乳腺癌绝经前后c-erbB-2、ER、PR的表达及与预后的相关性

 目的 探讨乳腺癌绝经前后c-erbB-2、ER、PR受体的表达差异及其与预后的相关性。 方法 回顾性分析432例乳腺癌的病理学资料,其中195例患者随访5年,c-erbB-2、ER、PR的表达采用免疫组化法检测。 结果 （1）绝经前组,c-erbB-2阳性患者的ER阳性率显著低于c-erbB-2阴性患者（P=0.003）;绝经后组,c-erbB-2阳性患者的ER、PR阳性率均显著低于c-erbB-2阴性患者（P＜0.001,P=0.005）。（2）多因素分析显示,绝经前组的独立预后因素为淋巴结转移、c-erbB-2,绝经后组的独立预后因素为淋巴结转移、c-erbB-2和ER。 结论 绝经前与绝经后乳腺癌c-erbB-2、ER、PR受体表达的临床意义有所不同。     

乳腺癌组织中p53、nm23-H1基因表达及其与绝经状态、淋巴结转移的相关性

[目的]研究乳腺癌患者中p53和nm23-H1基因表达,及其与绝经状态及腋窝淋巴结转移的关系.[方法]采用免疫组织化学SP方法检测60例乳腺癌组织中p53和nm23-H1的表达.[结果]60例乳腺癌患者中,p53和nm23-H1的阳性表达率分别为73.3%(44/60)和66.7%(40/60);在绝经前患者中p53和nm23-H1的阳性表达率分别为66.7%(16/24)和50.0%(12/24),而在绝经后患者中两者的阳性表达率分别为77.8%(28/36)和77.8%(28/36).在绝经后患者中p53和nm23-H1基因的阳性表达与腋窝淋巴转移呈显著性相关(P=0.019和P=0.019).[结论]p53可能参与绝经前妇女乳腺癌的发生,可能促进绝经后乳腺癌的转移;而nm23-H1可能参与绝经后乳腺癌的转移.     

Luminal A型乳腺癌的激素受体表达与绝经的相关性

目的探讨Luminal A型乳腺癌的激素受体表达水平与绝经的相关性,进一步认识该类乳腺癌的生物学特性。方法回顾性分析江苏省肿瘤医院2009年1月至2012年10月收治的135例LuminalA型乳腺癌患者的雌激素受体（estrogenreceptor,ER）及孕激素受体（progesteronereceptor,PR）的表达水平（高表达（H）〉50％;低表达（L）≤50％）,比较ER、PR的不同表达分组在绝经前后患者中的差异及ER、PR间的相关性。结果绝经前LuminalA型乳腺癌ER—H／PR-H表达最常见（63．8％）;ERH／PR—L表达在绝经后患者中最常见（51．1％）,在绝经前少见（17．0％）。ER、PR的相关性在绝经前比绝经后更明显（P值：0．003VS．0．047）。结论绝经前后的LuminalA型乳腺癌患者存在ER、PR的不同表达的差异性分布,体内雌激素水平可能是引起差异的原因。     

血清睾酮水平与乳腺癌雌、孕激素受体表达的相关性研究

目的:回顾性研究血清睾酮（testosterone,T）水平与乳腺癌雌激素受体（estrogen receptor,ER）,孕激素受体（progesterone receptor,PR）表达的相关性。方法:回顾性分析2016年1月至2018年12月在南京市妇幼保健院进行体检和治疗的63例健康女性,99例良性肿瘤,204例乳腺癌的临床病理资料,比较三组之间的血清睾酮水平的差异。将所有204例乳腺癌患者根据睾酮水平由低到高排序,按四分位数分为4组,采用Logistic回归比较不同睾酮水平下4组乳腺癌患者ER、PR、Her2表达状态的比值比（OR）。结果:乳腺癌组血清睾酮水平与乳腺良性肿瘤组、健康对照组相比差异均无统计学意义（P＞0.05）。ER+和PR+乳腺癌患者中血清睾酮水平分别高于ER-和PR-患者,而Her2+乳腺癌患者中血清睾酮水平低于Her2-患者,差异均有统计学意义（P＜0.05）。采用Logistic回归计算OR值,根据绝经与否进一步分层,其中T≥0.44 ng/mL组相对于T≤0.22 ng/mL组ER阳性表达的总体OR值为2.46（95%CI=1.04~5.86,P=0.042）,绝经前OR值为3.77（95%CI=1.11~12.80,P=0.034）,绝经后OR值为1.05（95%CI=0.28~3.92,P=0.945）;T≥0.44 ng/mL组相对于T≤0.22 ng/mL组PR阳性表达的总体OR值为3.69（95%CI=1.60~8.49,P=0.002）,绝经前OR值为4.80（95%CI=1.51~15.23,P=0.008）,绝经后OR值为1.78（95%CI=0.47~6.71,P=0.396）,结果显示绝经前乳腺癌患者中ER、PR的阳性表达与血清睾酮水平呈现出明显的正相关性;而Her2阳性表达与血清睾酮水平在总体、绝经前、绝经后乳腺癌患者中均未表现出明显的负相关性。结论:高血清睾酮水平与乳腺癌ER、PR的阳性表达呈正相关,在绝经前乳腺癌患者中表现尤为显著。血清睾酮水平可以作为预测绝经前激素受体状态的标志物之一。     

乳腺增生与乳腺癌组织中雌激素受体、孕激素受体的表达差异及其临床意义

 目的　探讨乳腺增生及乳腺癌组织中雌激素受体（ER）、孕激素受体（PR）的表达差异及其临床意义。方法　采用免疫组织化学方法检测68例乳腺增生和168例乳腺癌标本中ER、PR的表达。结果　 乳腺癌患者ER表达水平明显高于乳腺增生患者（P＜0.05）,而PR在两组中的表达差异无统计学意义。绝经后乳腺癌患者ER表达水平中位值为30 %,明显高于绝经后乳腺增生患者的10 %（P＜0.05）,而在绝经前两组患者ER表达水平差异无统计学意义。浸润性小叶癌组织内PR的表达明显高于浸润性导管癌等其他类型,差异有统计学意义（P＝0.005）。结论　ER、PR的表达能够较好地反映乳腺疾病的病理生物学特征。     

30例乳腺癌c-erbB2、nm23和ER蛋白联合检测分析

[目的]阐明肿瘤标志物c-erbB2、nm23和ER在乳腺癌三者间的相互关系及三者联合检测对乳腺癌预后判定的意义.[方法]应用免疫组织化学方法检测c-erbB2、nm23和ER蛋白在30例乳腺癌组织中的表达情况以及与转移的关系.[结果]在单纯癌和导管浸润癌中,nm23-H1、ER无统计学意义,而c-erbB2在两者中差异显著;c-erbB2、nm23-H1和ER未见阳性全部表达者,c-erbB2和nm23-H1均阳性占133%(4/30),nm23-H1阴性c-erbB2阳性者42.9%(6/14),两组差异显著.nm23-H1和ER均阳性6.7%(2/30),nm23-H1阴性ER阳性者为42.9%(6/14).c-erbB2和ER均阳性10%(3/30),c-erbB2阴性而ER阳性者233%(7/30).[结论]nm23、c-erbB-2和ER通过不同途径使其在乳腺癌中获得表达,c-erbB2阴性而ER阳性病人预后相对较好,通过此三项指标检测判定乳腺癌预后时不能单纯考虑某一项结果的阳性率,应通过多项指标检测结合临床症状综合判定.     

绝经前乳腺癌组织雌激素受体与血清雌激素水平相关性的初步探讨

目的:探讨绝经前乳腺癌雌激素受体(ER)表达与患者血清雌激素(E2)水平的关系。方法:使用全自动免疫分析仪化学发光分析法检测84例乳腺癌患者血清性激素6项(LH、FSH、PRL、E2、P和T)水平,免疫组化EnVi-sion二步法检测乳腺癌ER表达状态。据ER检测的结果,分为阳性及阴性两组,对其对应的雌激素数值进行统计学分析。结果:在P临界值设定为0.05水平下,进行t检验,t=-1.59912,P=0.11364,两组样本中显现的E2水平差异无统计学意义。结论:绝经期前乳腺癌患者ER表达可能与雌激素水平无关。     

乳腺癌雌孕激素受体与C-erbB-2、p53、nm23基因表达及相关分析

目的观察乳腺癌组织中雌、孕激素受体(ER、PR)与C-erbB-2、p53、nm23基因表达及其相互关系,及乳腺癌淋巴结转移与基因表达关系.方法应用免疫组织化学方法对85例乳腺癌进行了ER、PR、CerbB-2、p53、nm23检测,结果作统计学分析.结果(1)ER、PR阳性表达率分别为63.52%和72.94%;(2)C-erbB-2、p53、nm23的表达率各为68.23%、32.94%、63.52%;(3)ER、PR阳性患者的C-erbB-2或p53的阳性表达明显低于ER、PR阴性患者(P＜0.05);(4)淋巴结有转移的乳腺癌患者nm23阳性表达明显低于无淋巴结转移的患者(P＜0.05),p53表达则在有淋巴结转移者的乳癌中表达高(P＜0.01).结论ER、PR与C-erbB-2、p53、nm23这两种不同特性产物在乳腺癌组织中有一定的内在联系,p53、nm23的阳性表达对判断乳癌的肿瘤转移及预后有重要意义.     

戈舍瑞林联合三苯氧胺治疗绝经前ER~＋PR~＋及ER~＋PR~-复发转移性乳腺癌疗效观察

目的：探讨戈舍瑞林联合三苯氧胺辅助内分泌治疗绝经前雌激素（ER）、孕激素（PR）双阳性及ER＋/PR-两种复发转移乳腺癌的临床疗效,对比两种乳腺癌的治疗效果。方法：将104例绝经前、原癌基因（c-erbB-2）均为（＋）、淋巴结1-3个阳性的复发转移乳腺癌患者分成两组,52例ER＋/PR＋,52例为ER＋/PR-。两组患者均为手术后和辅助化疗后发现复发转移的乳腺癌接受戈舍瑞林3.6mg皮下注射,每28天1次,连续6个月以上;联合三苯氧胺口服,10mg/次,每日2次,连用6个月以上。结果：104例患者完全缓解（CR）3例,部分缓解（PR）31例,稳定（SD）31例,进展（PD）39例,总有效率（OR=CR＋PR）为32.7%,临床获益率（CBR=CR＋PR＋SD≥6个月）62.5%;其中ER＋、PR-组,CR 2例,PR 21例,SD 16例,PD 13例,OR为44.1%,CBR 74.9%;ER＋、PR-组CR 1例,PR 10例,SD 15例,PD 26例,OR 21.1%,CBR 49.9%。结论：戈舍瑞林联合三苯氧胺辅助内分泌治疗绝经前ER阳性、淋巴结1-3阳性、复发转移性的乳腺癌患者临床疗效显著,而ER＋/PR＋组患者效果明显优于ER＋、PR-组患者,临床治疗效果更佳。对于在辅助内分泌治疗期间发生PD,应立即中止辅助内分泌治疗,进行手术、解救化疗、放疗或分子靶向等治疗后再序贯内分泌治疗。     

绝经后乳腺癌雌、孕激素受体状态与血清性激素水平的关系

目的探讨绝经后乳腺癌雌激素受体(ER)、孕激素受体(PR)状态与患者血清性激素水平的关系及意义。方法使用全自动免疫分析仪化学发光分析法检测41例乳腺癌患者血清性激素六项(LH、FSH、PRL、E2、P、T)水平,免疫组化EnVision二步法检测乳腺癌ER、PR表达状态。结果绝经后乳腺癌PR阴性组与PR阳性组比较,患者血清LH、FSH水平显著增高(P值分别为0.005和0.031),PRL、E2、P、T水平在二组间差异无统计学意义;在ER阴性组与ER阳性组之间所测性激素水平差异无统计学意义。结论绝经后乳腺癌PR表达状态可能与垂体激素LH、FSH水平有关。     

Chemotherapy with mitomycin C and capecitabine in patients with advanced colorectal cancer pretreated with irinotecan and oxaliplatin

AIMS AND BACKGROUND: To assess the activity and tolerability of the combination of mitomycin C and capecitabine in patients with metastatic colorectal cancer after failure of irinotecan and oxaliplatin-containing regimens. METHODS: We retrospectively reviewed 28 patients with pretreated advanced colorectal cancer who had been treated with mitomycin C, 6 mg/m2 on day 1, and capecitabine, 1900 mg/m2 on days 1-14, every 3 weeks. Tumor assessment was performed every 3 cycles, toxicity assessed at each cycle. RESULTS: Main patient characteristics were median age, 61 years (range, 35-73); male/female ratio, 16/12; single metastatic site involvement, 5/28 (18%); > or =3 metastatic sites, 10/28 (36%). Ninety-six courses of therapy were given (median number, 3; range, 1-9). Twenty-six patients were assessable for response, and all were assessable for toxicity. There was 1 partial response (4%) and 12 had stable disease (43%). Median time to progression was 2 months (range, 1-9) and median overall survival was 6 months (range, 1-29+), with a 1-year overall survival rate of 25%. The regimen was very well tolerated without significant hematological toxicity. CONCLUSIONS: Our results are disappointing. Despite the good safety profile, they do not support further investigation or the routine use of this regimen in this setting.     

Excretion of nitrates with saliva and urine and nitrite excretion with saliva in patients with chronic gastritis and duodenal ulcer

The study assessed excretion of nitrates in urine and saliva and that of nitrites with saliva of patients suffering gastric and duodenal ulcer. In both study groups, a positive correlation was established between nitrate concentration in saliva, on the one hand, and that in urine, and nitrite level in urine, on the other. The groups failed to show a difference in nitrate concentrations in either urine or saliva. Since retention of nitrates in the body of chronic gastritis patients held as precancer of the stomach proved no higher than that in patients with duodenal ulcer, the authors cast doubt on endogenous nitroso compounds as a cause of gastric cancer in cases of chronic gastritis.     

Compliance with guidelines and correlation with outcome in patients with advanced germ-cell tumours

PurposeTo evaluate prior compliance with guidelines in patients treated with salvage chemotherapy for advanced germ-cell tumours (GCT).Patients and methodsData concerning the initial management of patients requiring salvage chemotherapy for GCT at Institut Gustave Roussy between 2000 and 2010 were obtained and correlated with recommendations for treatment. Criteria of non-compliance were defined based on guidelines. Compliance with guidelines, predictive factors for non-compliance and the impact on outcome were analysed.ResultsAmong 82 patients treated in the salvage setting, guidelines to initial treatment were followed in only 41 cases (50%). The most common non-compliance criteria were non-adherence to the planned dose (16%), an inappropriate interval between first-line chemotherapy cycles (16%), the lack of post-chemotherapy surgery (16%) and a long interval to post-chemotherapy surgery (48%). Compliance with standard care was better in cancer centres than in other hospitals (private or public) (Odd Ratio (OR): 6.9, P = 0.001). A poor-risk status according to the International Germ Cell Cancer Collaborative Group (IGCCCG) was also predictive of compliance in univariate but not in multivariate analysis. No significant difference in outcome after salvage chemotherapy was observed. Patients relapsing after non-compliant first-line therapy tended to be more easily salvaged, which is consistent with the fact that their initial treatment was inadequate. Some of these relapses were therefore probably not due to true biologically refractory disease.ConclusionGuidelines for first-line treatment are adhered to in only half the patients requiring salvage chemotherapy. As the only predictive factor for non-compliance was the treating centre, centralisation of patients with GCT in well-trained hospitals should be recommended.     

Social work with stepfamilies and their children with cancer

This paper explores the complexities of medical social work undertaken with stepfamilies caring for a child suffering from cancer. Although there is a growing literature dealing with the psycho-social effects of childhood cancer, there is an unexamined assumption that children are cared for by their birth parents within a traditional nuclear family. It is argued that the paediatric oncology social worker is challenged increasingly to develop understandings and modes of intervention which are appropriate and sympathetic to the particular issues facing stepfamilies. Using a systemic and chronological framework from referral and diagnosis through to bereavement, the authors identify challenges for the stepfamily, corresponding implications for social work practice, and questions for future research.     

Treatment with lenalidomide and dexamethasone in patients with multiple myeloma and renal impairment

Renal impairment (RI) is a common complication affecting patients with multiple myeloma (MM). Timely identification of MM-related RI and early treatment with novel antimyeloma agents can reverse renal damage in a high proportion of patients and improve outcomes. The IMiDs® immunomodulatory compound lenalidomide (Len) in combination with dexamethasone (Dex) is an effective and well-tolerated regimen for patients with relapsed or refractory (RR) MM. A retrospective analysis of Phase III data has shown that Len/Dex remains effective and well-tolerated in patients with moderate or severe RI, albeit with an increase in myelosuppression. This analysis demonstrated that in a high proportion of patients Len/Dex treatment can reverse MM-related RI and restore normal function. Lenalidomide has a predominantly renal route of excretion and in patients with RI the plasma concentration and half-life of the drug are significantly increased. As a consequence, lower starting doses are required in patients with RI to avoid over-exposure and an increased risk of adverse events, while maintaining good therapeutic index. A prospective cohort study in 50 patients with RRMM has reported that when Len/Dex dosing was adjusted according to renal function, response rates and survival outcomes were similar in patients with and without RI, and there was no increase in adverse events in patients with RI. Further clinical studies are required to confirm the efficacy and tolerability of Len/Dex regimens in MM patients with RI, and to evaluate the impact of reversing renal damage in terms of patient survival.     

Distress overlaps with anxiety and depression in patients with head and neck cancer

Psychological problems in cancer patients often go unrecognized until they are specifically sought. This is more in patients with depression as they are reluctant to complain about their symptoms. The present study was carried out to evaluate the relation of distress with anxiety and depression in 123 patients with head and neck cancers using Distress Inventory for Cancer version 2 (DIC2) and the Hospital Anxiety and Depression scale (HADS). The mean DIC 2 scores were 24.6 while that of subscales ranged from 2.6 to 11.0. Fifteen patients were found to have clinical caseness for anxiety while 12 (10%) were caseness for depression. Total distress, emotional and social distress subscales were found to have positive correlation with anxiety and depression suggesting a possible overlap of two constructs. In multivariate analysis only belief in god was found to significantly affect the distress. Results of present study suggest significant psychological morbidity in head neck cancer patients undergoing curative treatment. This is the first study reporting on the psychometric properties of distress inventory on cancer version 2 since its validation, the results suggest a possible overlap of two constructs similar to that seen with other tools on distress and this may have major implications for clinical practice.