乳房肿瘤患者免疫功能检测及其临床意义

[目的]探讨乳腺癌及乳房纤维瘤患者机体免疫功能。[方法]应用流式细胞仪对38例乳腺癌患者、23例乳房纤维瘤患者及38名健康妇性外周血T细胞亚群进行检测。[结果]①全组乳腺癌患者CD3^ 、CD4^ 细胞显著低于正常对照组及乳房纤维瘤组。②腋淋巴结转移组CD4^ /CD8^比值明显低于正常对照组、乳房纤维瘤组及腋淋巴结无转移组。③CD56^ 细胞在正常对照组、乳房纤维瘤组及伴或不伴腋淋巴结转移乳腺癌组之间无显著差异。④临床分期越晚的患者,免疫功能状态越差。[结论]细胞免疫功能检测对乳腺癌患者的病情判断、临床分期、预后观察有一定的意义。     

乳腺癌患者免疫指标检测及其临床意义

目的:分析乳腺癌及乳腺良性疾病患者机体免疫指标的特点及临床意义。方法:应用流式细胞术对30例乳腺癌患者、45例乳腺良性疾病患者外周血T细胞亚群及NK细胞进行检测。结果:乳腺癌患者CD3 、CD4 细胞百分比显著低于乳腺良性疾病组(P<0.05);CD8 细胞百分比以及CD4 /CD8 比值在乳腺癌组和乳腺良性疾病组之间无显著差异(P>0.05);乳腺癌患者NK细胞百分比显著高于乳腺良性疾病组(P<0.05);乳腺癌腋淋巴结转移组CD3 细胞百分比及CD4 /CD8 比值明显低于腋淋巴结无转移组(P<0.05),而NK细胞百分比显著高于腋淋巴结无转移组(P<0.05)。结论:乳腺癌患者存在细胞免疫功能紊乱,检测外周血T淋巴细胞亚群表达可能对评估患者的细胞免疫功能及疾病的预后具有一定意义。     

术前中等剂量,短期化疗对胃癌手术患者早期免疫功能的影响

目的 为探讨术前化疗是否对手术患者免疫功能引起影响。方法 对比进行期胃癌单纯手术组(对照组)、化疗一手术组(实验组)治疗前后T细胞亚群变化。结果 (1)实验组术前中小剂量、短期化疗,手术后第1、2周CD_3~ CD_4~ 细胞百分比、CD_1~ /CD_8~ 细胞比值低于正常水平,但与对照组比较,无显著性差异(P>0.05)。(2)实验组术后第3周(化疗第4周)CD_3~ CD_4~ 细胞百分比、CD_4~ /CD_8~ 细胞比值有所回升,但无统计学意义(P>0.05)。结论 肿瘤本身是降低细胞免疫功能主要因素,切除肿瘤后需长时间恢复免疫功能。术前中小剂量化疗对细胞免疫功能无明显损伤,为今后开展胃癌术前化疗提供理论依据。     

非小细胞肺癌组织中T淋巴细胞亚群的观察

目的:了解非小细胞肺癌组织局部免疫功能状况。方法:应用免疫组织化学技术对34例肺鳞癌和腺癌组织中的T淋巴细胞亚群(T—Ls)进行了原位定量观察。结果:肺癌组织比肺良性疾病组织中CD_4~ /CD_8~ 细胞比值降低,差异非常显著(P<0.01);肺癌淋巴结转移组、低分化肺癌组比对照组组织中CD_3~ 细胞减少,差异显著(P<0.05)。结论:肺癌组织局部的免疫功能低下,细胞免疫的调节机能紊乱。肺癌伴有淋巴结转移患者比未转移患者局部的免疫功能更低下。肺癌分化程度越低,局部的免疫机能越差。     

乳腺癌细胞DNA含量分析及其预后关系

本实验应用流式细胞检测技术对53例乳腺癌石蜡包理组织标本DNA含量进行了测定,并分析了DNA倍体性、合成期细胞百分比与其他临床病理指标及患者5年存活率的关系,其中43例获得可供分析的结果.结果表明:(1)合成期细胞百分比(SPF)与患者5年存活率及腋淋巴结转移有显著相关性.(2)SPF和腋淋巴结转移与否结合可更准确地评估乳腺癌患者的预后.(3)DNA倍体性SPF、乳腺癌组织学类型之间无显著关系.作者认为:SPF反映了乳腺癌细胞的增殖活性和侵袭能力,可做为评估乳腺癌患者预后的指标.     

p16和p27蛋白在乳腺癌的表达及其意义

目的 :探讨p16和p2 7在乳腺癌的表达特点及其判断乳腺癌患者预后的意义。方法 :应用免疫组化ABC法检测 89例乳腺癌的p16、p2 7的表达情况。结果 :89例乳腺癌中 ,p16蛋白阳性表达率4 8 3% (4 3/ 89) ,p2 7蛋白阳性表达率 57.3% (51/ 89)。p16蛋白在腋淋巴结转移阳性组表达率 31.8%(14/ 4 4 ) ,显著低于腋淋巴结转移阴性组表达率 6 4 .4 % (2 9/ 4 5) (P <0 .0 1)。p2 7蛋白在浸润性乳腺癌组和腋淋巴结转移阳性组表达率分别为 52 .0 % (39/ 75)、38.6 (17/ 4 4 ) ,显著低于非浸润性乳癌腺组和腋淋巴结转移阴性组的表达率 85.7% (12 / 14)、75.6 % (34/ 4 5) (P <0 .0 5、P <0 .0 1)。结论 :p16蛋白与p2 7蛋白的缺失表达均与乳腺癌的生物学行为有关。p2 7蛋白检测在判断乳腺癌患者预后方面比p16蛋白检测可能有更重要意义。     

Ki-67和DNA倍体分析与乳腺癌淋巴转移倾向

[目的]探讨乳腺癌组织的Ki鄄67基因表达和DNA倍体与其淋巴转移倾向的关系。[方法]采用流式细胞技术对72例乳腺癌组织新鲜标本进行Ki鄄67表达及肿瘤细胞DNA倍体含量检测的研究。[结果]Ki鄄67表达与乳腺癌病变大小、病理类型和ER无关。乳腺癌腋淋巴转移阳性组DNA异倍体高于无淋巴转移组(P<0.05)。Ki鄄67在腋淋巴转移阳性组高表达,其阳性表达百分比分别是:腋淋巴结转移组为12.61±6.23;无转移组为7.61±3.85(P<0.05)。[结论]Ki鄄67表达及DNA倍体可作为判断乳腺癌具有淋巴转移倾向的临床参考指标。     

乳腺癌组织中PTEN和p27kip1蛋白的表达及其相互关系

目的:探讨PTEN和p27kip1在乳腺癌组织中的表达规律及其相互关系。方法:采用免疫组化SP法检测64例乳腺癌组织中PTEN和p27kip1蛋白的表达。结果:乳腺癌组织PTEN(34/64)和p27kip1(33/64)蛋白表达显著低于正常乳腺组织(15/15),P值分别为0·0082和0·0078。有腋淋巴结转移、远处转移及ER阴性组PTEN表达分别为13/33、3/11和16/38,明显低于无腋淋巴结转移(21/31)、无远处转移(31/53)和ER阳性组(18/26),P值分别为0·0240、0·0063和0·03475。p27kip1在乳腺癌有腋淋巴结转移、远处转移及ER阴性组的表达分别为7/33、2/11和8/38,明显低于无腋淋巴结转移(15/31)、无远处转移(20/53)和ER阳性组(14/26),P值分别为0·0230、0·0440和0·0071。两者表达均与肿瘤大小无关。两种蛋白表达水平具有显著的相关性,P=0·0041。结论:PTEN、p27kip1表达异常与乳腺癌转移及恶性程度密切相关,两种基因蛋白表达强度一致,显示其在乳腺癌演进中具有协同作用。     

喉癌局部免疫反应中TIL细胞亚群与TCF-β_1的作用及其相关性

目的 探讨TIL、TGF-β_1在喉癌中表达及其肿瘤临床分期、细胞分化、转移的关系。方法 采用鼠抗人单克隆抗体通过免疫组化SABC法对10例正常对照组(扁桃体)和38例喉癌标本中各因子进行检测。结果 喉癌中单个核细胞主要是CD_3、CD_4和CO_8分布与CD_3一致,CD_8:CD_4为1.4:1。正常对照组中浸润总数及各亚群细胞数均明显多于喉癌组。随TNM分期增高,CD_4/CD_8下降,NK、Mφ及IL-2R~ 下降。分化好的间质中淋巴细胞数多于分化差的。在发生肿瘤转移的喉癌病人CD_8增高、CD_4减少、TGF-β_1在喉癌及正常对照组中差异显著,在不同分期及不同发生部位间差异不显著,而在高低分化者间差异显著,TGF-β_1与CD_4表达无相关性、而与CD_8表达有相关性。结论 TIL淋巴亚群、TGF-β_1在喉癌的临床分期,病理分级、转移等方面各有作用,CD_4在喉癌局部免疫中起关键作用,CD_8细胞在对抗癌中起主要作用,TGF-β_1可能在抑制喉癌细胞增殖分化方面有较积极的作用,在判断是否有淋巴结转移方面有明显临床意义,CD_4、CD_8与TGF-β_1在喉癌中的表达有一定协同性。     

乳腺癌术后随机分组辅助放疗15年疗效观察

目的　探讨乳腺癌术后辅助放疗的远期疗效。方法　 16 2例手术后乳腺癌随机分为放疗组与对照组。放疗组照射锁骨上区和 (或 )内乳区各 5 0Gy,对照组不放疗。按临床分期、肿瘤部位及腋淋巴结有无转移比较两组生存差异。结果　 5 ,10 ,15年生存率放疗组分别为 72 .0 %、5 6 .1%和5 4 .3% ,对照组分别为 6 6 .3%、5 1.3%和 4 9.4 % ,两组差异无显著性 (P >0 .0 5 )。按临床Ⅰ～Ⅲa期、腋淋巴结 (+)或 (- )比较 ,除腋淋巴结 (+)≥ 4外 ,两组差异均无显著性。在腋淋巴结 (+)≥ 4时 ,放疗组 5 ,10 ,15年生存率分别为 5 5 .6 %、38.9%和 37.1% ,对照组分别为 2 9.0 %、16 .1%和 16 .1% ,放疗组疗效有明显提高 (P <0 .0 5 )。结论　乳腺癌术后放疗对腋淋巴结 (- )患者未能改善预后 ,对腋淋巴结 (+)≥ 4个者有益。     

乳腺癌腋窝淋巴结跳跃式转移的临床病理研究

目的 探讨乳腺癌腋窝淋巴结跳跃式转移与患者临床病理特征的关系及其对预后的影响.方法 回顾性分析1502例行完全腋窝淋巴结清除术乳腺癌患者的临床资料,观察腋窝淋巴结跳跃式转移的发生规律,分析其与患者临床病理特征的关系及对预后的影响.结果 有淋巴结转移者814例,其中腋窝淋巴结跳跃式转移者119例,占14.6%;跳跃式转移中,最常见的是从第Ⅰ、Ⅱ水平跳过第Ⅲ水平至腋尖,发生率为5.2%.跳跃式转移的发生与患者的年龄、肿瘤大小、临床分期以及雌激素受体状态均无关(均P＞0.05).Ⅰ～Ⅱ期患者中,跳跃式转移组的10年无病生存率较非跳跃式转移组低(58.5%∶ 77.3%,P＝0.003);Ⅲ期患者中,两组的10年无病生存率差异无统计学意义(50.0%∶ 57.6%,P＝0.457).Cox多因素分析显示,肿块大小、淋巴结转移数目、淋巴结结外是否受侵及是否发生跳跃式转移,是影响患者预后的独立因素.结论 某些常见的临床病理指标尚不能准确地预测腋窝淋巴结跳跃式转移的发生;早期乳腺癌发生跳跃式转移者预后差,对其应坚持严格而规范的治疗.     

Determinants of axillary recurrence after axillary lymph node dissection for invasive breast cancer.

AIM: This study was undertaken to gain insight into the risk factors for axillary recurrence among patients with invasive breast cancer who underwent breast-conserving treatment or mastectomy and axillary lymph node dissection. METHODS: In a matched case-control design, 59 patients with axillary recurrence and 295 randomly selected control patients without axillary recurrence were compared. Matching factors included age, year of incidence of the primary tumour and postsurgical axillary nodal status. RESULTS: For patients with negative axillary lymph nodes, those with a tumour in the medial part of the breast had a 73% (95% CI: 4-92%) lower risk of axillary recurrence compared to those with a tumour in the lateral part of the breast. For the patients with positive axillary lymph nodes the risk of axillary recurrence was 65% (95% CI: 16-86%) lower for those who had received axillary irradiation compared to those without axillary irradiation. Within the age group <50 years, the risk or axillary recurrence was 82% lower (95% CI: 45-94%) for patients with more than six lymph nodes found in the axillary specimen compared to those with six or less than six lymph nodes. CONCLUSIONS: Although based on a small number of patients, this study indicates that axillary irradiation is effective in reducing the risk of axillary recurrence for patients with positive lymph nodes. This favourable effect only applies to the subgroup with extranodal extension or nodal involvement in the apex of the axilla, as these were the only patients receiving axillary radiation during the study period. Copyright Harcourt Publishers Limited.     

Interferon production in lymph nodes draining breast carcinoma and its augmentation by OK-432

In breast cancer patients on whom modified radical mastectomy is performed, relatively more of the regional lymph nodes draining the breast carcinoma remain in comparison with standard radical mastectomy. Therefore, investigation of the functions of lymph nodes draining breast carcinoma has become important. Lymphocyte subsets of 33 axillary lymph nodes from 19 breast cancer patients were analysed using flow cytometry. In axillary lymph nodes, both OKT-3(+) cells and OKT-8(+) cells were decreased in comparison with those in peripheral blood. However, the OKT 4/8 ratio was increased in axillary lymph nodes. These findings suggest that axillary lymph nodes are immunologically more functional against cancer spread than peripheral blood. OK-M1(+) cells, Leu-7(+) cells and Leu-11a(+) cells were decreased in axillary lymph nodes in comparison with peripheral blood. The ability of IFN production in axillary lymph nodes and peripheral blood was analysed using the cytopathic effect of VSV-sindbis virus. After 72 hours incubation, IFN production of axillary lymph nodes showed maximum titer. When lymph nodes were co-cultured with OK-432, IFN production of axillary lymph nodes was strongly augmented. IFN production of axillary lymph nodes draining breast carcinoma were increased in comparison with peripheral blood. Axillary lymph nodes draining breast carcinoma would thus seem to be important as cytokine-producing organs. IFN has been found to be an activator of NK cells, cytotoxic T cells and IL-2 production. Axillary lymph nodes may therefore play an important role against the spread of breast cancer.     

The impact of axillary lymph nodes removed in staging of node-positive breast carcinoma

PURPOSE: Number of positive lymph nodes in the axilla and pathologic lymph node status (pN) have a great impact on staging according to the current American Joint Committee on Cancer staging system of breast carcinoma. Our aim was to define whether the total number of removed axillary lymph nodes influences the pN and thus the staging. METHODS AND MATERIALS: The records of 798 consecutive invasive breast cancer patients with T1-3 tumors and positive axillary lymph nodes who underwent modified radical mastectomy between 1999 and 2005 in our hospital were reviewed. The total number of removed nodes were grouped, and compared with the patient and tumor characteristics and the influence of the number of nodes removed on the staging was analyzed. RESULTS: The proportion of patients with > or =4 positive nodes (59%), and pN3 status (51%) were the highest in the group with 21-25 nodes removed. Compared with patients with 1-20 nodes removed, the proportion of patients with > or =4 positive nodes (52%), and pN3 status (46%) were significantly higher in those with more than 20 nodes removed. Although the proportion of Stage IIA and IIB decreased, the proportion of Stage IIIA and IIIC increased in patients with >20 nodes removed compared with those with 1-20 nodes removed. CONCLUSIONS: In patients with axillary node-positive breast carcinoma, staging is highly influenced by total number of removed nodes. Levels I-III axillary dissection with more than 20 axillary lymph nodes removed could lead to more effective adjuvant chemotherapy and increases substantially the proportion of patients to receive radiotherapy.     

Immunological characterization of mononuclear cells in peripheral blood and regional lymph nodes of breast cancer patients.

Mononuclear cells from peripheral blood and draining lymph nodes of 40 patients with invasive locoregional breast cancer were examined for immunological cell surface markers (E, EAhuman, EAox, EAC, SIg pos.). Concomitantly, blood lymphocytes from 36 healthy women and axillary and mesenteric lymph-nodes from patients without malignant diseases were tested as controls. In peripheral blood of tumor patients E rosette-forming cells were slightly diminished as compared to the control group, whereas EAox and EAC rosette-forming cells were increased. These differences may be age-dependent rather than tumor-related. In the draining lymph nodes of breast cancer patients as well as in the control lymph nodes, the percentages of EAC rosette-forming cells and SIg positive lymphocytes were significantly increased compared to peripheral blood, whereas E and EAhuman rosette values remained unchanged. Percentages of EAox rosettes on the other hand were strongly diminished in the draining lymph nodes, suggesting that the EAhuman and EAox rosetting techniques detect 2 types of Fc-receptor bearing cells. No significant differences were found between the cell surface marker analysis of tumor-free and metastatic lymph nodes of breast cancer patients and the control lymph nodes.     

Complete axillary lymph node dissection for stage I-II carcinoma of the breast

We reviewed the complete axillary dissection specimens of 136 patients with stage I-II breast cancer to clarify the distribution of axillary lymph node metastases in this disease. Our series included 71 patients undergoing axillary dissection as part of a modified radical mastectomy (MRM) and 65 patients undergoing axillary dissection in conjunction with conservative surgery of the breast and definitive postoperative breast radiotherapy (CAD). These two groups of patients were comparable according to age, menopausal status, tumor size, and clinical stage. In all patients the pectoralis minor muscle was excised and all axillary tissue removed. Each specimen contained a median of 23 lymph nodes. The axillary levels (I, II, III) were determined according to the relationship of axillary tissue to the pectoralis minor muscle (lateral, inferior, medial). Thirty-nine percent of the lymph nodes were contained in level I, 41% in level II, and 20% in level III. There were no significant differences noted in the number of lymph nodes or in the distribution of lymph nodes according to axillary level between dissections performed as part of the MRM or those done as a single procedure (CAD). Sixty-five patients (47.8%) had one or more positive lymph nodes in their axillary specimen. The clinical and pathologic stage was determined and compared for all patients. Among patients judged to have a clinically negative axilla, 37.6% had histologically positive lymph nodes (clinical false-negative rate). For patients with a clinically positive axilla, 11.1% had, histologically, no evidence of metastatic disease (clinical false-positive rate). When the distribution of lymph node metastases according to axillary level was studied, it was found that 29.2% of lymph node-positive patients (or 14.0% of all patients) had metastases only to level II and/or III of the axilla, with level I being negative (skip metastases). This incidence of skip metastases was greater among clinically node-negative than among clinically node-positive patients, but was not related to the size or location of the primary tumor in the breast. In addition, it was found that 20.0% of lymph node-positive patients (or 9.6% of all patients) were converted from three or fewer to four or more positive nodes by analysis of lymph nodes contained in levels II and III. This conversion from three or fewer to four or more positive nodes was due primarily to information contained in level II, with level III contributing to a smaller degree.(ABSTRACT TRUNCATED AT 400 WORDS)     

Completion of axillary dissection for a positive sentinel node: Necessary or not?

Sentinel node excision has been widely accepted as the initial surgical step for evaluating the axilla for metastatic breast cancer. When the nodes are positive, the standard of care is to complete the axillary node dissection, a more extended procedure that carries an increased risk for morbidity. This article reviews data from sentinel lymph node trials, case series reports of outcomes when axillary node dissection was not performed in the setting of positive sentinel nodes, models for predicting the status of nonsentinel nodes, and the morbidity associated with axillary operations. Despite an approximate 10% false-negative rate, early results indicate that there is a much lower local recurrence rate after sentinel node excision alone and that systemic therapy may sterilize the axilla. In selected patients, it may be appropriate to forgo an axillary node dissection, although there are no randomized clinical trial data to support or refute this suggestion.     

Modified radical mastectomy and lymphocyte subsets of regional lymph nodes

Whether or not regional lymph nodes in tumor-bearing hosts possess special immunological properties, still remains an important problem in the management of breast cancer. Regional lymph node cells from 22 patients with breast cancer were immunologically studied using monoclonal antibodies, OKT-3, 4, 8, OK-M 1, Leu-7, and laser flow cytometry. Among these patients, 13 early cancer patients underwent modified radical mastectomy (Auchincloss operation or Patey operation) and 9 underwent standard radical mastectomy (resection of breast, pectoralis major muscle and axillary dissection). More helper T lymphocytes defined by OKT-4 were found in regional lymph nodes in modified radical mastectomy patients in comparison with standard radical mastectomy patients. In patients given the modified operations, NK activity defined by OK-M 1 or Leu-7 were significantly increased, especially in lateral axillary lymph nodes. Also, OK-M 1 lymphocytes and Leu-7 lymphocytes were increased in lymph nodes without metastasis rather than those with metastasis. These findings suggest that regional lymph nodes may have defence mechanisms against the spread of tumor cells in early cancer patients.     

Axillary surgery in breast cancer management--background, incidence and extent of nodal spread, extent of surgery and accurate axillary staging, surgical procedures

The prime objectives of axillary surgery in the management of breast cancer are 1) accurate staging, 2) treatment to cure and 3) quantitative information of metastatic lymph nodes for prognostic purposes and allocation to adjuvant protocols. It is generally agreed that axillary node status in potentially curable breast cancer is considered the single best predictor of outcome and the main determinant of allocation to adjuvant therapy. No physical examination, no imaging techniques, and no molecular biologic markers can today replace axillary surgery for staging purposes. The objectives of axillary surgery are best obtained by carrying out a complete axillary clearance. Nonetheless, less radical surgery is generally performed by carrying out a sampling procedure with a yield of about 4 nodes or a partial axillary dissection level I-II with at least 10 nodes recovered. Understaging the axilla is detrimental to outcome and, furthermore, locoregional tumor control is important for survival. Axillary surgery should therefore be conducted in accordance with high professional standards.