CD44+/CD24-细胞在乳腺癌组织中比例与乳腺癌远处转移关系

目的:旨在探讨CD44+/CD 24-细胞在乳腺癌组织中的比例与乳腺癌远处转移之间关系。方法:随机选取2003年1 月至2004年10月于天津医科大学肿瘤医院确诊的乳腺癌患者60例,并将其分为30例转移组及30例非转移组（对照组）。 免疫组织化学双重染色技术检测60例患者石蜡切片中CD44+/CD 24-细胞在乳腺癌组织中所占比例,分析其与远处转移之间关系。结果:转移组与对照组中CD44+/CD 24-细胞在乳腺癌组织中所占比例具有显著性差异（χ2= 11.334 ,P < 0.05）。 骨转移中CD44+/CD24-细胞在乳腺癌组织中比例有显著性差异（χ2= 9.250 ,P = 0.01）。 CD44+/CD 24-细胞在乳腺癌组织中5 年无瘤生存期比例有显著性差异（χ2= 8.058,P = 0.005）。结论:CD44+/CD 24-细胞在乳腺癌组织中所占比例与乳腺癌远处转移密切相关,特别是骨转移。      

改良根治术后腋窝淋巴结阳性乳腺癌放疗效果与ER、PR及HER2相关性分析

目的 探讨改良根治术后腋窝淋巴结阳性乳腺癌放疗效果与雌激素受体（ER）、孕激素受体（PR）及人类表皮生长因子受体2（HER2）的相关性.方法 选取福建医科大学附属漳州市医院2008年1月至2013年1月乳腺外科收治的进行改良根治术的腋窝淋巴结阳性的乳腺癌患者350例,其中216例接受了放疗,134例未接受放疗,根据ER、PR及HER2的免疫组织化学结果,将所有患者分为三阴性乳腺癌（ER-/PR-/HER2-）、HER2阳性（ER-/PR-/HER2＋）、Luminal B（ER ＋/PR＋/HER2＋）及Luminal A（ER ＋/PR ＋/HER2-）4组,比较放疗对4组患者局部复发率、远处转移率和无瘤生存率的影响.结果 中位随访48个月,放疗降低了三阴性乳腺癌、HER2阳性、Luminal B及Luminal A 4组患者的局部复发率（x2=6.23,P=0.01;x2=8.02,P=0.00;x2=15.43,P=0.00;x2 =4.47,P=0.03）,且前3组放疗患者的远处转移率（x2=4.18,P=0.04;x2 =6.35,P=0.01;x2=43.31,P=0.00）和无瘤生存率（x2=9.78,P=0.00;x2=10.83,P=0.00;x2=16.95,P=0.00）相对于未放疗患者差异具有统计学意义.但放疗对Luminal A组患者的远处转移率和无瘤生存率无影响（P＞0.05）.结论 不同的ER、PR和HER2状态对于改良根治术后腋窝淋巴结阳性乳腺癌患者的放疗结果具有一定影响.     

基于磁共振成像乳腺癌远处转移预测模型的研究

  目的  建立基于平扫磁共振成像（magnetic resonance imaging，MRI）和动态对比增强（dynamic contrast enhanced，DCE）-MRI影像特征参数的乳腺癌远处转移预测模型。  方法  回顾性分析2011年1月至2016年12月3 032例于天津医科大学肿瘤医院行乳腺MRI检查并经病理证实为乳腺浸润性癌患者的临床资料，根据纳入标准筛选出转移组93例和非转移组186例。分析转移组远处转移部位与分子分型的关系，同时对两组MRI影像特征进行单因素分析及多因素Logistics回归分析，获得独立预测因子并建立预测模型。  结果  转移组中Luminal型、HER-2过表达型、三阴性乳腺癌最常见远处转移部位分别为骨、肝脏、肺脏。单因素分析结果显示，两组间的病变类型、是否多发、T1WI和T2WI信号均匀度及病灶最大径进行比较差异具有统计学意义（P < 0.05）。多因素Logistics回归分析结果显示，病变类型、是否多发、T2WI信号均匀度及病灶最大径为独立预测因子。根据独立预测因子建立的预测模型准确率、敏感度、特异度和受试者工作特征曲线（receiver operating characteristic，ROC）下面积（area under receiver operat? ing characteristic curve，AUC）分别为82.8%、85.7%、75.0%和0.801。  结论  基于MRI影像特征的模型对预测乳腺癌远处转移具有潜在价值。      

Outcome after treatment of patients with mammographically occult, magnetic resonance imaging-detected breast cancer presenting with axillary lymphadenopathy

Although magnetic resonance imaging (MRI) for patients with mammographically occult breast cancer with axillary lymphadenopathy has been accepted for staging, treatment outcome data in this patient group is lacking. In this study, 16 patients, median age of 45 years (range, 27-66 years), presented with malignant axillary lymphadenopathy, negative mammograms, negative breast physical examination, and abnormal breast MRI. All 16 patients were found to have >/= 1 suspicious lesions on breast MRI. Ten patients had a solitary enhancing lesion; 1 patient had 2 enhancing lesions; 3 patients had 3 enhancing lesions; 1 patient had a mass lesion and diffuse patchy enhancement in the breast; and 1 patient had regional enhancement but no discrete lesion on MRI. Six patients underwent breast-conservation surgery using MRI-guided wire localization and 10 patients had modified radical mastectomy. Fourteen patients received adjuvant chemotherapy and the remaining 2 patients received neoadjuvant chemotherapy. With a median follow-up of 5 years (range, 1.2-7.6 years), the 5-year actuarial local control was 100%, relapse-free survival was 74%, and overall survival was 87%. Three patients developed distant metastases. Two patients died from distant metastases, and 1 patient is alive with metastatic disease. One patient had a relapse in the contralateral axilla and was treated with paclitaxel and is disease free. Although the patient population is small, the outcome after treatment for this group of patients with a mammographically occult, MRI-detected breast cancer presenting with axillary adenopathy is similar to the expected outcome for patients with breast cancer with positive axillary lymph nodes.     

磁共振动态增强乳腺扫描及时间信号曲线结合在早期乳腺癌诊断中的应用价值(英文)

Objective: The aim of this study was to investigate the application value of breast dynamic contrast-enhanced magnetic resonance imaging combined with time signal curve in diagnosis of early breast cancer. Methods: Conducted dynamic contrast-enhanced MRI and drew the time signal curves of breast lesions in 60 patients with breast disease (malignant 46, benign 14). Results: Morphological features of malignant tumors mostly showed blurred or thin spiculate outlines, irregular shape or lobular signs, signal heterogeneity or peripheral enhancement in dynamic contrast-enhanced MRI. Time signal curve showed type Ⅲ or Ⅱ. Morphologic features of benign tumors mostly showed clear edge, regular shape and homogeneous signal, or diffuse spot enhancement. Time signal curve showed type Ⅰ or Ⅱ. Conclusion: breast dynamic contrast enhanced scan in MRI can provide morphology and functional diagnosis information of the breast tissues. Dynamic contrast-enhanced MRI combined with time signal curve can further improve the accuracy of diagnosis of early breast cancer.     

Clinical relevance of soluble c-erbB-2 for patients with metastatic breast cancer predicting the response to second-line hormone or chemotherapy.

Concentrations of soluble c-erbB-2 were determined in the sera of 64 patients with distant metastasis from advanced breast cancer receiving second-line hormone or chemotherapy in comparison to 35 breast cancer patients without detectable recurrent disease and 17 healthy blood donors. The sera of non-metastatic breast cancer patients contained s-erbB-2 concentrations similar to those of healthy blood donors. Patients with distant metastasis from advanced breast cancer had significantly higher values of s-erbB-2 in comparison to patients with non-disseminated disease (mean: 59.6 vs. 11.6 U/ml; p = 0.022). A significant correlation was observed between s-erbB-2 serum levels and serum LDH concentrations (p < 0.001), levels of alkaline phosphatase (p < 0.001), and the presence of hepatic metastasis (p = 0.001). Time to tumor progression was significantly shorter in patients with s-erbB-2 levels above 40 U/ml (mean: 23.4 vs. 56.7 months; p = 0.002). Furthermore, breast cancer patients with hepatic metastasis and those with elevated s-erbB-2 serum levels above 40 U/ml had limited response to hormone or chemotherapy. Non-responders had significantly higher s-erbB-2 levels (mean: 270.3, range: 42-500 U/ml;) compared with the responder group (mean: 23.1, range: 0-149 U/ml; p < 0.001). Logistic regression analysis indicated that elevated s-erbB-2 serum levels above 40 U/ml independently predicted an unfavorable response to second-line hormone or chemotherapy in patients with advanced metastatic breast cancer.     

三阴性乳腺癌的临床病理特征及预后因素分析

目的:分析三阴性乳腺癌的临床病理学特征及其影响预后的因素,探索更为有效的治疗方案。方法:收集2000年1月至2005年9月收治的经病理组织学证实、有完整随访资料的510例可手术乳腺癌患者的临床资料,108例(21.2%)患者证实为三阴乳腺癌。比较三阴乳腺癌组与非三阴乳腺癌组的临床特征、复发或远处转移、生存情况。结果:510例患者中108例患者是三阴性乳腺癌,其组织学III级、髓样癌的比例明显高于非三阴性乳腺癌(P<0.05)。三阴性乳腺癌的5年复发或远处转移率(30.8%)明显高于非三阴性(18.7%,P<0.05)。三阴性乳腺癌的5年总生存率(78.4%)明显低于非三阴性(88.1%,P<0.05)。结论:三阴性乳腺癌具有独特的临床病理特征,比非三阴性乳腺癌更易发生局部复发和远处转移,预后较差。     

CT增强时间密度曲线与肺癌血管生成关系的研究

背景与目的 新生血管形成与肿瘤细胞无限增殖密切相关.本研究的目的是分析肺癌组织中环氧化酶-2(COX-2)、血管内皮生长因子(VEGF)表达,微血管密度(MVD)与CT增强表现的相关性.方法 对经病理证实的25例肺癌及35例肺良性疾病患者行CT增强扫描,并应用PV法对病理标本进行免疫组化分析.结果 肺癌组COX-2(P＜0.05)、VEGF(P＜0.05)、MVD(P＜0.05)及CT强化峰值(P＜0.01)均明显高于肺良性肿瘤组.肺癌组织中COX-2、VEGF、MVD与组织学类型、临床分期、淋巴结转移及CT强化峰值之间有密切关系,与肺癌的分化程度无明显关系.结论 COX-2、VEGF、MVD可作为临床评价肿瘤发展、估计肿瘤预后的重要分子生物学指征.CT增强检查可以反映肺癌的血供特点,可根据CT增强峰值来推测肿瘤的侵袭、转移及预后情况.     

EVALUATION OF THE PROGNOSTIC VALUE OF nm23 GENE EXPRESSION IN BREAST CANCER

Mortality of breast cancer is almost due to subsequent metastases, but the micrometastasis is difficult to be detected. Early diagnosis of distant metastasis is a key to improve prognosis of breast cancer. The nm23 gene is a putative metastasis suppressor gene originally identified in murine melanoma cells. The purpose of this study was to investigate the relationship between nm23 gene expression (mRNA and protein) and distant metastasis of breast cancer. MATERIALS AND METHODS Pati…     

Improved accuracy in differentiating malignant from benign mammographic abnormalities: a simple, improved magnetic resonance imaging method

BACKGROUND: Although several refinements have been reported for breast magnetic resonance imaging (MRI), there has been no uniform agreement by researchers on the optimal method. The authors report a simple and effective MRI method that incorporated the best qualities of other breast MRI methods yet eliminated the complexity of dynamic sequences and computer subtraction. This new method used fat-suppression, a 3D technique, a dedicated breast coil, and quantitation of lesion enhancement. METHODS: Sixty-one mammographically suspicious lesions were evaluated with a fat-suppressed T1-weighted 3D FLASH sequence before and after administration of Gd-DTPA. Abnormalities were evaluated primarily by the degree of lesional enhancement; lesional morphology was assessed as a secondary criterion. For small or multiple lesions, the authors reformatted images to produce MRI findings that corresponded to the mammographic abnormality. To allow accurate pathologic correlation, all subjects underwent stereotactic or excisional biopsy of the suspicious lesions. RESULTS: Using this new method, all 15 breast carcinomas were enhanced with a signal intensity (SI) increase of > or = 180% (mean = 337%). No benign lesions enhanced at a SI of > 180%. The difference in degree of enhancement between malignant and benign lesions was statistically significant (P < 0.05). There were overlapping degrees of postcontrast enhancement among fibroadenomas (n = 13; mean SI = 70%) and atypical hyperplasias (n =; 11; mean SI = 82%), but morphologic characteristics allowed for discrimination between these two entities. In the remaining benign breast disease lesions, there was minimal enhancement. CONCLUSIONS: 3D fat-suppressed sequencing using this new MRI method accurately discriminated between benign and malignant mammographic abnormalities and eliminated the time-intensive and complex MRI methods without sacrificing accuracy.     

乳腺动态增强MRI及其后处理技术在乳腺肿瘤诊断中的应用

背景与目的：乳腺癌常用诊断手段主要包括体格检查、钼靶、超声等,MRI技术被视为乳腺疾病诊断最具有潜力的一种检查手段。本研究旨在探讨乳腺动态增强MRI及其后处理技术的优越性在临床诊断中的应用。方法：选取2006年5月至2007年9月在中山大学肿瘤防治中心行MRI检查的乳腺疾病初诊病例30例,全部行MRI平扫和动态增强扫描,并通过工作站分别进行减影处理、动态曲线绘制、三维立体重建等后处理。选取病灶远隔部位正常组织为对照．计算最大线性斜率比值。结果：本组30例患者共49个病灶,MRI诊断正确率93.3％。结论：乳腺MRI是一种敏感性和准确性较高的检查方式,动态增强扫描、减影处理、时间-信号曲线的处理、三维立体重建后处理以及最大线性斜率比值．均有助于乳腺病灶的正确诊断。     

检测十二指肠胆汁癌胚抗原对诊断大肠癌肝转移的价值

目的 探讨十二指肠胆汁癌胚抗原（ＣＥＡ）水平对诊断大肠癌肝转移的意义。方法 Ａ组３０例,为非肿瘤患者,Ｂ组３０例,为大肠癌患者;Ｃ组１５例,为大肠癌合并肝转移患者,所有患者空腹抽取前壁静脉血,同时经鼻十二指肠引流管取十二指肠胆汁,用宝林曼公司提供的试剂盒测定ＣＥＡ值。     

MTS1及E-cadherin的表达与乳腺癌转移的关系

背景与目的:乳腺癌患者主要死于远处转移,目前还没有一种预测和早期诊断乳腺癌转移的方法。本研究旨在观察多肿瘤抑制基因(multipletumorsuppressor1,MTS1/p16)及上皮型钙粘附素(E-cadherin)的表达与乳腺癌转移的关系。方法:应用免疫组化S-P法,检测54例乳腺癌组织中的MTS1、E-cadherin的表达。结果:MTS1在远处转移组和多于4枚局部淋巴结转移组的表达率(分别为40.7%、38.1%)均低于相应对照组(74.1%、69.7%)(P<0.05);在组织学分级Ⅰ、Ⅱ、Ⅲ级三组中的表达率分别为76.2%、58.8%、31.3%,三组间差异有显著性(P<0.01)。E-cadherin在远处转移组和多于4枚局部淋巴结转移组的表达率(分别为37%、23.8%)均低于相应对照组(70.4%、66.7%)(P<0.05);在组织学分级Ⅰ、Ⅱ、Ⅲ级三组中的表达率分别为80.9%、47.1%、25.0%,三组间差异有显著性(P<0.01)。结论:MTS1及E-cadherin与乳腺癌的浸润和转移相关。     

Luminal B 型早期乳腺癌临床病理特点及预后危险因素分析

目的:探讨Luminal B型早期乳腺癌临床病理特点及影响预后的因素。方法:回顾性分析2010年01月至2016年06月我院收治的Luminal B型乳腺癌患者285例,分析其临床病理特点和影响预后的相关因素。结果:Luminal B(HER-2阴性)乳腺癌患者190例（66.7%）,Luminal B(HER-2阳性)患者为95例（33.3%）。Luminal B(HER-2阴性)与Luminal B(HER-2阳性)在脉管癌栓、腋窝淋巴结状态和放疗例数差异具有统计学意义（P＜0.05）。Luminal B(HER-2阳性)复发转移率高（P＜0.05）,且5年的无病生存和总生存率均低于Luminal B(HER-2阴性) （P＜0.05）。单因素和多因素分析显示脉管癌栓、淋巴结状态、PR和Ki-67是Luminal B型乳腺癌预后独立的影响因素（P＜0.05）。结论:与Luminal B(HER-2阴性)相比,Luminal B(HER-2阳性)乳腺癌患者恶性程度更高,预后更差。脉管癌栓、淋巴结转移、Ki-67高表达和PR阴性是影响Luminal B型乳腺癌预后的独立危险因素。     

乳腺癌肿瘤标志物CEA、CA15-3表达水平的临床意义

目的:探讨血清CEA、CA15-3与乳腺癌临床诊断方面的关系.方法:应用微粒子免疫萤光技术对210例乳腺癌患者、75例乳腺良性疾病患者及50例正常对照者血清CEA CA15-3表达水平进行检测比较.结果:CEA、CA15-3在乳腺癌Ⅲ、Ⅳ期中表达明显增高(P＜0.005),在Ⅰ、Ⅱ期中表达与正常组及良性疾病组比较无显著性差异(P＞0.05).两种标志物与肿瘤分期、淋巴结受累程度有关,腋淋巴结转移≥4枚或远处脏器转移时CEA、CA15-3浓度明显增高(P＜0.005).两种标志物与肿瘤病理学分型的关系不明显(P＞0.05).乳腺癌术后动态监测CEA、CA15-3对肿瘤远处转移呈高表达(P＜0.005),对局部复发CEA无显著性(P＞0.05),而CA15-3有指导意义(P＜0.005).结论:CEA、CA15-3并非乳腺癌早期诊断的理想标志物,但其与肿瘤临床分期、淋巴结转移程度、远处转移关系密切,是乳腺癌术前预测转移及监测术后复发转移与评估乳癌预后的有效指标.     

Abnormal monocyte chemotaxis in patients with breast cancer: evidence for a tumor-mediated effect

The chemotactic responsiveness of peripheral blood monocytes was measured in 194 individuals: 37 patients with breast cancer, 17 patients with a history of breast cancer but clinically free of disease after surgery, 42 patients with benign breast masses, and 98 normal controls. Monocyte chemotactic responsiveness (MCR) in vitro was not significantly different from normal [mean = 72.8 migrating monocytes/oil immersion field, +/- 9.3 (1 SD)] in 2 groups of patients: a) those with benign breast masses (mean = 72.6 +/- 15.1; P greater than 0.3) and b) those previously having breast cancer resected and remaining clinically free of disease (mean = 69.0 +/- 12.5; P greater than 0.4). However, MCR was significantly depressed in the group of patients with active breast cancer (mean = 57.2 +/- 20.7; P less than 0.0025). Resection of malignant breast masses resulted in a significant change in MCR (P less than 0.0025), whereas resection of benign lesions did not (P greater than 0.4). MCR was abnormal in all clinical stages of breast cancer, including breast cancer without evidence of metastasis to regional lymph nodes. These data supported the hypothesis that neoplasms adversely affect monocyte function and may thereby hinder immunologically mediated destruction of malignant cells.     

血脂与激素受体阴性乳腺癌远处转移及疗效的关系

目的 测定激素受体阴性乳腺癌患者的血脂水平,探讨血脂异常与远处转移的关系,及化疗后血脂水平变化与近期疗效的关系。方法 收集154例激素受体阴性乳腺癌患者的临床病理资料和空腹血脂水平,远处转移组患者化疗2周期后第14天再次测定血脂水平。χ²检验分析临床病理特征及基线血脂水平与远处转移的关系,Logistic回归分析远处转移的独立危险因素,配对t检验分析远处转移组患者化疗后血脂各指标变化与疗效关系。结果 乳腺癌远处转移与肿块大小、区域淋巴结转移、组织学分级、高TC、高TG及高LDL-C血症有关(P＜0.05)。Logistic回归分析显示,肿块大小(OR=1.563)、区域淋巴结转移(OR=1.983)、高TC血症(OR=1.502)、高TG血症(OR=1.877)是远处转移的独立危险因素。远处转移组中化疗有效组(PR+SD),TC、TG及LDL-C水平有降低趋势,HDL-C水平有升高趋势,疗效PR组TG水平降低有统计学意义。结论 高脂血症与激素受体阴性乳腺癌远处转移相关,有效的抗肿瘤治疗可降低血脂水平。动态监测血脂水平可作为激素受体阴性乳腺癌远处转移及疗效评价的辅助参考指标。     

Method of primary tumor detection as a risk factor for local and distant recurrence after breast-conservation treatment for early-stage breast cancer

BACKGROUND: Recent studies have shown that breast cancer detected by screening has a more favorable prognosis than interval breast cancer. To further understand the biologic significance of this finding, we investigated the association of disease recurrence, local and distant, with the method of detection of the primary breast cancer in a cohort of 1686 women treated with breast conservation. PATIENTS AND METHODS: The charts of 1686 women with primarily stage I or II invasive breast cancer treated by breast conservation between 1977 and 2002 were reviewed. The median length of follow-up was 6 years. Univariate and multivariate analyses using binary logistic regression were performed for 2 subgroups: (1) those with local recurrence versus those without; and (2) those with distant metastasis versus those without distant metastasis. RESULTS: Our data confirmed several of the well-known risk factors for local and distant recurrence. In addition, we found that individuals with breast cancer detected on physical examination alone have a significantly higher risk for local recurrence compared with patients with cancer detected on mammogram alone, independent of tumor size (odds ratio [OR], 2.369; 95% CI, 1.235-4.547; P = .01). We also found a similar correlation for risk of distant metastasis in these 2 groups of women (OR, 2.201; 95% CI, 1.211-3.998; P = .01). CONCLUSION: Breast cancers that are palpable might represent an aggressive biologic subtype with an increased risk of local and distant recurrence. Risk stratification might need to include this clinical feature in addition to conventional prognostic factors.     

Changes in the findings of dynamic MRI by preoperative CAF chemotherapy for patients with breast cancer of stage II and III: pathologic correlation.

Preoperative neoadjuvant chemotherapy is essential for treatment of patients with breast cancer who have a large tumor mass and/or regional lymph node involvement, in terms of both tumor shrinkage and further improvement of the survival rate. In order to safely perform breast-conservation treatment for these patients, a detailed diagnostic procedure for precisely evaluating the therapeutic response is needed. Dynamic magnetic resonance imaging (MRI) is thought to be important in the evaluation of responses to neoadjuvant therapy in patients with considerably large tumors, however, few studies have detailed the changes, as depicted by dynamic MRI, that can be expected with neo-adjuvant chemotherapy. The purpose of this study was to document the changes that occur in response to neoadjuvant chemotherapy and to correlate them with the pathological findings observed in the surgical specimen. The study was performed at Kochi Medical School Hospital from 1995 to 1998. The series consisted of 31 patients with stage II and III breast cancer. Prior to and after 1-5 courses of neoadjuvant chemotherapy, dynamic MRI examinations were performed. Eight of the time-intensity curves for the 10 grade 1a tumors flattened during neoadjuvant chemotherapy, while two remained the same. Six of the curves flattened for the 14 grade 1b tumors, 7 remained the same, and one spiked. And for the seven grade 2 tumors, two of the curves flattened and five remained the same (p=0.0340). In the five grade 1 tumors, the mean after/before normalized peak signal intensity ratio was 0.42+/-0.22. In the 18 grade 2 and 8 grade 3 tumors, the mean normalized signal intensity ratios were 0.59+/-0.28, 0.88+/-0.10, respectively (p<0.05). In the 15 tumors that showed shrinkage of the linear enhancement during neo-adjuvant chemotherapy, 10 had no remarkable intraductal spreading and 9 had a negative surgical margin. In the 16 tumors that had no shrinkage of the linear enhancement during chemotherapy, 13 had remarkable intraductal spreading and 12 had a positive surgical margin (p<0.05). It is concluded that dynamic MRI is a valuable tool for determining tumor response and predicting a positive surgical margin. Breast-conservation treatment can be performed for these patients by meticulous assessment using such detailed diagnostic procedures after local tumor control by combined chemotherapy with high dose-intensity.