家族性乳腺癌BRCA1/BRCA2基因突变的研究

目的:研究家族性乳腺癌患者BRCA1/ BRCA2基因的突变位点及携带情况.方法:应用聚合酶链反应-单链构象多态性分析(single strand confor- mation polymorphism analysis of polymerase chain reaction products,PCR-SSCP)和基因测序技术,对12个家族性乳腺癌家系的13例患者进行BRCA基因检测.结果:实验发现1个突变位点(4193insA)和2个核苷酸多态性位点(4165T>A,5416C>A).结论:河北地区家族性乳腺癌的BRCA1基因突变率为7.7%,低于国外和国内其它地区;BRCA基因突变携带者家系中成员具有较高的发病风险.     

家族性乳腺癌患者及家系成员乳腺癌易感基因携带情况调查

目的 乳腺癌易感基因1(breast cancer susceptibility gene 1,BRCA1)和BRCA2基因已经证实与家族性乳腺癌密切相关.本研究旨在分析中国汉族家族性乳腺癌患者及家系成员BRCA1和BRCA2突变特征及携带情况.方法 收集2013 12-02-2015-06-08军事医学科学院附属医院确诊的中国汉族家族性乳腺癌患者55例及家系成员48名,共计103例样本.柚取外周静脉血提取DNA,应用聚合酶链反应(polymerase chain reaction,PCR) DNA直接测序方法检测BRCA1和BRCA2基因全编码外显子序列.结果 55例家族性乳腺癌患者中发现5个BRCA基因致病性突变位点,1个突变位点乳腺癌信息库中见报道(BRCA1:4730insG),4个为新发现突变位点(BRCA1:1937insC,4538insAG;BRCA2:1382delA,2820delA).家族性乳腺癌患者BRCA1/2突变率为9.09％(BRCA1,5.45％;BRCA2,3.64％),其中三阴性乳腺癌患者突变率为22.22％(x2 =1.99,P=0.20),早发性乳腺癌患者(≤35岁)突变率为20.00％,x2=0.79,P=0.39.48例家系成员检测到3个新发现突变位点(BRCA1:1370insA,3459insA;BRCA2:6502insT),总突变率为6.25％.结论 中国汉族家族性乳腺癌患者BRCA基因突变率显著低于国外,应重点关注有家族史的三阴性乳腺癌患者和早发性乳腺癌患者;家系成员中发现BRCA基因致病性突变,家系成员突变率和发病风险有待进一步研究,应引起重视.     

家族性乳腺癌BRCA1／BRCA2基因突变的研究

目的：研究家族性乳腺癌患者BRCAl／BRCA2基因的突变位点及携带情况。方法：应用聚合酶链反应一单链构象多态性分析（singlestrand confor—marion polymorphism analysis of polymerase chain reaetion products,PCR—SSCP）和基因测序技术,对12个家族性乳腺癌家系的13例患者进行BRCA基因检测。结果：实验发现1个突变位点（4193insA）和2个核苷酸多态性位点（4165T〉A,5416C〉A）。结论：河北地区家族性乳腺癌的BRCAl基因突变率为7．7％,低于国外和国内其它地区;BRCA基因突变携带者家系中成员具有较高的发病风险。     

中国湖南家族性和早发性乳腺癌BRCA1和BRCA2基因突变分析

背景与目的:BRCA1和BRCA2基因是已经证实的乳腺癌遗传易感基因,与家族性及早发性乳腺癌密切相关.本研究旨在分析中国湖南省家族性和早发性乳腺癌中BRCA1和BRCA2基因的突变位点及携带情况.方法:以来自湖南地区的50例家族性和早发性乳腺癌(发病年龄≤35岁)为研究对象,其中26例(52%)有乳腺痛家族史.由静脉血提取基因组DNA,对BRCA1和BRCA2基因的全部编码序列进行扩增.突变分析由变性高效液相色谱分析(DHPLC)进行预筛,之后进行DNA测序证实.结果:在50例乳腺癌患者中发现有5种致病性突变,其中2种为新发现突变--BRCA2基因无义突变2372C>G和移码突变2808delACAA.BRCA1基因中发现一种已报道的无义突变220C>T;其他两种为已报道的BRCA2移码突变位点1796delTTTAT和6275delTT.我们还发现4个未知功能的突变位点(UV)及11个基因多态性位点.湖南家族性乳腺癌中BRCA1突变率4%低于BRCA2突变率16%. 结论:在中国湖南人群中,BRCA2基因的突变对于遗传性乳腺癌的发生可能具有较重要意义:新发现的2个突变位点可能是中国人群中的特有突变;湖南地区BRCA1在家族性乳腺癌中突变率明显低于国内外报道,而BRCA2突变发生率与西方国家相近,但明显高于国内其他地区,这可能是中国湖南人群中的特有特征.     

散发性乳腺癌BRCA1和BRCA2基因突变分析

目的探讨散发性乳腺癌患者BRCA1及BRCA2基因突变与健康人的差异。方法应用聚合酶链反应-单链构象多态性（PCR-SSCP）分析方法,对83例散发性乳腺癌患者（乳腺癌组）与86例健康人（健康对照组）的血液标本,针对BRCA1和BRCA2基因,选择4个突变发生率较高的外显子[BRCA1中的第5、11（11A、11B）、18外显子,BRCA2中的第11外显子]共5对引物进行突变检测,并应用限制性片段长度多态性（RFLP）方法对具有单核苷酸多态的碱基位点作单核苷酸多态性定性分析。成组设计的定性资料比较采用χ^2检验。结果部分散发性乳腺癌患者和健康人BRCA1基因第5外显子的cDNA 273和287（C→G和A→T）,第11外显子的2430、2532、2630、2685、3191、3232和3667、3876（T→C、T→C、T→G、T→C→G、A→G、A→G和C→A）以及第18外显子的5206和5214（T→A和C→T）碱基位点处存在单个碱基的变化,散发性乳腺癌患者的BRCA1基因突变率高于健康人（14．5％比2．3％,P〈0．05）;应用RFLP方法证实cDNA 2430、2630（T→C、T→G）碱基位点的变化为单核苷酸多态（SNP）;散发性乳腺癌患者与健康人2430（T→C）碱基位点等位基因频数分布不相同,但差异无统计学意义（P〉0．05）。结论散发性乳腺癌患者BRCA1基因突变较常见,而BRCA2的突变十分罕见。     

苏州地区乳腺癌患者BRCA1和BRCA2基因突变的分析

目的 探讨中国苏州地区乳腺癌患者乳腺癌易感基因1(BRCA1)和乳腺癌易感基因2(BRCA2)基因的突变位点及携带情况，并对携带致病突变基因患者的家系成员进行基因筛查和风险管理。方法 收集2018年7月至2021年10月确诊的85例乳腺癌患者，其中早发性乳腺癌40例，家族性乳腺癌36例，三阴性乳腺癌35例。采用高通量测序技术，对患者外周血中BRCA1和BRCA2基因的外显子及其部分内含子序列进行检测，将检测到的致病突变与ClinVar数据库进行对照，确定是否为新发现的致病突变。通过对家系先证者进行遗传咨询和肿瘤易感基因检测，进一步对携带致病基因患者的健康家系成员进行BRCA基因突变筛查。结果 85例乳腺癌患者中BRCA1和BRCA2的总致病突变率为21.2%(18/85),其中BRCA1致病突变率为11.8%(10/85), BRCA2致病突变率为9.4%(8/85)。在18例致病性突变患者中发现3个新发位点，分别为BRCA1基因c.1559dupA,BRCA2基因c.8939-8941delinsT和BRCA2基因c.3677-3678insATGAAAT。进一步对携带BRCA1/B...     

中国家族性和早发性乳腺癌BRCA1基因突变的研究

目的　研究中国家族性和早发性乳腺癌患者的BRCA1基因突变情况。方法　选取 4 1例家族性和早发性乳腺癌患者的外周血单个核细胞DNA ,应用PCR SSCP和DNA序列测定方法 ,对BRCA1基因全序列进行突变检测和分析。结果　 4 1例乳腺癌患者中 ,3例发生BRCA1疾病相关性突变 ,其中年龄 <35岁的患者 2例 ,具有乳腺癌家族史的患者 1例。结论　中国早发性乳腺癌患者的BRCA1突变发生率与西方国家相近 ,而家族性乳腺癌患者的突变发生率明显低于西方国家。     

中国乳腺癌家族BRCA1突变分析

为了探讨中国乳腺癌家族中BRCAl基因突变情况,我们收集了15个乳腺癌家系,共41个对象,其中23例为乳腺癌患者,采用聚合酶链反应-单链构像多态性分析(PCR-SSCP)、直接DNA测序法对BRCA1编码基因进行了全序列分析。结果发现在15个家系中有4例(3种)基因突变,突变比例为26.7％(4/15)。其中一例2228insC为插入突变,致编码子711处蛋白截短;另3例(2种)突变为1884A→T和3232 A→G,分别引起单个氨基酸改变。我们认为BRCA1为家族性乳腺癌的遗传基因;在BRCA1以外还存在其他的乳腺癌易感基因。     

散发性乳腺癌患者BRCA1基因突变分析

目的：探讨BRCA1基因突变在散发性乳腺癌发生和发展中的作用及在乳腺癌临床诊断和治疗中的应用前景。方法：应用PCR-SSCP和直接测序法检测30例散发性乳腺癌和15例正常乳腺组织中RRCA1基因外显子2、11和20的突变情况。结果：15例正常乳腺组织在3个外显子上郜未显示电泳异常．30例乳腺癌中有6例在外显子2上显示电泳条带异常．其中4例经测序证实有突变，1例在外显子2上，3例在内含子拼接区。BRCA1基因突变率在初诊年龄、临床分期和肿瘤体积上差异无统计学意义．但与肿瘤转移密切相关。结论：BRCA1基因突变与散发性乳腺癌的发生和发展密切相关，该基因突变筛查可作为一种预后指标。     

100例遗传性乳腺癌胚系基因BRCA1/2突变研究

目的探讨遗传性乳腺癌患者胚系基因BRCA1/2的外显子区域突变情况及其与临床病理特征的关系。 方法本研究为回顾性研究。根据纳入和排除标准,选择2014年2月至2016年2月山西省人民医院乳腺外科确诊的100例遗传性乳腺癌患者作为研究对象,采用二代测序技术检测患者胚系基因BRCA1/2突变的情况,并收集其年龄、组织学分级、淋巴结状态以及ER、PR、HER-2状态等临床病理资料。然后,采用Fisher确切概率检验比较BRCA1与BRCA2基因突变类型的差异,并用χ²检验分析BRCA1/2基因突变与乳腺癌患者临床病理特征的关系。 结果在100例遗传性乳腺癌患者中,有6例患者携带BRCA1基因突变,11例患者携带BRCA2基因突变。而在6例BRCA1基因突变者中,发生移码突变和无义突变者分别占4/6、2/6;在11例BRCA2基因突变者中,发生移码突变和无义突变者分别占4/11、7/11;2组间比较,基因突变类型的差异无统计学意义(P＝0.335)。在组织学分级1、2级的患者中,携带BRCA1、BRCA2基因突变者以及不携带BRCA1/2基因突变者分别占4.4%(4/91)、8.8%(8/91)和86.8%(79/91),而在组织学分级为3级的患者中,携带BRCA1、BRCA2基因突变者及不携带BRCA1/2基因突变者分别占2/9、3/9和4/9,组间比较,差异有统计学意义(χ²＝9.398,P＝0.007)。在HER-2阴性乳腺癌患者中,携带BRCA1、BRCA2基因突变者及不携带BRCA1/2基因突变者分别占10.7%(6/56)、16.1%(9/56)和73.2%(41/56),而在HER-2阳性乳腺癌患者中,携带BRCA1、BRCA2基因突变者及不携带BRCA1/2基因突变者分别占0(0/44)、4.5%(2/44)和95.5%(42/44),组间比较,差异有统计学意义(χ²＝9.072,P＝0.007)。 结论遗传性乳腺癌患者胚系基因BRCA1/2突变在不同组织学分级、不同HER-2状态的患者间存在差异。本研究在丰富遗传性乳腺癌临床遗传学资料的同时,可能为后期的个体化精准治疗奠定一定的理论依据。     

家族性乳腺癌家系成员乳腺癌易感基因突变的研究

目的研究河北省地区家族性乳腺癌家系中的患者及健康一级亲属乳腺癌易感基因1（BRCAl）和乳腺癌易感基因2（BRCA2）突变位点及携带情况。方法研究对象为2002年6月至2008年5月河北医科大学第四医院接诊的乳腺癌患者及其亲属,分别来自12个独立的汉族家族性乳腺癌家系,该家系中有2个及2个以上一级或二级亲属乳腺癌患病史,研究病例包括13例患者及46例健康一级亲属,共59例样本。由外周血提取基因组DNA,采用聚合酶链反应一单链构象多态性分析（PCR—SSCP）和基因测序技术对国内外报告中常见的4个BRCAl／BRCA2突变热点区域（BRCAl：外显子2、11、20;BRCA2外显子11）进行检测。结果发现1个BRCAl突变位点（4193insA）和1个BRCA2突变位点（5329insT）,全部为移码突变;发现4个变异位点（BRCAl：4165T〉A、287G〉C,BRCA2：6251G〉T、5416C〉A）,4193insA、5329insT、287G〉C携带者的家系中均有3例乳腺癌患者。结论BRCAl（4193insA）、BRCA2（5329insT）以及BRCAl：4165T〉A、287G〉C和BRCA2：6251G〉T、5416C〉A可能是河北省家族性乳腺癌相关性突变位点,其携带者家系中乳腺癌发病率明显升高,建议对其一级亲属密切随访或尽早进行手术或药物干预。     

Estrogen receptor status could modulate the genomic pattern in familial and sporadic breast cancer.

PURPOSE: Familial breast cancer represents 5% to 10% of all breast tumors. Mutations in the two known major breast cancer susceptibility genes, BRCA1 and BRCA2, account for a minority of familial breast cancer, whereas families without mutations in these genes (BRCAX group) account for 70% of familial breast cancer cases. EXPERIMENTAL DESIGN: To better characterize and define the genomic differences between the three classes of familial tumors and sporadic malignancies, we have analyzed 19 BRCA1, 24 BRCA2, and 31 BRCAX samples from familial breast cancer patients and 19 sporadic breast tumors using a 1-Mb resolution bacterial artificial chromosome array-based comparative genomic hybridization. RESULTS: We found that BRCA1/2 tumors showed a higher genomic instability than BRCAX and sporadic cancers. There were common genomic alterations present in all breast cancer groups, such as gains of 1q and 16p or losses of 8ptel-p12 and 16q. We found that the presence/absence of the estrogen receptor (ER) may play a crucial role in driving tumor development through distinct genomic pathways independently of the tumor type (sporadic or familial) and mutation status (BRCA1 or BRCA2). ER(-) tumors presented higher genomic instability and different altered regions than ER+ ones. CONCLUSIONS: According to our results, the BRCA gene mutation status (mainly BRCA1) would contribute to the genomic profile of abnormalities by increasing or modulating the genome instability.     

家族性和早发性乳腺癌BRCA1基因突变分析

目的 分析中国黑龙江省家族性和早发性乳腺癌中BRCA1基因的突变情况。方法 以黑龙江地区的92例家族性和早发性乳腺癌(发病年龄≤35岁)为研究对象。由静脉血提取基因组DNA,对BRCA1基因的全部编码序列(除外1,4号外显子)进行扩增。由聚丙烯酰胺凝胶电泳分析(SSCP)进行突变的初筛,之后进行DNA直接测序证实。结果 在92例乳腺癌患者中发现有5种致病性突变,其中3种为新发现的突变,发现的已报道的2种突变均为无义突变。结论 在中国黑龙江人群中,BRCA1基因的突变对于遗传性乳腺癌的发生可能具有较重要意义;新发现的3个突变位点可能是中国人群中的特有突变;黑龙江地区BRCA1在家族性乳腺癌中突变率明显低于国内外报道,但其中的移码突变3712insG分别在3个患者中检出,提示有可能成为该地区的基础突变。     

Survival in familial, BRCA1-associated, and BRCA2-associated epithelial ovarian cancer. United Kingdom Coordinating Committee for Cancer Research (UKCCCR) Familial Ovarian Cancer Study Group

The natural history of hereditary and BRCA1- and BRCA2-associated epithelial ovarian cancer may differ from that of sporadic disease. The purpose of this study was to compare the clinical characteristics of BRCA1- and BRCA2-associated hereditary ovarian cancer, hereditary ovarian cancer with no identified BRCA1/2 mutation, and ovarian cancer in population-based controls. BRCA1 and BRCA2 mutation testing was carried out on index cases from 119 families with site-specific epithelial ovarian cancer or breast-ovarian cancer. We estimated overall survival in 151 patients from 57 BRCA1 and BRCA2 mutation families and compared it with that in 119 patients from 62 families in which a BRCA1/2 mutation was not identified. We compared clinical outcome and data on tumor histopathology, grade, and stage. We also compared survival in familial epithelial ovarian cancer, whether or not a mutation was identified, with that of an age-matched set of population control cases. Overall survival at 5 years was 21% (95% confidence interval, 14-28) in cases from BRCA1 mutation families, 25% (8-42) in BRCA2 mutation families, and 19% (12-26) in families with no identified mutation (P = 0.91). Survival in familial ovarian cancer cases as a whole was significantly worse than for population controls (P = 0.005). In the familial cases, we found no differences in histopathological type, grade, or stage according to mutation status. Compared to population control cases, mucinous tumors occurred less frequently in the familial cases (2 versus 12%, P<0.001), and a greater proportion of the familial cases presented with advanced disease (83% stage III/IV versus 56%; P = 0.001). We have shown that survival in familial ovarian cancer cases is worse than that in sporadic cases, whether or not a BRCA1/2 mutation was identified, perhaps reflecting a difference in biology analogous to that observed in breast cancer.     

Mutation screening of BRCA1 using PTT and LOH analysis at 17q21 in breast carcinomas from familial and non-familial cases

Germline mutations in the BRCA1 gene predispose to breast and ovarian cancer. An estimated 45% of families with multiple breast cancer cases and more than 80% of breast-ovarian cancer families are linked to BRCA1. Mutation analyses by collaborative laboratories have revealed around 460 distinct BRCA1 sequence alterations, mostly germline mutations from familial cases. The majority of these alterations were nonsense and frame-shift mutations. In the present study, breast tumors of both sporadic and familial origin were investigated for allelic imbalance (AI) at the BRCA1 locus. AI was observed in 52% of the sporadic cases and in 17% of the familial cases. Furthermore, 104 breast carcinomas from patients with sporadic disease and 77 patients with positive family histories of breast and/or ovarian cancer were examined for translation-terminating mutations in exon 11 of the BRCA1 gene using the protein truncation test (PTT). No somatic mutations were detected in any of the tumors analysed, and only one BRCA1 mutation carrier was found among the familial cases. The result of this study gives no indication that truncating somatic mutations in exon 11 of BRCA1 play a major role in the tumorigenesis of the breast. Furthermore, the frequency of such mutation carriers in breast cancer populations with weak family histories of breast and/or ovarian cancer seems to be low.     

胃癌BRCA1基因甲基化与BRCA1 mRNA表达的关系研究

目的：探讨乳腺癌易感基因1（BRCA1）启动子CpG岛甲基化与BRCA1 mRNA表达的相关性及其意义。方法采用甲基化特异性PCR技术检测37例胃癌组织和对应癌旁组织及6例正常胃组织中BRCA1基因启动子CpG岛甲基化状态;采用逆转录PCR技术检测37例胃癌组织和对应癌旁组织及6例正常胃组织中BRCA1 mRNA 表达水平。结果胃癌组织中 BRCA1基因启动子 CpG 岛总甲基化率为48.6%（18/37）,显著高于癌旁组织[5.4%（2/37）]和正常胃组织[0.0%（0/6）],差异有统计学意义（χ2=17.541、5.021,P均〈0.05）。胃癌组织中BRCA1 mRNA阳性表达率为48.6%（18/37）,显著低于癌旁组织[94.6%（35/37）]和正常胃组织[100.0%（6/6）],差异有统计学意义（χ2=19.215、5.520,P均〈0.05）。BRCA1基因启动子CpG岛甲基化与BRCA1 mRNA表达成负相关（ r=-0.515,P〈0.05）。结论 BRCA1基因启动子CpG岛甲基化可能是导致BRCA1 mRNA失表达的主要原因之一。     

BRCA1/BRCA2 Mutations Shaped by Ancient Consanguinity Practice in Southern Mediterranean Populations

The aim of this study is to investigate the involvement of consanguinity on BRCA1/2 mutation incidence in SouthernMediterranean populations and to confirm their low penetrance by comparison of their recurrence in sporadic and familialbreast cancer in a context of ancient consanguinity practice. Our study comprises of two parts: First, a comparison ofthe consanguinity rates of the South Mediterranean countries in a relationship with the frequency of BRCA1 deleteriousmutations in breast cancer families and the recurrence of these mutations. Second, we investigated 23patients with afamily history of breast cancer, 51 patients without a family history of breast cancer using next-generation sequencingof BRCA2 and then confirmed by Sanger sequencing for the novel mutation. As results, we clearly show a strongrelationship between the frequency of BRCA1 deleterious mutations in breast cancer families and rate of consanguinity,since they are significantly inversely correlated. Four deleterious mutations were found in BRCA2 gene including anovel frame-shift mutationc.9382_9383dup in a patient with familial breast cancer and three other frame-shift mutationsc.6591_6592del, c.1310_1313del and c.7654dup in patients with sporadic breast cancer.These results are discussedin a context of selective pressure of ancient consanguinity practice. In conclusion, the study of BRCA1/2 gene inSouthern Mediterranean countries revealed low penetrance recurrent mutations in sporadic and familial breast cancer.These mutations have been selected in a context of ancient consanguinity practice along with protective genetic andenvironmental factors.     

乳腺癌中ERK2、nm23、MMP9基因蛋白的表达及意义

目的探讨乳腺癌中ERK2基因蛋白表达与淋巴结转移相关基因nm23、MMP9蛋白表达的关系。方法采用HE染色光镜观察96例乳腺癌,用免疫组织化学技术检测病灶中ERK2、nm23、MMP9蛋白表达情况。结果ERK2蛋白表达在乳腺浸润性癌中有高于原位癌的趋势（χ^2=3.783,P=0.052）;nm23蛋白表达在淋巴结转移组中显著低于无淋巴结转移组（χ^2=9.222,P=0.010）,与ERK2蛋白表达呈显著负相关（χ^2=4.085,P=0.043）;MMP9蛋白表达在淋巴结转移组中显著性高于无淋巴结转移组（χ^2=4.153,P=0.043）,与ERK2蛋白表达无明显相关性（P〉0.05）。结论ERK2信号蛋白可能通过与nm23基因蛋白的作用影响乳腺癌的进展、淋巴结转移。     

散发性乳腺癌中DJ-1蛋白高表达与不良预后

目的 探讨DJ-1蛋白表达水平在散发性乳腺癌发生、发展及预后中的临床意义.方法 采用免疫组织化学法检测了包含199例散发性乳腺癌组织与160例乳腺良性增生组织的组织微阵列芯片中DJ-1蛋白的表达情况,同时应用酶联免疫吸附试验检测48例散发性乳腺癌及35例乳腺良性增生患者血清中DJ-1蛋白的水平,并分析组织中DJ-1蛋白表达水平与乳腺癌患者临床病理指标及生存资料的相关性.统计分析采用Pearson ×^2检验和独立样本t检验;生存分析采用log-rank检验绘制Kaplan-Meier曲线,Cox回归用于进行多变量分析.结果 DJ-1蛋白在乳腺良性增生组织及乳腺癌组织中阳性表达率分别为33.8％ （54/160）、48.7％（97/199）,在乳腺良性增生及乳腺癌患者血清中DJ-1蛋白平均水平分别为（25.86±7.28） ng/ml和（31.31±8.39） ng/ml,与乳腺良性增生相比,乳腺癌组织（×^2=8.182,P=0.004）及血清（t=3.161,P=0.002）中DJ-1蛋白的表达水平均显著增加;淋巴结转移阳性的乳腺癌组织与阴性组织相比,DJ-1表达水平显著增加（×^2=5.372,P=0.020）;随着组织学分级的增加,浸润性导管癌中DJ-1表达水平显著增高（×^2=5.244,P=0.022）;DJ-1阳性表达与患者生存期缩短显著相关（OS：×^2=5.427,P=0.020;×^2=4.606,DFS：P=0.032）.单变量Cox回归分析发现,DJ-1表达水平作为危险因素与患者的OS及DFS显著相关（OS：P=0.023; DFS：P=0.036）,但多变量Cox回归分析发现,DJ-1表达水平并非影响患者预后的独立风险因素（OS：P=0.561; DFS：P=0.342）.结论 在散发性乳腺癌中,DJ-1蛋白表达水平显著增高,其高表达与乳腺癌的侵袭转移、病程进展及不良预后相关.