代谢综合征及其组分与前列腺癌发病风险的关系

目的:探讨代谢综合征(metabolic syndrome, MS)及其组分与男性前列腺癌发病风险的关系。方法:基于2014年1月至2016年12月在四川省人民医院健康管理中心进行团队健康体检的在职及离退休男性单位职工作为研究对象,构建健康体检动态队列,通过问卷调查、体格检查、实验室检测等方法收集基线社会人口学特征、MS及其组分指标,随访前列腺癌发病结局,采用Cox比例风险回归模型分析MS及其组分与男性前列腺癌发病风险的关系。结果:293 872例研究对象中,累积随访1 616 296人年,中位随访时间6.15年,随访期间新发前列腺癌病例425例,总体发病密度为26.29/10万人年。在调整年龄等混杂因素后,MS组分分组中,相较于BMI、血压、血脂正常者,超重和(或)肥胖、高血压及血脂紊乱的体检人群其前列腺癌的发病风险明显升高[aRR(95%CI)分别为：1.621(1.330～1.976)、1.868(1.086～3.215)、1.992(1.370～2.896)],同时与非MS患者相比,MS患者前列腺癌的发病风险也明显升高[aRR(95%CI)为：1.998(1.353～2.951...     

皮纹（单、双眼皮）与食管癌患病风险关系的病例对照研究

目的 探讨单、双眼皮与食管癌患病高风险的关系。方法 采用问卷调查、家访（80%以上）和非条件Logistic回归分析方法,对2 262 例病例组（经组织病理学确诊为食管鳞状细胞癌患者）及3 459 例对照组（均经食管内镜检查确诊为非癌人群）单、双眼皮和其他临床资料等进行相关性分析。结果 病例组单、双眼皮频率（58% vs. 42%）高于对照组（51% vs. 49%）（P <0.001）,单眼皮人群患食管癌的风险性比双眼皮人群高（OR=1.29, 95%CI:1.15-1.44,P<0.001）。年龄分层分析发现：45~64岁的单眼皮人群发生食管癌的风险高于同年龄段双眼皮人群 （OR:1.26-1.61,95%CI:1.08-2.02）。结论 单眼皮表型与食管癌患病高风险相关,提示单眼皮可作为食管癌高风险评估的危险指标之一,并为进一步研究皮纹与食管癌发生的相关分子机制,提供了线索。     

肿瘤患者同型半胱氨酸与静脉血栓及凝血功能的相关性研究

目的:研究血浆同型半胱氨酸(Hcy)水平与肿瘤患者静脉血栓(VTE)及凝血功能的相关性,同时探讨肿瘤患者发生静脉血栓的相关危险因素,为临床治疗提供参考。方法:检测182例发生VTE的肿瘤患者和200名普通肿瘤患者及200名健康体检者（对照组）血浆Hcy、D-二聚体(D-Dimer,D-D)、纤维蛋白原(FIB)、凝血因子VIII(FVIII)、组织纤维溶酶原激活物(t-PA)等指标。结果:VTE患者Hcy、D-D、FVIII、FIB及t-PA检测水平均高于普通肿瘤患者及健康体检者（P＜0.05）;而普通肿瘤患者组D-D、FIB水平高于健康体检者（P＜0.05）;Hcy、D-D检测VTE的ROC曲线下面积分别为0.72（95%CI:0.68~0.79）和0.77（95%CI:0.72~0.83）;VTE肿瘤患者组中,Hcy、D-D血液含量存在明显的相关性（P=0.003 3,r=0.622）;高Hcy水平、D-D高水平以及t-PA血浆含量高是肿瘤患者发生VTE的危险因素。结论:Hcy水平能有效反映治疗患者的凝血状态,监测Hcy及D-D水平可以提高VTE的诊断效率,对肿瘤患者的预后有重要的临床参考价值。     

高敏C反应蛋白水平与肺癌患病风险的病例对照研究

目的:探讨外周血中血清高敏C反应蛋白（high sensitivity C-reactive protein，HsCRP）水平与肺癌患病风险的关系。方法:选取126例初次确诊的肺癌患者（肺癌组）和同期体检的非肺癌者126例（对照组），检测外周血中HsCRP水平。应用多因素Logistic回归，分析HsCRP水平与肺癌患病风险的关系。结果:两组人群在性别、年龄分组、吸烟状况、饮酒状况、体重指数（BMI）分布上均无明显差异（P>0.05）。调整患者性别、年龄、吸烟、饮酒和BMI等因素后，多因素Logistic回归分析结果显示，HsCRP水平最高组（>3 mg/L）患肺癌的风险是HsCRP最低组（<1 mg/L）的3.94倍（95%CI:2.06~7.53），在目前吸烟者中风险最高（OR=5.87，95%CI:2.08~16.58）。结论:血清HsCRP水平与肺癌的患病风险密切相关，提示其对筛查肺癌高危人群具有潜在应用价值。     

混合型小细胞肺癌外科治疗后预后分析

  目的  探索混合型小细胞肺癌（C-SCLC）术后患者生存的预后影响因素。  方法  回顾性分析2010年1月至2014年12月在上海交通大学附属胸科医院行肺癌根治性切除及系统性淋巴结清扫C-SCLC患者的临床资料。  结果  共计78例患者入组,其中C-SCLC合并大细胞神经内分泌肿瘤（large cell neuroendocrine carcinoma,LCNEC）患者所占比例最多（n=42）,其次是C-SCLC合并鳞癌（SCC）患者（n=18）、C-SCLC合并腺癌（AC）患者（n=10）及C-SCLC合并腺鳞癌（ASC）患者（n=8）。本研究队列5年生存率（OS）39.1%。多因素Cox回归分析表明:肿瘤大小[ < 3 cm vs. >3 cm;危险度（HR）=0.406;95%可信区间（95%CI）:0.202~0.816;P= 0.011]、体力状态评分（ < 2 vs. >2;HR=0.113;95%CI:0.202-0.631;P=0.013）、混合性非小细胞肺癌（NSCLC）成分（LCNEC vs.非LCNEC成分,HR=3.00;95%CI:0.096~0.483;P < 0.001）、病理分期（ⅢA期vs. Ⅰ期;HR=0.195,95%CI:0.063-0.602;P=0.004）及辅助治疗（是vs.否,HR=0.402;95%CI:0.195~0.831;P=0.014）为C-SCLC患者预后影响因素。  结论  混合型小细胞肺癌中的大细胞神经内分泌肿瘤成分会显著影响患者生存;术后辅助治疗明显有益于C-SCLC术后患者生存率的提高。      

2型糖尿病对卵巢恶性肿瘤患者预后的影响

目的:探讨2型糖尿病对卵巢恶性肿瘤患者预后的影响。方法:选择2002年1月-2012年12月就诊于我院妇科的卵巢恶性肿瘤患者108例为研究对象,根据是否患有2型糖尿病分为糖尿病组和非糖尿病组,随访时间截止到2013年12月。比较两组间基本情况及生存时间,采用logistic回归方法分析2型糖尿病对卵巢恶性肿瘤患者预后的影响。结果:糖尿病组患者FIGO分期为III期者比例（68.1% vs 45.9%）、低分化者比例（53.2% vs 29.5%）均高于非糖尿病组患者,差异有统计学意义（P<0.05）。糖尿病组患者死亡率（74.5%）高于非糖尿病组（52.5%）,生存时间（中位生存时间40个月）小于非糖尿病组（中位生存时间51个月）,差异均有统计学意义（P<0.05）。在校正年龄等因素后,2型糖尿病是影响卵巢恶性肿瘤患者死亡的危险因素（OR=1.941,95%CI:1.305-3.431）。结论:2型糖尿病是影响卵巢恶性肿瘤患者预后的危险因素。     

调强放疗联合TP方案化疗治疗局部晚期非小细胞肺癌的疗效及预后影响因素分析

目的:探析调强放疗联合TP方案治疗局部晚期非小细胞肺癌的疗效及相关影响因素。方法:回顾性分析124例接受放疗及TP化疗的局部晚期非小细胞肺癌患者的临床数据,根据化疗时机分为同步放化疗组（85例）及序贯放化疗组（39例）。比较两组的远期疗效,采用多因素COX回归分析预后的影响因素。结果:同步放化疗组在治疗后的治疗应答率高于序贯组（70.59% vs 51.28%,P=0.037）。生存随访显示,同步放化疗组的中位生存时间18.2个月高于序贯放化疗组的12.1个月,Log-rank检验P=0.026。对预后进行单因素分析后,年龄、肿瘤直径、CA125、CA199、治疗方案显示有统计学差异。COX多因素分析结果显示,患者年龄＞60岁（HR=3.075,95%CI 2.025~4.126）、肿瘤直径＞5 cm（HR=5.071,95%CI 2.626~7.118）以及序贯放化疗（HR=1.709,95%CI 1.205~2.113）影响远期疗效。结论:TP方案治疗局部晚期非小细胞肺癌中,同步放化疗方案优于序贯放化疗,其中患者年龄＞60岁、肿瘤直径＞5 cm、序贯放化疗是预后的危险因素。     

肝细胞肝癌患者外周血CD8+T淋巴细胞凋亡相关机制探讨

目的:探讨肝细胞肝癌患者外周血CD8+T淋巴细胞（CTL细胞）凋亡的相关机制及临床意义。方法:收集30例健康体检者及60例不同临床分期肝细胞肝癌患者外周血,应用流式细胞仪检测分析 CTL细胞相对百分比、凋亡情况及CTL细胞表面Fas(CD95)表达情况。结果:肝细胞肝癌患者外周血CTL细胞相对百分比含量高于健康体检者［（26.4%±9.2%） vs （19.7%±4.7%）,P＜0.05］。肝细胞肝癌患者外周血 AnnexinV+CTL细胞凋亡率高于健康体检者［（25.3%±6.5%) vs (12.1%±6.5%),P＜0.05］。肝细胞肝癌患者Fas+CTL细胞含量高于健康体检者［（62.2%±18.5%) vs (42.6%±16.5%),P＜0.05］。Fas表达与CTL细胞的凋亡呈正相关。不同TNM分期患者CTL细胞凋亡能力不同,随着病情程度恶化,细胞凋亡水平增加［（27.7%±5.9%） vs （20.6%±5.1%）,P＜0.001］。结论:肝细胞肝癌患者外周血中CTL细胞的百分比增加,提示在肿瘤的发生发展过程中机体存在抗肿瘤免疫效应,但是基于Fas/FasL途径的CTL细胞凋亡比例增加,可能是肿瘤细胞免疫逃逸的重要机制。     

新疆汉、维族代谢综合征合并结直肠癌患者临床特点及预后分析

目的:探讨新疆汉、维族代谢综合征合并结直肠癌患者的临床特点及预后。方法:回顾分析2010年1月1日-2012年12月31日新疆医科大学第一附属医院初次收治的临床资料完整经病理确诊的汉、维族结直肠癌患者,共430例。比较结直肠癌患者中代谢综合征（metabolic syndrome,MS）与非代谢综合征患者的临床特点及预后。生存分析采用Kaplan-Meier统计方法,生存率的比较采用Log-rank检验,应用Cox比例风险模型进行生存多因素分析。结果:合并MS组结直肠癌患者维族比例（P=0.027）、女性比例（P=0.018）及平均发病年龄（P=0.037）明显高于非MS组。合并MS组患者肿瘤侵润深度T3期和T4期所占比例(P=0.000)、局部淋巴结转移率（P=0.004）、远处转移率（P=0.000）以及Dukes分期C期和D期患者所占比例（P=0.037）均高于非MS组。Log-rank检验显示MS组患者累积生存率低于非MS组患者(P<0.05)。Cox多因素分析显示:MS为影响结直肠癌患者预后的独立影响因子之一（RR=0.596,P=0.038）。结论:合并MS结直肠癌患者维族比例、女性比例、发病年龄高于非MS结直肠癌患者,且更易发生淋巴结及远处器官的转移;MS为影响结直肠癌患者预后的独立影响因子,合并MS的结直肠癌患者累积生存率更低,预后更差。     

结直肠癌发病风险与ABO血型分布的关系

目的:探讨结直肠癌患病风险与ABO血型分布的关系。方法:通过LinkDoc数据库（LinkDoc Data）抽取辽宁省肿瘤医院含有ABO血型信息的结直肠癌住院患者的数据2 333例,与本地区另一家三甲医院的血型样本（36 124例）对照,回顾性分析不同血型患结直肠癌的风险。结果:2 333例结直肠癌患者中,A型患者663例（28.42%）,AB型患者689例（29.53%）,B型患者721例（30.90%）,O型患者260例（11.14%）。与对照组比较,AB型较非AB型结直肠癌患病风险升高（OR=3.54,95%CI=3.219~3.893）,O型较非O型结直肠癌患病风险下降（OR=0.299,95%CI=0.262~0.341）。结论:结直肠癌患者ABO血型分布与对照人群ABO血型分布有明显差别,AB型人群较其它血型人群结直肠癌发生风险升高,而O型结直肠癌发生风险降低,血型可能是结直肠癌发生的危险因素之一,但是有地域差别,在本地区AB血型人群应该是结直肠癌重点筛查对象。     

Impact of Obesity on Outcomes of Operable Breast Cancer: A Retrospective Cohort Study

Objective: Obesity is increasing worldwide. Previous studies of the impact of obesity on breast cancer outcomes have reported conflicting results. We investigated the association of obesity and breast cancer survival in Thai patients. Methods: Medical records of operable breast cancer patients diagnosed and treated at Siriraj Hospital between January 2004 and December 2011 were reviewed. Demographic data, tumor characteristics, stage, treatment and adverse event were described. Obesity was defined as body mass index (BMI) ≥ 25 kg/m2 using Asian’s cutoff value.  Survivals in both obese and non-obese patient groups were analyzed. Results: A total of 400 patients were included, 200 in each group. Obese patients were older and associated with more comorbidity. Obesity was associated with larger tumor size (p = 0.011), greater numbers of lymph node involvement (p = 0.003) and more advanced stage (p = 0.01). Obese patients were more likely to receive less adjuvant chemotherapy and hormonal treatment. There was no statistically significant difference in disease-free survival (DFS) (Hazard ratio [HR] 0.72, 95% confidence interval [CI] 0.46 to 1.13) and overall survival (OS) (HR 0.77, 95% CI 0.43 to 1.39) between obese and non-obese patients. Interestingly, obesity was associated with fewer complications from chemotherapy than non-obese patients (p = 0.047). Conclusion: Obesity had no adverse prognostic impact association on both DFS and OS in Thai patients with operable breast cancer, although obese patients more often presented with larger tumor and higher numbers of lymph node involvement.     

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。     

Associations between obesity,metabolic syndrome,and endometrial cancer risk in East Asian women

ObjectiveThis study investigated the associations between obesity, metabolic syndrome (MetS), the combination of these two components as a metabolic obesity phenotype, and endometrial cancer risk in East Asian women.MethodsA total of 6,097,686 cancer-free women aged 40–74 years who underwent the National Health Insurance Service health examination between 2009 and 2010 were included. Cancer incidence was identified using the healthcare utilization database. Associations between baseline obesity (body mass index <23 kg/m², 23–24.9 kg/m², ≥25 kg/m²), MetS, each component of MetS, MetS stratified by obesity status, combination of obesity and MetS, and endometrial cancer risk were investigated using hazard ratios (HRs).ResultsObesity, each component of MetS, and MetS increased the endometrial cancer risk. After these factors were mutually adjusted for, the association did not change. When stratified by obesity, MetS and MetS components were not associated with endometrial cancer in normal-weight or overweight women. However, in obese women, MetS and MetS components increased the risk of endometrial cancer (HR=1.29; 95% confidence interval [CI]=1.20–1.39). Compared with normal-weight women without MetS, endometrial cancer risk was not increased in normal-weight women with MetS. Overweight women showed an increased risk of endometrial cancer irrespective of the presence of MetS (HR=1.37 and 1.38, respectively). The HR of obese women with MetS was higher than that of obese women without MetS (HR=2.18 and 1.75).ConclusionThe association between MetS and endometrial cancer was most prominent in obese women, suggesting that obese women with MetS would be more vulnerable to endometrial cancer.     

Behavioral consequences of testing for obesity risk.

OBJECTIVE: There is considerable hope that genetic susceptibility testing will motivate behavior that can prevent or reduce the risk of complex conditions such as obesity. This study examined potential behavioral consequences of such testing. METHODS: Participants (n = 249) were randomly assigned to review one of four vignettes that asked them to imagine that they had been tested for their risk of becoming overweight or obese. The experimental factors were test type (genetic versus hormone test) and risk level (increased versus average risk for obesity). Study measures included behavioral intentions and perceived behavioral control related to eating a healthy diet, as well as weight locus of control. RESULTS: Participants assigned to the increased risk conditions indicated greater intentions to eat a healthy diet compared with participants assigned to the average risk conditions (P < 0.02). There were significant interaction effects of risk x perceived behavioral control (P < 0.02) and risk x weight locus of control (P < 0.003) on dietary intentions. Individuals with low perceived behavioral control or an external weight locus of control who were told to imagine they were at average risk expressed significantly lower intentions to eat a healthy diet. A three-way interaction of body mass index, family history of overweight/obesity, and assigned risk level found the greatest effects of risk feedback among those who either had a family history or a higher body mass index (P < 0.007). CONCLUSION: This study provides preliminary evidence that testing for susceptibility to obesity may motivate healthier behavior. However, some individuals may be susceptible to a false reassurance effect after receiving test results indicating a lack of increased risk.     

Effect of NUCKS-1 Overexpression on Cytokine Profiling in Obese Women with Breast Cancer

Background: Overweight and obesity are recognized as major drivers of cancers including breast cancer.Several cytokines, including interleukin-6 (IL-6), IL-10 and lipocalin 2 (LCN2), as well as dysregulated cellcycle proteins are implicated in breast carcinogenesis. The nuclear, casein kinase and cyclin-dependent kinasesubstrate-1 (NUCKS-1), is a nuclear DNA-binding protein that has been implicated in several human cancers,including breast cancer. Objectives: The present study was conducted to evaluate NUCKS-1 mRNA expressionin breast tissue from obese patients with and without breast cancer and lean controls. NUCKS-1 expression wascorrelated to cytokine profiles as prognostic and monitoring tools for breast cancer, providing a molecular basisfor a causal link between obesity and risk. Materials and Methods: This study included 39 females with breastcancer (G III) that was furtherly subdivided into two subgroups according to cancer grading (G IIIa and GIIIb) and 10 control obese females (G II) in addition to 10 age-matched healthy lean controls (G I). NUCKS-1expression was studied in breast tissue biopsies by means of real-time PCR (RT-PCR). Serum cytokine profileswere determined by immunoassay. Lipid profiles and glycemic status as well as anthropometric measures werealso recorded for all participants. Results: IL-6, IL-12 and LCN2 were significantly higher in control obeseand breast cancer group than their relevant lean controls (p<0.05), while NUCKS-1 mRNA expression wassignificantly higher in the breast cancer group compared to the other groups (p<0.05). Significant higher levelsof IL-6, IL-12, and LCN2 as well as NUCKS-1 mRNA levels were reported in G IIIb than G IIIa, and positivelycorrelated with obesity markers in all obese patients. Conclusions: Evaluation of cytokine levels as well as relatedgene expression may provide a new tool for understanding interactions for three axes of carcinogenesis, innateimmunity, inflammation and cell cycling, and hope for new strategies of management.     

Short-Term Outcomes for Laparoscopic Surgery for BMI≥30 Patients with Rectal Cancer

Objective: Obesity is known to be a preoperative risk factor for rectal cancer surgery. This study aimed to investigate the influence of obesity on the surgical outcomes of laparoscopic surgery for rectal cancer. Methods: The clinical data of 356 patients with rectal cancer from Jan 2012 to Dec 2015 were analyzed retrospectively. Perioperative outcomes were compared between 48 patients with a BMI (body mass index) ≥30 kg/m2 [obese group ] and 308 patients with a BMI≥30 kg/m2 [non-obese group] who underwent laparoscopic surgery. Results: Operation times were significantly longer for the obese group than for the non-obese group (125.2±30.5 min vs. 180.5±58.2 min, P=0.021). There were no statistically significant differences between two groups in terms of intraoperative blood loss, the number of retrieved lymph nodes, postoperative recovery and postoperative complications (P≥0.05). During the follow-up period, the overall survival rates were not significantly different between the two groups [66.7% (32/48) vs 67.2% (207/308), P=0.787]. The differences in recurrence and metastasis between the two groups were not statistically significant. Conclusion: Our analysis revealed that laparoscopic surgery can be safely performed in patients with BMI≥30. The procedure was considered to be difficult but sufficiently feasible.     

Obesity as a risk factor for triple-negative breast cancers: a systematic review and meta-analysis

Triple-negative breast cancer (TNBC) is a subtype of breast tumor with unique characteristics in terms of clinical?pathological presentation, prognosis, and response to therapy. Epidemiological investigations focusing on the identification of risk factors involved in the onset and progression of TNBCs have identified unique demographic, anthropometric, and reproductive characteristics involved in the etiopathogenesis of this subtype of breast tumors. This systematic review and meta-analysis evaluates the association between TNBCs and obesity and menopause status. Eligible articles were identified through three databases and secondary reference analysis. The search was conducted from the first record to February 2012. Eleven original articles meeting a priori established inclusion criteria were incorporated in the quantitative analysis. Case?case and case–control comparisons were performed. In addition, a case–case comparison was conducted before and after stratification according to menopausal status. Based on the level of between-study heterogeneity, pooled odds ratio (OR) and 95 % confidence interval were calculated using fixed or random models. The case?case comparison showed a significant association between TNBC and obesity (OR: 1.20; 95 % CI: 1.03?1.40). These results were confirmed by the case–control comparison (OR: 1.24; 95 % CI: 1.06?1.46). Once stratification based on menopausal status was applied to the case–case analysis, significant results were observed only in the pre-menopausal group (OR: 1.43; 95 % CI: 1.23?1.65). According to this analysis, obese women are at a greater risk of presenting with a TNBC than non-obese women, and menopause status may be a mitigating factor. If validated, these findings should be taken into consideration for the development of targeted preventive programs.     

Risk of Cancer Mortality according to the Metabolic Health Status and Degree of Obesity

Background: We investigated the risk of cancer mortality according to obesity status and metabolic healthstatus using sampled cohort data from the National Health Insurance system. Materials and Methods: Data onbody mass index and fasting blood glucose in the sampled cohort database (n=363,881) were used to estimaterisk of cancer mortality. Data were analyzed using a Cox proportional hazard model (Model 1 was adjusted forage, sex, systolic blood pressure, diastolic blood pressure, total cholesterol level and urinary protein; Model 2 wasadjusted for Model 1 plus smoking status, alcohol intake and physical activity). Results: According to the obesitystatus, the mean hazard ratios were 0.82 [95% confidence interval (CI), 0.75-0.89] and 0.79 (95% CI, 0.72-0.85)for the overweight and obese groups, respectively, compared with the normal weight group. According to themetabolic health status, the mean hazard ratio was 1.26 (95% CI, 1.14-1.40) for the metabolically unhealthygroup compared with the metabolically healthy group. The interaction between obesity status and metabolichealth status on the risk of cancer mortality was not statistically significant (p=0.31). Conclusions: We found thatthe risk of cancer mortality decreased according to the obesity status and increased according to the metabolichealth status. Given the rise in the rate of metabolic dysfunction, the mortality from cancer is also likely to rise.Treatment strategies targeting metabolic dysfunction may lead to reductions in the risk of death from cancer.