青年女性乳腺癌201例临床病理分析

目的 探讨青年女性乳腺癌的临床病理特点.方法 回顾性分析201例35岁以下青年女性乳腺癌(青年组)的临床及病理资料,并与随机数字表法分段抽取同期收治的60岁以上老年女性乳腺癌251例(老年组)进行比较,所有病例均经手术治疗及病理证实.结果 青年组乳腺癌病程≤6个月者所占比例高于老年组[82.09％(165/201)、72.11％(181/251)],差异有统计学意义(x2=6.19,P＜0.05);青年组原发肿瘤直径≤2 cm的患者比例低于老年组[19.90％(40/201)、30.28 ％(76/251)](x2=6.302,P＜0.05),淋巴结转移率高于老年组[63.68％(128/201)、54.19％(136/251)](x2 =4.145,P＜ 0.05);青年组0～Ⅰ期患者比例低于老年组[11.94 ％(24/201)、17.53 ％(44/251)](x2=2.729,P＞ 0.05).结论 青年乳腺癌患者就诊时肿瘤直径大,pTNM分期晚,淋巴结转移率高,病情进展较快,危险性较高,但患者警惕性较低.应大力提倡自我体检、定期体检,力争早期发现、早期诊断、早期治疗.     

青年和老年乳腺癌病理特征及预后差异的分析

目的:比较分析青年和老年乳腺癌患者的病理特征与预后的差异。方法:对我科自2011年6月至2012年12月收治42例青年乳腺癌（≤35岁,青年组）和63例老年乳腺癌（≥60岁,老年组）女性患者的临床资料进行整理,将两个年龄段的一般临床资料、病理特点、治疗方式和随访等情况进行比较分析。采用SPSS 24软件进行数据分析。结果:两组在肿瘤发生位置上、手术方式、辅助化疗、内分泌治疗和基因靶向治疗的比较上两组无统计学差异（P>0.05）,而在病程、肿瘤大小、组织病理分级和分期、淋巴结转移情况上比较存在差异性（P<0.05）。青年组中新辅助化疗、乳房重建和辅助放疗多于老年组（P<0.05）。与青年组比较,老年组中PR阳性高表达而HER-2和Ki-67低表达（P<0.05）,两组分子分型与ER阳性表达的比较无统计学意义（P>0.05）。随访3年和5年两组的总生率均无统计学意义（P>0.05）,但青年组中复发转移多于老年组（P<0.05）。结论:青年乳腺癌患者具有组织病理学分级和分期晚、恶性程度高、侵袭性强、复发转移率高,预后差的特点。     

可手术青年女性乳腺癌的临床特征

目的：探讨青年女性乳腺癌的临床病理特征、治疗方式以及其临床意义。方法：回顾性分析2001年1月至2006年3月收治的127例35岁以下可手术青年女性乳腺癌的影像学诊断、组织学类型、腋窝淋巴结状态、激素受体及C—erbB-2表达的临床资料。结果：青年乳腺癌占同期收治乳腺癌的15．4％，浸润性导管癌占81．9％，B超与X线联合诊断率为81．3％，腋窝淋巴结转移率为55．5％，雌孕激素受体阳性表达为43．锄、C—erbB-2阳性表达为70．3％、雌孕激素受体及C—erbB-2表达与淋巴结状态无关。结论：青年乳腺癌侵袭性强，淋巴结转移及C—erbB-2表达高，应强调系统治疗。     

Clinical pathological characteristics and prognostic analysis of diabetic women with luminal subtype breast cancer

This study selected luminal-type breast cancer patients as the study subjects. The patients were divided into groups according to the presence of diabetes and the types of medication used, and the patients' clinicopathological characteristics and prognostic indicators were explored. A total of 5,785 patients with luminal-type breast cancer admitted to Tianjin Medical University Cancer Institute and Hospital between January 2002 and December 2006 were selected as the study subjects. The subjects included 680 breast cancer patients with diabetes and 5,105 breast cancer patients without diabetes. The patients were divided into Luminal A, Luminal B (high ki67), and Luminal B (her-2/neu+) subtypes. Each subtype was further divided into a metformin group, a non-metformin group, and a nondiabetic group. The research indicators included breast cancer mortality, age, body mass index (BMI), amenorrhea, the presence of cardiovascular and cerebrovascular disease, pathological stage, pathological type, lymph node involvement, vessel carcinoma embolus, and the chemotherapy and endocrine regimen. A Kaplan–Meier analysis was conducted to analyze the differences in breast cancer mortality rates among the groups. The Cox proportional hazard model was adopted to detect independent factors related to prognosis. Kaplan–Meier univariate analysis showed that for the Luminal A, Luminal B (high ki67), and Luminal B (her-2/neu+) subtypes, the cancer-specific mortality rates differed significantly among the metformin, non-metformin, and nondiabetic groups. The 5-year survival rates were 94 %, 82 %, and 91 % (P?=?0.002); 93.5 %, 81 %, and 89 % (P?<?0.001); and 84 %, 77 %, and 83 % (P?=?0.035) for the subtypes within each group, respectively. Cox regression multivariate analysis showed that compared with the metformin group, all three subtypes of the, the non-metformin group showed poorer prognosis (hazard ratio [HR], 3.579; 95 % confidence interval [CI], 1.506–8.506 [P?=?0.004]; HR, 3.232; 95 % CI, 1.839–5.678 [P?<?0.001]; HR, 2.034; 95 % CI,1.019–4.059 [P?=?0.044] for Luminal A, Luminal B (high ki67), and Luminal B (her-2/neu+, respectively). Compared with the metformin group, the diabetic group showed poorer prognosis only for the Luminal B (high ki67) subtype (HR, 1.762; 95 % CI, 1.033–3.005 [P?=?0.038]). In addition, for the Luminal A, Luminal B (high ki67), and Luminal B (her-2/neu+) subgroups, there was a higher proportion of elderly patients (P?<?0.001) and postmenopausal patients (P?<?0.001) in the metformin and non-metformin groups than in the nondiabetic group. Moreover, the probability of having cardiovascular and cerebrovascular disease was also higher (P?<?0.001) in the metformin and non-metformin groups. For the Luminal B (high ki67) and Luminal B (her-2/neu +) subgroups, there was a higher proportion of obese patients in the metformin and non-metformin groups (P?<?0.001). In terms of clinical characteristics, for the Luminal B (high ki67) subtype, the proportion of patients with invasive ductal carcinoma was lower in the non-metformin group than in the other two groups (P?=?0.001). In both the metformin and non-metformin groups, the proportion of T3/4 patients was higher (P?<?0.001), the proportion of patients with lymph node metastasis was higher (P?=?0.001), and the proportion of patients with vessel carcinoma embolus was higher (P?=?0.001) compared with the nondiabetic group. In conclusion, compared with the metformin group, the non-metformin group had a poorer prognosis for all subtypes of luminal breast cancer. In the diabetic group, only patients with the Luminal B (high ki67) subtype exhibited a poorer prognosis. Therefore, different diabetes medication may have a different impact on the prognosis of different subtypes of luminal breast cancer.     

Molecular characteristics and prognostic features of breast cancer in Nigerian compared with UK women

Although breast cancer (BC) incidence is lower in African-American women compared with White-American, in African countries such as Nigeria, BC is a common disease. Nigerian women have a higher risk for early-onset, with a high mortality rate from BC, prompting speculation that risk factors could be genetic and the molecular portrait of these tumours are different to those of western women. In this study, 308 BC samples from Nigerian women with complete clinical history and tumour characteristics were included and compared with a large series of BC from the UK as a control group. Immunoprofile of these tumours was characterised using a panel of 11 biomarkers of known relevance to BC. The immunoprofile and patients' outcome were compared with tumour grade-matched UK control group. Nigerian women presenting with BC were more frequently premenopausal, and their tumours were characterised by large primary tumour size, high tumour grade, advanced lymph node stage, and a higher rate of vascular invasion compared with UK women. In the grade-matched groups, Nigerian BC showed over representation of triple-negative and basal phenotypes and BRCA1 deficiency BC compared with UK women, but no difference was found regarding HER2 expression between the two series. Nigerian women showed significantly poorer outcome after development of BC compared with UK women. This study demonstrates that there are possible genetic and molecular differences between an indigenous Black population and a UK-based series. The basal-like, triple negative and BRCA1 dysfunction groups of tumours identified in this study may have implications in the development of screening programs and therapies for African patients and families that are likely to have a BRCA1 dysfunction, basal like and triple negative.     

Epidemiology of breast cancer in young women

Breast cancer is mainly a postmenopausal disease, but in younger women breast tumors often exhibit more aggressive features and worse prognosis. Furthermore, high-risk and low-risk tumors present different age distributions suggesting that breast cancer comprises a mixture of two different disease processes. In agreement with this hypothesis, breast cancer presents different epidemiologic traits in pre- and postmenopausal women. Regarding racial distribution, incidence is higher in black women at younger ages in US, while the reverse is true among women older than 50 years. Genetic predisposition is a stronger risk factor in young women. On the contrary, nulliparity and obesity decrease the risk of early-onset breast cancers while are associated with higher incidence in older women. Epidemiologic data related with the hormonal exposure in utero suggest that the effect is stronger in early breast cancers. In most developed countries, breast cancer has shown an upward trend until recent years in postmenopausal women, while incidence rates in younger women have been stable. However, Spain is an exception to this rule: Spanish women younger than 45 years of age have registered a steady increase of breast cancer that may be related with the remarkable lifestyle changes experienced by women born in the second half of the twentieth century.     

青年女性乳腺癌患者临床病理及超声影像学特征分析

摘要目的分析青年女性乳腺癌患者的临床病理及超声影像学特征。方法回顾性分析2016年1月至2017年10月中国医科大学附属第四医院经手术病理证实的42例青年女性乳腺癌患者（≤35岁,青年组）的临床病理及超声检查资料,以同期经手术病理证实的62例老年女性乳腺癌患者（〉60岁,老年组）为对照,进行对比分析。结果青年组脉管癌栓率、淋巴结转移阳性率高于老年组[31.0%（13/42）比29.0%（18/62）,59.5%（25/42）比38.7%（24/62）],差异有统计学意义（χ2=16.187,χ2=5.749,均P〈0.05）。与老年组相比,青年组乳腺癌雌激素受体（ER）阳性率较低（χ2=11.598,P=0.001）,人类表皮生长因子受体2（HER-2）、Ki-67阳性率较高,差异有统计学意义（χ2=5.396,P=0.024;χ2=5.166,P=0.026）。青年组乳腺癌内部回声不均匀、有微小钙化灶、血流Ⅱ~Ⅲ级及阻力指数（RI）≥0.7的患者比例均高于老年组[83.3%（35/42）比59.7%（37/62）,57.1%（24/42）比22.6%（14/62）,78.6%（33/42）比58.1%（36/62）,83.3%（35/42）比59.7%（37/62）,差异均有统计学意义（χ2值分别为6.576、12.899、4.716、6.578,均P〈0.05）。结论青年女性乳腺癌患者与老年患者相比恶性度高、侵袭性强且转移率高。     

肥胖与年轻乳腺癌患者临床病理特征的相关性研究

目的:探讨年轻乳腺癌患者的临床病理特点,进一步分析肥胖与其临床病理特征的关系。方法:回顾性分析甘肃省肿瘤医院放疗科2013年1月1日至2017年12月31日收治的108例均经术后病理证实的浸润性乳腺癌患者的临床资料(年龄均≤35岁),根据中国成年人肥胖划分标准,以体重指数≥28 kg／m2为分界点将患者分为肥胖组和非肥胖组,统计分析两组在临床病理特征方面的差异。结果:相较于非肥胖患者,肥胖患者原发肿瘤更大（P=0.000）,肥胖患者中临床分期III期比例以及淋巴结阳性率更高（P值分别为0.003和0.003）,肥胖患者Ki-67表达率更高,起病至首诊时间更长（P值分别为0.000和0.020）,肥胖患者在分子分型及脉管癌栓方面与非肥胖患者相比均无统计学差异（P值分别为0.100和0.828）。结论:年轻乳腺癌的临床病理特征具有自身特点,相较于非肥胖患者,肥胖患者的病理特征较差。因此,在早期乳腺癌的精准医疗中,除了依据临床病理学特征之外,体重指数也应该在预后风险评估和制定个体化治疗策略中予以重视。     

预后营养指数与胃癌病理特征的相关性分析

目的 探讨OPNI 及临床病理特征对胃癌患者预后的影响。方法   选取46 例接受胃癌根治术患者,回顾性分析 其临床资料,根据每例患者入院时化验结果计算每位患者的OPNI,计算公式为OPNI= 血清白蛋白水平（g/L）+5× 外周 血淋巴细胞总数（×109/L）。采用受试者工作特征曲线计算Youden 指数,获取具有最佳敏感度和特异度组合的OPNI 作 为本组患者OPNI 分界值,并以此将本组患者分为高OPNI 组及低OPNI 组,采用Kaplan-Meier 生存曲线和Cox 比例风险 模型研究OPNI 对胃癌预后的影响。结果  淋巴结无转移、pTNM 分期为Ⅱ期、CEA 及 CA199 未升高、术后未出现并发症 的胃癌患者OPNI 平均值均明显高于对照组。而采用4 年生存作为终点绘制OPNI 的 ROC 曲线,当OPNI 值为38.175 时, Youden 指数最大,因此以OPNI=38.175 将本组患者分为高OPNI 组和低OPNI 组,与低OPNI 组的患者相比,高OPNI 组 的患者肿瘤浸润深度更浅、淋巴结转移更少、pTNM 分期相对早期、CEA 及 CA199 水平均处于正常范围内。单因素及多 因素分析显示,患者年龄和OPNI 值是胃癌患者总生存时间的独立预后因素。结论  OPNI 可作为一项简洁直观的指标来协 助临床医生判断胃癌患者的预后。     

青年女性乳腺癌的影像学特征与免疫组织化学分子亚型相关性分析

背景与目的：乳腺癌在30岁以下的青年女性中很罕见,但近几年乳腺癌趋向年轻化并且发病率逐年增高,而早期乳腺癌免疫组织化学分子亚型的识别可以完善治疗方案。该研究旨在探讨青年女性（≤30岁）乳腺癌的超声、数字乳腺Ｘ线摄影（digital mammography,DM）及数字乳腺断层合成摄影（digital breast tomosynthesis,DBT）特征与免疫组织化学分子亚型的相关性。方法：回顾并分析2013年12月—2019年7月于青岛大学附属医院进行过乳腺超声、DM和DBT检查,且经手术后病理学检查证实为乳腺癌,年龄≤30岁的139例青年女性患者。影像学特征参照第5版乳腺影像报告及数据系统（Breast Imaging Reporting and Data System,BI-RADS）进行评估及分类。对肿块样病变,3种检查方法均评估了病变的形状、边缘,DM和DBT对肿块密度另加以评估,超声对病变内部回声、后方回声、血流信号另加以评估;对异常钙化评估其形态及分布;依据BI-RADS评估了乳腺纤维腺体构成;分子亚型根据2015年修订的St. Gallen国际专家共识建议确定。结果：病变多表现为可触及肿块（89.9%）、临床T ₂ 期（50.4%）、组织学Ⅱ级（58.3%）、腋窝淋巴结转移（59.7%）、luminal B型乳腺癌（44.6%）,BI-RADS多为4类或5类。在所有成像中,肿块病变均多表现为不规则形（P<0.001）,luminal A型乳腺癌及三阴性乳腺癌（triple-negative breast cancer,TNBC）多为肿块样病变,luminal B型乳腺癌中肿块伴钙化病变多见,HER2过表达型多见单纯钙化样病变（P<0.001）。在DM和DBT上,诊断为阴性情况更常见于luminal A型乳腺癌（P<0.001）。对于肿块样病变,DM中最常见表现为边缘模糊（71.9%）,而DBT多见毛刺影（51.8%）,毛刺边缘多与luminal A和luminal B型乳腺癌相关（P<0.01）。良性影像学特征多与TNBC相关,表现为卵圆形或圆形（P<0.001）,边缘清楚（P<0.01）。HER2过表达型和TNBC型两组中肿块病变的范围均大于luminal A和luminal B型乳腺癌（P=0.003）。结论：30岁以下青年女性乳腺癌的部分影像学特征可用于预测某些肿瘤免疫组织化学分子亚型。DBT的乳腺癌检出率高于DM,对乳腺致密的青年女性具有广泛的应用价值。     

Comparative phase II study of idarubicin versus doxorubicin in advanced breast cancer

The aim of the present study is to confirm the antitumor activity of orally administered idarubicin (IDA) in patients with advanced breast cancer. Doxorubicin (ADRIA) was chosen as control treatment and the patients were randomized to receive either IDA or ADRIA according to a 2:1 ratio. Sixty-three patients, 77% of whom were pretreated with chemotherapy excluding anthracyclines, entered the study. The doses were: IDA 45 mg/m2 orally on 3 consecutive days every 28 days: ADRIA 75 (60) mg/m2 intravenously every 21 days. A complete + partial response (CR + PR) was observed in 11/37 (30%) evaluable cases treated with IDA and in 6/19 (32%) cases treated with ADRIA. If all the patients were included, the CR + PR remission rates were 27.5 and 27%, respectively. There were no significant differences as regards time to remission, duration of remission and survival. None of 10 cases who crossed over the treatments responded to the second therapy. The most frequent side effects of IDA were myelosuppression and nausea/vomiting. The only significant statistical difference between the two anthracyclines was the lower incidence of alopecia after IDA. Although there were 3 cases of cardiotoxicity after ADRIA, 2 of which severe, no case of clinical cardiotoxicity was observed after IDA. The present study confirms that orally administered IDA is an active agent in advanced breast cancer.