绝经前乳腺癌是否存在手术治疗的最佳时间

乳腺癌患者的年龄、肿瘤大小、腋淋巴结状况、临床分期、病理类型、由体激素受体水平、细胞增生率、DNA含量及癌基因的改变等等，都是影响乳腺癌预后的因素，在患者就诊时已经确定，临床医生无法改变。寻求一种能提高疗效的方法，是临床医生多年来的愿望。1985年Ratsjczak等报告了对植入乳腺癌的雌小鼠模型，选择在动情期手术，能减少术后肺转移的发生。这一发现引起了临床医生的广泛关注。月经周期中手术时间的选择如能影响预后，无疑将有助于提高绝经前乳腺癌患者的生存率。一、是否存在手术治疗的最佳时间近年来许多学者对这一问题进行…     

绝经前乳癌患才手术时间和预后

乳腺是一个性器官，乳癌的发生，发展和预后和卵巢激素的关系十分密切，绝经前乳腺癌手术时机的选择影响其预后。在月经周期中的黄体早期实施手术和在非黄体早期手术者，术后局部复发率无差异；３．５年远处转移和生存率相似，１０年远处经黄体早期组低于非黄体早期组（Ｐ〈０．０５）；１０年生存率黄体早期组高于非黄体早期组（Ｐ〈０．０５）。提示，黄体早期是绝经前乳腺癌的优选手术时机。     

手术时机对绝经前乳腺癌术后复发转移的影响

国内外对于绝经前乳腺癌手术时机的选择问题仍有争议 , 但多数资料显示 , 黄体期手术者预 后较好 [1- 4]. 本课题通过回顾分析 164例绝经前乳腺癌术后 5年复发转移的危险因素 , 探讨 是否在黄体期手术有利于病人无瘤生存 ; 同时 , 通过检测表皮生长因子受体 ( epidermal growth factor receptor, EGFR) 和血管内皮生长因子 ( vascular endothelial growth factor, VEGF) 探讨其可能的原因 .     

绝经前乳腺癌病人血清激素测定及其与预后的关系

目的 探讨月经周期不同阶段手术及预后的关系。方法 对月经周期不同分期（卵泡期、黄体期及围排卵期和围月经期）分别测定其血清泌乳素、雌二醇和孕酮的浓度。了解其与3、5年生存期的关系。结果 （1）围排卵期及黄体血清孕酮含量明显增高；（2）围排卵期3、5年生存率均高；（3）黄体期3年生存率高，而5年生存率无差异。结论 乳腺癌病人在月经不同时期血液性激素水平呈现不同的变化，对肿瘤的发生发展产生一定的影响，生存率与血清孕酮含量有关，与雌激素、泌乳素的相关性需进一步探讨。     

乳腺癌月经周期中手术时间的选择与预后的关系

作者回顾了中国医学科学院肿瘤医院１９５８年３月至１９８４年至１２月有末次月经记录并随诊１０年以上的绝经前乳腺癌手术治疗患者２１８例。通过单因素分析发现：乳腺癌患者的预后除与原发肿瘤大小、淋巴结转移状况、ＴＮＭ分期、组织学类型、术后辅助治疗等因素有关外，还与手术在月经周期中的时间有关。本组有１２３例在围排卵期手术（末次月经周期的第７－２０天），９５例在围月经期手术（末次月经周期的第０－６天，２１－４     

可手术乳腺癌预后的评价

 乳腺癌是妇女常见的恶性肿瘤之一,据报导欧洲每年发病约20万人,其中90%为早期可手术治疗的乳腺癌。随着对乳腺癌研究与认识的进展,传统的根治性或扩大根治性乳癌切除术在发达国家已属罕见,单纯肿瘤切除术或乳房部分、全切加同侧腋     

绝经前激素受体阳性乳腺癌内分泌治疗现状

内分泌治疗是激素受体阳性乳腺癌患者术后辅助治疗的重要手段之一。在内分泌治疗的背景下,接受5年他莫昔芬治疗一直是绝经前患者的标准治疗方案。近年来,这一标准受到挑战。许多大型随机临床试验结果为绝经前患者辅助内分泌治疗提出了新的选择。本文拟将绝经前激素受体阳性乳腺癌患者的内分泌治疗现状做一综述。     

男性与绝经后女性乳腺癌患者的预后分析CSCD

目的比较男性乳腺癌(MBC)与绝经后女性乳腺癌(FBC)患者的预后。方法收集经手术确诊的50例无远处转移MBC患者及512例无远处转移FBC患者的临床病理资料。采用Kaplan-Meier法绘制生存曲线,用Log rank检验分析各曲线之间的差异。采用Cox比例风险分析方法,对有差异的亚类变量进行生存分析。MBC与绝经后的FBC组采用倾向得分匹配及Cox回归分析。结果ER/PR在MBC患者中的表达率高于FBC患者(χ^2=30.651,P=0.000;χ^2=26.909,P=0.000),HER-2阳性表达率较FBC患者低(χ^2=24.274,P=0.000)。单因素分析结果表明,MBC患者的OS与绝经前期FBC患者相似(P=0.268),但与绝经后FBC患者差异有统计学意义(P=0.005);Cox回归显示MBC患者比绝经后FBC患者预后差(P=0.000)。结论与绝经前后的FBC患者相比,MBC患者表现出较高的ER、PR阳性和较低的HER-2阳性表达率,且MBC患者的OS比绝经后FBC患者低。     

356例乳腺癌延期手术的预后观察

影响乳腺癌预后因素很多,而延期手术对预后的影响如何?作者将1964年4月—1987年12月,因各种原因而延期手术的乳腺癌356例,与同期1656例一次手术病人作比较,观察其5、10、15年生存率、腋窝淋巴结转移率及两次手术时间间距(15天—3个月以上)对预后的影响。分析结果表明,15天内进行第二次手术较好,超过3个月作第二次手术生存率明显下降。     

Timing of surgery for primary breast cancer with regard to the menstrual phase and prognosis

The hormonal milieu of the patient at the time of surgery may influence the prognosis of patients with primary breast cancer. Circulating unopposed estrogen is perhaps detrimental, while circulating progesterone may confer a survival advantage. This hypothesis has particular relevance to the timing of surgery in relation to the menstrual cycle. After all, the first 14 days of the menstrual cycle (follicular phase) are characterized by high levels of circulating unopposed estrogen, while circulating progesterone is present during the second 14 days of the cycle (luteal phase). Several retrospective studies have shown that surgery during the follicular phase of the menstrual cycle results in a worse disease- free and overall survival. Randomized controlled trials addressing the effect of timing of surgery or neoadjuvant hormonal therapy on breast cancer mortality are urgently needed to confirm or refute the unopposed estrogen hypothesis. Such trials may provide important insights into the natural history of breast cancer, and a basis for significantly reducing breast cancer mortality.     

Timing of breast cancer surgery in relation to menstrual cycle phase: no effect on 3-year prognosis: the ITS Study

The effect of breast cancer surgery timing during the menstrual cycle on prognosis remains controversial. We conducted a multicentre prospective study to establish whether timing of interventions influences prognosis. We report 3-year overall and disease-free survival (OS/DFS) results for 'primary analysis' patients (regular cycles, no oral contraceptives within previous 6 months). Data were collected regarding timing of interventions in relation to patients' last menstrual period (LMP) and first menstrual period after surgery (FMP). Hormone profiles were also measured. Cox's proportional hazards model incorporated LMP in continuous form. Exploratory analyses used menstrual cycle categorisations of Senie, Badwe and Hrushesky. Hormone profiles with LMP and FMP data were also used to define menstrual cycle phase. Four hundred and twelve 'primary analysis' patients were recruited. Three-year OS from first surgery was 90.7, 95% confidence interval (CI) [87.9, 93.6%]. Menstrual cycle according to LMP was not statistically significant (OS: hazard ratio (HR)=1.02, 95%CI [0.995,1.042], P=0.14; DFS: HR=1.00, 95%CI [0.980,1.022], P=0.92). Timing of surgery in relation to menstrual cycle phase had no significant impact on 3-year survival. This may be due to 97% of patients receiving some form of adjuvant therapy. Survival curves to 10 years indicate results may remain true for longer-term survival.     

Timing of weight gain in relation to breast cancer risk

Excessive weight gain in women at the time of intense hormonalchange can result in metabolic dysfunction. The metabolic/endocrineeffect of puberty, pregnancy or menopause on breast tissue ‘aging’is likely tobe more relevant to a woman's breast cancer riskthan is her degree of obesity at the time when the cancer presents.Experimental evidence suggests that the susceptibility of mammarytissue to carcinogenesis is greatest in early adultlife, andmultiple studies show that a history of weight gain in earlyadult life is associated with increased breastcancer risk inWestern women. Excessive weight gain in that age group is associatedwith the development of hyperinsulinaemia in individuals withgenetic susceptibility to insulin resistance. The insulin resistance syndrome may be a metabolic link betweenweight gain and breast cancer risk in Western women. Some studiessuggest that in postmenopausal women, hyperinsulinaemia is relatedmore to overall obesity, whereas in premenopausal women it isrelated more to abdominal localisation of fat. This may explainwhy an increased body mass index is a risk marker for breastcancer in postmenopausal but not premenopausal women. (A premenopausalwoman withanaverage body mass index may have a large intra-abdominalfat mass associated with the presence of hyperinsulinaemia.)Itis hypothesised thatovernutrition and inadequate physical exercisefavour the development of hyperinsulinaemia and also increasebreast cancerrisk in women with a genetic susceptibility toboth conditions. The hypothesis can betested by specific interventionstudies. breast cancer, aetiology, hyperinsulinaemia, obesity, weight gain     

Timing of breast cancer surgery in relation to the menstrual cycle--the rise and fall of a hypothesis

It has been claimed that the timing of surgery in relation to the menstrual cycle can significantly influence the prognosis among premenopausal women with primary breast cancer. The literature on the subject is reviewed. The results are heterogeneous, and the quality of the studies is in general low. Many studies suffer from statistical problems concerning small sample sizes and sub-group analyses. In all, the scientific basis for the hypothesis seems weak.     

Reconstructive surgery in young women with breast cancer

Aquaporin1 (AQP1) is a water channel protein that facilitates water flux across cell membranes. It is widely expressed in epithelial and endothelial cells in several tissues. AQP1 is also associated with angiogenesis, cell migration and metastasis in some human malignancies. In this study the immunohistochemical expression of AQP1 in 203 invasive breast carcinomas with long-term follow up was investigated. AQP1 expression was demonstrated in 11 tumours (5.4%) and showed highly significant correlation with high tumour grade, medullary-like histology, “triple-negativity”, cytokeratin 14 and smooth muscle actin expression. In univariate analysis, AQP1 was significantly associated with poor prognosis. In multivariate analysis, AQP1 expression proved to be an independent prognostic marker if stratified by age, tumour size, lymph node status, histological grade, ER status and CMF therapy. Our results strongly suggest that AQP1 expression is a new characteristic feature of a particularly aggressive subgroup of basal-like breast carcinomas.     

Breast cancer prognosis in relation to family history of breast and ovarian cancer

We linked four nationwide Swedish population-based registries to identify first-degree family history of breast and ovarian cancer among breast cancer cases diagnosed between 1991 and 1998 and followed them until death, emigration or end of follow-up in December 1998. The median follow-up was 36 months. Using Cox proportional hazards models, the hazard ratio of death (HR) due to breast cancer was estimated. Women with a family history of breast or ovarian cancer (n=2175, 12.7%) had a nonsignificantly better prognosis than women without any family history, HR 0.86 (95% CI 0.71-1.05); this appeared unrelated to age at diagnosis either in the index case or in relative(s) with breast and/or ovarian cancer. Our study shows that prognostic outlook is not worse among breast cancer patients with family history.     

Pre-morbid body size and the prognosis of women with breast cancer

Obesity has been associated with poor prognosis of breast cancer, but studies investigating indicators of adiposity, independent of height, such as skinfold thickness and weight/height ratio, have been limited. From a cohort of 89,835 women in the National Breast Screening Study, data on histologically confirmed, incident cases of invasive carcinoma of breast, diagnosed between January 1981 to June 1992, were analyzed. Body measurements were taken at enrollment and other risk-factor information from a self-administered questionnaire completed prior to diagnosis of the breast cancer. Mortality data were obtained by linkage to Statistics Canada, provincial cancer registries, and annual follow-up of cases through physicians. Of the 5 measures of body size studied among cases, poor prognosis was associated with higher triceps skinfold thickness only. With every 5 mm increase in skinfold, the risk of dying increased approximately 12% (relative risk, 1.12; 95% confidence intervals, 1.01 to 1.24) in the 1033 cases examined and adjusted for age at diagnosis, number of positive axillary nodes involved, and body weight. Compared with women in the lowest quartile of skinfold thickness, women in the fourth quartile had a relative risk (RR) of 1.64 (95% CI, 0.99 to 2.73). None of the other measures—weight, height, body mass index or weight/height ratio—reached any statistical significance. Since the reliability and validity of skinfold measures used in our study were never established, and no data were available for changes in body size after diagnosis, the results of this study on skinfold thickness should be used only as indicative of a need for further studies. © 1994 Wiley-Liss, Inc.     

Lack of correlation between timing of surgery in relation to the menstrual cycle and prognosis of premenopausal patients with early breast cancer

In a retrospective cohort of a randomised study of adjuvant endocrine, chemotherapy and chemoendocrine therapy, we investigated the correlation between timing of mastectomy and relapse-free survival (RFS) and overall survival (OS) in 721 premenopausal patients with early breast cancer. The median follow-up was 10.1 years (range: 6.1-19.1 years). We grouped the patients by three kinds of classification according to Badwe, Senie, and Hrushesky. The logrank test after the Kaplan-Meier curves showed that there were no significant differences between the categorised menstrual phase in cycle and RFS or OS, except for RFS using Badwe's classification, where the patients whose timing of operation was in the follicular phase had a better RFS compared with those in the luteal phase. These were confirmed by the Cox proportional hazard model. These results suggest that a positive result might be a chance finding, dependent upon the cut-off levels in the menstrual cycle.     

Annual hospital volume of surgery for gastrointestinal cancer in relation to prognosis

BackgroundStudies examining hospital volume for surgery for various gastrointestinal (GI) cancer types have shown conflicting results regarding the influence on long-term prognosis. The aim of this study was to examine annual hospital volume in relation to long-term survival after elective surgery for all GI cancers (esophagus, stomach, liver, pancreas, bile ducts, small bowel, colon, and rectum).MethodsPopulation-based cohort study including all 45,908 patients who underwent elective surgery for GI cancers in Sweden in 2005–2013. Follow-up was until 2016 for disease-specific 5-year mortality (main outcome) and 2018 for all-cause 5-year mortality (secondary outcome). Hospitals were divided into quartiles for each GI cancer according to a 4-year average annual volume of the year of surgery and three years earlier. Multivariable Cox regression provided hazard ratios (HRs) with 95% confidence intervals (CIs), adjusted for relevant confounders.ResultsHigher hospital volume was associated with a survival benefit in the large group of patients (n = 26,688) who underwent colon cancer resection, with HR 0.89 (95% CI 0.84–0.96) for disease-specific 5-year mortality comparing the highest with the lowest quartile. Higher hospital volume improved 5-year mortality in sub-groups of patients who underwent surgery for cancer of the esophagus, pancreas, and rectum. No such improvements were found for cancer of the stomach, liver, bile ducts, or small bowel.ConclusionLong-term survival was improved at higher volume hospitals for some GI cancers (colon, esophagus, pancreas, rectum), but not for others (stomach, liver, bile ducts, small bowel).