prognostic variable for recurrence (P= 0.002) and survival (P = 0.032). Tumour recurrence in c-erbB-2-positive cases tended to occur early in the course of follow up and was associated with poorer survival. Conclusion: C-erbB-2 was found to be a useful prognostic indicator for early recurrence and poorer survival in axillary node-negative breast cancer patients.     

THE PROGNOSTIC VALUE OF OESTROGEN RECEPTORS IN BREAST CANCER*

Survival data for 2006 women who had oestrogen receptor assay carried out on primary breast cancer tissue between 1976 and 1982 are presented. There was a significant trend to shorter survival in patients with low ER levels than in those with high ER levels (P < 0.01). This trend was evident in both pre- and post-menopausal women. The point of maximum discrimination between prognostic groups occurred at 8 fm in premenopausal women and the four year survival rates of patients above and below this level were 84% and 48%, respectively. In post-menopausal women, maximum discrimination occurred at 90 fm, and the four year survival rate above and below this level were 82% and 64%, respectively.     

PROGNOSTIC FACTORS AND THE CURABILITY OF BREAST CANCER

Over the years three different concepts regarding the cure of treated breast cancer have emerged. These are clinical cure, personal cure and statistical cure. The latter is the most accurate estimate of the curability of a disease which is presumed to be fatal unless treated. Statistical cure is the elimination of the hazard of death in a treated group compared with an age-matched control population. When statistical cure is studied in patients treated for early breast cancer, it is clear that breast cancer is an incurable disease. The expected gains from the relatively recent introduction of adjuvant therapy are too small to alter this concept. The significance of prognostic factors in a disease deemed to be incurable therefore requires re-examination. The conventional prognostic factors of tumour size, nodal status and a combination of those two in staging systems significantly discriminates in terms of survival in the short term. However, when the characteristics of long-term survivors are examined, neither tumour size nor nodal status discriminates effectively. If this is the case, then we need to reconsider novel treatment strategies which have been introduced in the hope of increasing the curability of the disease and the selection for those treatment strategies of patients using the conventional prognostic factors of tumour size or nodal involvement.     

COSMETIC OUTCOME OF BREAST-CONSERVING THERAPY IN CHINESE PATIENTS WITH EARLY BREAST CANCER

Background : Breast-conserving surgery combined with radiotherapy has emerged as an alternative to mastectomy for women with early breast cancer, and cosmetic outcome has correlated closely with the psychosocial and physical well-being of the patient. Cosmetic outcome assessment after breast-conserving therapy in Chinese patients has so far not been conducted among the clinicians, the patients or their spouses. Methods : The cosmetic results from breast-conserving therapy were evaluated in a group of 33 patients who had been selected as suitable for undergoing local excision, axillary dissection and postoperative radiation therapy for early stage breast cancer. The success of the procedures was assessed by the patients, the clinicians and the patient'spouse, and their ratings were compared with each other. Results : Eighty per cent of the patients and their spouse were satisfied with the cosmetic outcome. Using McNemar'test, when the groups were evaluated on a case-by-case basis, there was a good level of concordance between the patients and their spouses, and that of the patients and the clinicians. Conclusions : Evaluation of the cosmetic and psychosocial sequelae of breast cancer patients is essential when new approaches to treatment are introduced; our data suggest that cosmetically successful breast conservation is feasible in a selected group of Chinese women with early breast cancer.     

阻塞性黄疸患者血浆心钠素水平的增高及其临床意义

我们检测了２３例阻塞性黄疸（ＯＪ）患者术前及术后第２，５，１０，１５日血浆心钠素（ＡＮＦ）水平，同时观察其肾功能变化。结果，术前血浆ＡＮＦ水平，黄疸组较对照组明显增高；内生肌酐清除率（ＣＣｒ）明显降低。术后，ＣＣｒ随ＡＮＦ下降而呈上升趋势，１０天恢复正常。结果提示，ＯＪ患者ＡＮＦ水平增高可能系其并发肾功能受损的一个重要原因。     

THE MONITORING OF SERUM FACTORS IN PATIENTS WITH CANCER

Numerous changes occur in the sera of patients bearing malignant neoplasms. These changes may take the form of appearance of oncofetal proteins that are normally not detectable in non-cancer-bearing patients, or an alteration in the normally present serum constituents such as the serum proteins. Monitoring of these serum factors may be of considerable value in assessing the progress of cancer patients following treatment of their primary tumour. This paper reviews progress in this area to date and documents our early results with six non-specific serum factors (total protein, total protein hexose, total protein hexosamine, ceruloplasmin, alpha-1-antitrypsin, and haptoglobin), in 64 patients bearing a variety of malignant neoplasms in various stages of the disease. Present methods of postoperative assessment of cancer patients are inadequate for detecting early recurrence. Preliminary results indicate that the nonspecific serum factors that we are studying may be of considerable value for monitoring of cancer patients, and may also possibly serve as a diagnostic screen in high-risk groups.     

联合检测血清YKL-40和CA19-9在胰腺癌病人中的应用

目的 探讨联合检测血清YKL-40和CA19-9对胰腺癌手术的意义。方法采用YKL-40 ELISA试剂盒和CA19-9 ELISA试剂盒分别检测血清YKL-40和CA19-9。结果YKL-40在胰腺癌各期中均较正常组明显升高，尤以Ⅲ、Ⅳ期显著，即胰腺癌侵犯周围组织时血清YKL-40水平高。结论YKL-40是一个独立的指标，提示我们在判断胰腺癌能否切除时可以结合YKL-40、CA19-9检测和CT检查；YKL-40和CA19-9联合检测有助于胰腺癌的术前预测。     

CyclinD_1基因扩增及其蛋白表达在乳腺癌中的意义

目的　探讨乳腺癌中CyclinD1基因扩增和其蛋白表达的相关性及其临床意义。方法　应用半定量PCR和免疫组化技术 ,检测和分析了乳腺癌及其癌旁组织、乳腺良性组织及正常乳腺标本中CyclinD1基因的扩增和CyclinD1蛋白的表达情况。结果　 62例乳腺癌中 ,CyclinD1基因扩增占 2 2 .6% ( 14 /62 ) ,蛋白过度表达占 48.4% ( 3 0 /62 ) ,二者有一定相关性 ,而其它各种乳腺组织的CyclinD1基因扩增及蛋白过度表达与之相比差异有显著性意义 (P <0 .0 5 )。Cy clinD1基因扩增及蛋白过度表达与乳腺癌组织学分级呈明显正相关 ,且CyclinD1蛋白过度表达还与雌孕激素受体状况呈正相关。结论　乳腺癌中CyclinD1基因扩增程度和其蛋白过度表达虽有一定相关性 ,但并不完全一致 ,说明还存在着其它导致CyclinD1蛋白过度表达的机理 ,CyclinD1蛋白的表达可能还受雌激素的调控。对乳腺癌中CyclinD1基因及其蛋白表达的检测有一定临床意义。     

CyclinD1基因扩增及其蛋白表达在乳腺癌中的意义

目的 探讨乳腺癌中ＣｙｃｌｉｎＤ１基因扩增和其蛋白表达的相关性及其临床意义。方法应用半定量ＰＣＲ和免疫组化技术,检测和分析了乳腺癌及其癌旁组织、乳腺良性组织及正常朱标本中ＣｙｃｌｉｎＤ１基因扩增占２２．６％（１４／６２）,蛋白过度表达占４８．４％（３０／６２）,二者有一定相关性,而其它各种乳腺组织的ＣｙｃｌｉｎＤ１基因扩增及蛋白过度表达与之相比差异有显著性意义（Ｐ〈０．０５）。ＣｙｃｌｉｎＤ１基因     

乳腺癌C-erb B-2癌基因与雌、孕激素受体的关系及预后意义

用ＬＳＡＢ免疫组织化学法检测２４５例乳腺癌石蜡标本Ｃ－ｅｒｂＢ２癌基因的表达，结果显示：该癌基因的过度表达与乳腺癌的临床分期晚、组织学分级高、腋窝淋巴结有转移、雌、孕激素受体缺乏及预后差有关，该癌基因的表达是乳腺癌中腋淋巴结状况之外的又一个独立预后因素。该基因表达的检测作为乳腺癌常规病理检查，可用于判断乳腺癌的预后及拟定术后治疗方案。     

THE ASSESSEMENT OF PROTEIN-CALORIE MALNUTRITION IN PATIENTS WITH GASTROINTESTINAL CANCER

Daily protein and calorie intake, three plasma protein estimations, two upper limb anthropometric measurements, and estimated weight loss were all determined in 31 patients attending a surgical oncology outpatient department. The patients, who had had prior resection of a gastrointestinal cancer, could be divided Into three groups depending on (I) the absence of clinically detectable tumour; (ii) the presence of clinically detectable tumour with survival over the ensuing four-month period. and (iii) clinically detectable tumour without survival over the ensuing four-month period. The variables least able to discriminate between these groups, and to Interrelate to the other variable in a cross-correlation matrix, were the dietary intake data and the estimated weight loss, it is concluded that protein-calorie mainutrition can be adequately assessed In patients with advanced cancer from studies of the plasma albumin, prealbumin, transferrin, arm fat area, and arm muscle area.     

BS15PFACILITATING NATIONAL CONSISTENCY IN BREAST CANCER DATA COLLECTION

In Australia there is currently no consistent approach to collecting breast cancer specific data. The National Health Data Dictionary (NHDD) recommends a core set of generic data items for clinical cancer registration. However this list does not include the more detailed items required by specific tumour streams. The NBCC has developed a supplementary set of Breast Specific Data Items and definitions to serve as a guide for specialist breast cancer data collection in Australia. A multidisciplinary Working Group comprising clinical and consumer representation, including three breast surgeons, identified 16 breast specific data items for collection. The items are designed to align with items collected through the RACS National Breast Cancer Audit and leading cancer centres. A range of items from patient data (menopausal status), diagnostic data (HER2 status, sentinel lymph node), treatment (surgical margin clearance and involvement), and breast reconstruction are included. The data items are recommended as best practice for breast cancer specific data collection and aim to facilitate national consistency in defining, recording, and monitoring information about patients with breast cancer. This national approach will contribute to improved patient outcomes by informing planning, quality improvement and evaluation strategies for cancer services. The items are currently being piloted in two sites in NSW and will be available nationally in late 2007.