淋巴结微转移检测对胃癌病理分期的影响

目的 分析淋巴结微转移对胃癌pN分期的影响。方法 采用CK-20 mRNA逆转录聚合酶链反应（RT-PCR）技术对2003年12月至2004年4月间行手术切除的30例胃癌患者共计850枚淋巴结扩增检测微转移。结果 应用苏木精-伊红染色法淋巴结转移检出率为27．1％（233／850），而RT-PCR法淋巴结转移的检出率则为36．5％（310／850）；两种方法比较，P〈0．01，差异有统计学意义。77枚淋巴结检出有微转移（12．5％，77／617）。有7例（23．3％）患者的肿瘤TNM分期提高，分别为IB→Ⅱ、IB→ⅢA、Ⅱ→ⅢA、ⅢA→ⅢB、ⅢA→Ⅳ各1例，ⅢB→Ⅳ2例。结论 RT-PCR法可以显著提高淋巴结转移的检出率，有助于更准确地进行临床病理分期。     

c-met mRNA在乳腺癌术后腋窝引流液中表达的意义

目的探讨c-met mRNA在乳腺癌患者术后腋窝引流液中表达的意义。方法用RT—PCR法检测乳腺癌患者术后腋窝引流液中c-met mRNA的表达，分析其表达与肿瘤大小、腋窝淋巴结转移、雌激素受体（estrogen receptor，ER）、孕激素受体（progesterone receptor，PR）及生长因子受体2（c—erbB-2）的关系，以及5-FU加蒸馏水冲洗手术野对c—met mRNA表达的影响。结果①c—met mRNA能在乳腺癌术后腋窝引流液中表达，其阳性率高于病理检查腋窝淋巴结转移的阳性率（P〈0．05）。②腋窝淋巴结转移、肿瘤大小与c—met mRNA的表达有关。③肿瘤ER、PR及c—erbB-2的表达与c—met mRNA的表达无关。④5-FU加蒸馏水冲洗手术创面能明显降低c-met mRNA的表达。结论c—met mRNA是乳腺癌微转移研究的理想特异性标志物，与常规病理检查腋窝淋巴结相比，RT—PCR检测腋窝引流液中c—met mRNA的表达能更早检测出肿瘤细胞在胸壁淋巴管中的转移，并具有更高的准确性。     

淋巴结转移比率在预测淋巴结转移乳腺癌患者预后中的价值

目的探讨淋巴结转移比率(MLNR)在预测淋巴结转移乳腺癌患者预后中的应用价值。方法回顾性分析94例接受改良根治术治疗的淋巴结转移乳腺癌患者的临床资料,并对患者生存情况及影响预后的相关因素进行分析。结果 94例患者随访时间为12~75个月,中位随访时间为64个月,5年生存率为72.34%(68/94)。总MLNR为0.31(486/1 553)。单因素分析显示原发肿瘤大小、淋巴结转移数目、ER状态、放疗与否和MLNR影响淋巴结转移乳腺癌患者的预后(P<0.05),而患者年龄、绝经与否、PR状态、内分泌治疗与否和组织学类型与预后无关(P>0.05)。多因素分析发现MLNR(OR=2.565,95%CI=1.043~6.309,P=0.040)和肿瘤大小(OR=2.220,95%CI=1.045~4.716,P=0.038)是影响淋巴结转移乳腺癌患者预后的独立因素。结论 MLNR是影响淋巴结转移乳腺癌患者的独立预后因素,且其预测效果比淋巴结转移数目更为准确和客观。     

乳腺癌特异基因1在乳腺癌预后评估中的作用

目的探讨乳腺癌特异基因(BCSG1)mRNA在不同乳腺组织的表达及其与乳腺癌各项临床病理参数的相关性和乳腺癌的预后评估价值。方法随机抽取1999年9月至2002年12月收治的84例女性乳腺疾病患者,其中乳腺癌72例。采用逆转录．聚合酶链反应(RT-PCR)检测标本BCSG1基因表达,统计分析BCSG1基因表达与乳腺癌各项临床病理参数的相关性;跟踪随访72例乳腺癌患者,随访期4—43个月,作生存分析,确立影响乳腺癌预后的独立因素。结果经RT-PCR法检测,BCSG1基因在12例乳腺良性疾病无表达,而在乳腺癌中表达率为36．1％(26／72),其中Ⅲ、Ⅳ期乳腺癌中表达率高达79．2％(19／24)。BCSG1基因表达与乳腺癌肿瘤分期(P=0．000)和大小(P=0．007)正相关。ER(P=0．027)和：BCSG1(P=0．001)为乳腺癌的独立预后参考因素。结论：BCSG1是乳腺癌肿瘤标记物之一,其基因表达与乳腺癌的肿瘤分期以及大小相关;BCSG1可能是乳腺癌新的一种独立预后指标。     

雌激素受体亚型在人乳腺癌的表达及意义

目的　研究人乳腺癌组织以及癌旁正常乳腺组织中雌激素受体 (ER)亚型ERα和ERβ的表达 ,及其在乳腺癌发生发展中的作用。方法　应用逆转录聚合酶链反应方法检测 30例患者乳腺癌组织以及相应癌旁正常组织中ERα和ERβ的mRNA的表达情况。结果　ERα在人乳腺癌组织的表达明显高于癌旁正常组织 (t=7 399,P <0 0 1) ,ERβ在人乳腺癌组织的表达明显低于癌旁正常组织 (t=- 3 2 36 ,P <0 0 1) ,ERα/ERβ比值在人乳腺癌组织明显高于癌旁正常组织 (t =6 385 ,P <0 0 1) ;没有淋巴结转移的乳腺癌患者ERα/ERβ比值明显高于有淋巴结转移的乳腺癌患者 (t =2 6 0 2 ,P <0 0 5 ) ;在分期较晚的肿瘤ERα/ERβ比值明显低于分期较早的肿瘤 (t =3 75 4 ,P <0 0 5 )。结论　ERα在乳腺癌发生发展过程中与ERβ发挥不同的作用 ,并有可能成为乳腺癌基因治疗的新靶点。     

乳腺癌前哨淋巴结活检对腋窝淋巴结状态的预测价值研究

为探讨乳腺癌前哨淋巴结（SLN）组织学特征对腋窝淋巴结状态的预测价值，笔者应用专利蓝或锝99m标记的大分子右旋糖苷（99mTc-DX）为示踪剂成功显示20例乳腺癌患者的SLN。术中先进行前哨淋巴结活检（SLNB），再行乳腺癌改良根治术。并应用常规病理（HE）、免疫组化（IHC）和逆转录聚合酶链反应（RT-PCR）方法检测腋窝淋巴结转移。结果示，20例患者共找到腋窝淋巴结254个，其中SLN48个，NSLN206个。常规病理证实3例患者7个前哨淋巴结有癌转移，NSLN206个均无癌转移。免疫组化染色检测到7例患者11个SLN CK-19表达阳性，2个NSLN表达阳性。RT-PCR检测CK-19mRNA14例患者30个SLN和22个NSLN表达阳性。提示乳腺癌前哨淋巴结活检能准确预测患者腋窝淋巴结的状态。     

印迹基因SLC22A18在乳腺癌中的表达及其意义

目的 研究印迹基因SLC22A18在乳腺浸润性导管癌中mRNA和蛋白水平的表达.并分析SLC22A18表达与乳腺癌临床病理特征之间的相关性,从而探讨SLC22A18基因在乳腺癌发生发展中的作用.方法 应用实时荧光定量逆转录聚合酶链反应方法检测46例乳腺浸润性导管癌和对应癌旁乳腺组织,以及20例乳腺良性病变组织中SLC22A18 mRNA的表达,应用免疫组织化学方法检测46例乳腺浸润性导管癌组织、20例乳腺良性病变中SLC22A18蛋白表达,分析SLC22A18 mRNA和蛋白表达与乳腺癌临床病理特征间的关系.结果 SLC22A18在46例乳腺浸润性导管癌中mBNA表达量低于癌旁组织(Z=-4.900,P＜0.01);46例乳腺浸润性导管癌中SLC22A18 mRNA表达量低于乳腺良性病变(Z=-3.182,P＜0.01).40例乳腺浸润性导管癌中SLC22A18 mRNA表达量低于6例导管内癌灶性浸润(Z=-2.022,P＜0.05).SLC22A18蛋白在20例乳腺良性病变、46例乳腺浸润性导管癌中表达阳性率分别为95%、69.6%,两组阳性表达率差异有统计学意义(x2=5.135,P＜0.05).SLC22A18 mRNA和蛋白表达与患者年龄、肿瘤大小、组织学分级、TNM分期及淋巴结转移均无相关性(P＞0.05).结论 SLC22A18在乳腺浸润性导管癌中表达下调,SLC22A18可能参与了乳腺癌的发生,并有可能成为乳腺癌早期诊断的新分子标志物.     

腋窝淋巴结转移率对乳腺癌患者预后的影响

目的 探讨淋巴结转移率(LNR)对腋窝淋巴结阳性乳腺癌患者预后的影响。方法 回顾性分析2012-01—2014-12月河南省妇幼保健院收治的201例腋窝淋巴结阳性乳腺癌患者的临床和病理资料,并进行随访。比较不同LNR患者的预后。结果 肿瘤较大、HER2阳性、病理淋巴结分期(pN)高,以及LNR高者的5 a总生存率(OS)较低(P<0.05)。pN1、pN2、pN3患者5 a的OS分别为99.32%、97.50%、30.77%,差异有统计学意义(P<0.01);而LNR≤0.30患者的OS为99.42%,LNR>0.30者的OS为58.62%,差异有统计学意义(P<0.01)。结论 LNR和pN对预测乳腺癌患者预后有相似的价值,且避免了因为淋巴结清扫数量差异带来的偏差,可作为pN的补充指标。     

人乳腺癌组织中环氧化酶-2的表达

目的　探讨环氧化酶 2 (COX 2 )在乳腺癌组织、正常腺体及乳腺良性肿瘤中的表达 ,COX 2与雌激素受体 (ER)表达的关系及COX 2在乳腺癌发生发展中的意义。　方法　以 β actin基因为参照 ,应用逆转录聚合酶链反应 (RT PCR)技术检测 30例乳腺癌、相应癌旁正常腺体及 15例乳腺良性肿瘤中COX 2mRNA的表达。应用条带密度分析软件定量分析RT PCR产物电泳带密度。应用免疫组化方法测定 30例乳腺癌中ER表达情况。　结果　COX 2mRNA在 30例癌组织中有 2 8例表达水平明显增高 ,全距 0 0 5～ 0 91,中位数 0 5 3;正常腺体中无表达或表达很弱 ,全距为 0～0 0 9,中位数为 0 ;在部分良性肿瘤中表达明显增高 ,全距 0～ 0 6 8,中位数为 0 0 7。癌组织与正常腺体或良性肿瘤间COX 2的表达差异有显著性意义 (秩和检验 ,P <0 0 5 )。ER阳性组与ER阴性组的COX 2表达差异有非常显著性意义 (秩和检验 ,P <0 0 1)。　结论　乳腺癌组织中COX 2mRNA表达水平高于正常腺体或乳腺良性肿瘤 ,激素依赖型乳腺癌中COX 2表达高于非激素依赖型乳腺癌 ,其表达在乳腺癌的发生、发展中具有重要意义。     

An update on prognosis in breast cancer patients with extensive axillary disease

Abstract:  Lymph node (LN) status is the most important factor in predicting survival in breast cancer. Historically, patients with 10 or more positive LN have been thought to have a particularly poor prognosis, which has in the past been used to alter therapeutic recommendations. Studies conducted both prior to and after the use of anthracycline-based chemotherapy demonstrate poor survival. We hypothesized that the current survival rate is considerably higher. All patients with breast cancer treated at our institution between July 1991 and December 2005 with at least 10 positive axillary LN were identified. A multivariate Cox proportional hazards model was performed using age, number of positive nodes, and primary tumor characteristics. Of 55 patients identified, two were excluded for incomplete follow-up information. The median patient age was 53; median follow-up was 5-years. The overall 5-year survival rate was 71.9%. On univariate analysis estrogen receptor (ER) status (p = 0.0001), progesterone receptor status (p = 0.004), use of adjuvant chemotherapy (p = 0.01), T-stage (p = 0.03), and adjuvant hormonal therapy (p = 0.002) were statistically significant for survival. In the multivariate analysis, only ER status and the use of adjuvant chemotherapy remained significant for survival. ER negativity conferred a hazard ratio of 12.6 (95% confidence interval: 3.7–43.2) and the use of adjuvant chemotherapy had a hazard ratio of 0.14 (95% confidence interval: 0.04–0.46). In our study, patients with at least 10 positive axillary LN had a 5-year survival of 71.9% which may be due to the improvements in local and systemic therapy.     

乳腺癌行腋窝淋巴结清扫规范、争议与共识

乳腺癌的有效治疗方法很多,但外科手术是公认的乳腺癌治疗的基础。手术成功与否的最根本标志是肿瘤手术区域的局部控制。腋窝淋巴结受累的程度是预测乳腺癌术后复发和生存,指导进一步个体化治疗的最为重要指标。规范的腋窝淋巴结清扫和病理检查对乳腺癌的治疗至关重要。术前判断存在腋窝淋巴结转移的乳腺癌病人,腋窝淋巴结清扫是乳腺癌手术的规范和要求。术前临床诊断无腋窝淋巴结转移（cN0）的早期乳腺癌病人,如果前哨淋巴结活检阴性可不做进一步的腋窝淋巴结清扫也已成为共识。对于前哨淋巴结1或2枚阳性的乳腺癌病人可以不行腋窝淋巴结的清扫的观点仍然存在争论。     

Failure to harvest sentinel lymph nodes identified by preoperative lymphoscintigraphy in breast cancer patients

Abstract: Selective sentinel lymphadenectomy dissection has been demonstrated to have high predictive value for axillary staging in breast cancer patients. Preoperative lymphoscintigraphy can localize and facilitate the harvesting of sentinel lymph nodes (SNLs) with a high success rate. The failure rate of selective sentinel lymphodenectomy ranges between 2% and 8%. Details of the failures were seldom addressed. This study analyzes the causes of failure to harvest SLNs in spite of positive preoperative lymphoscintigraphy. From November 1997 through November 2000, 201 female patients with histologically confirmed and operable breast carcinoma underwent selective sentinel lymphadenectomy at the University of California, San Francisco (UCSF) Carol Franc Buck Breast Care Center. Among these patients, 183 (91%) received preoperative lymphoscintigraphy to identify axillary lymph nodes. The causes of failure to harvest the SLNs in this group of patients despite successful preoperative lymphoscintigraphy were analyzed. In our series, the failure rate of SLN identification was 7.0% (14/201). The failure rate for our first year was 11.1% (6/54), second year 9.1% (7/77), and third year 1.4% (1/70). The incidence of failure in spite of positive preoperative lymphoscintigraphy was 3.5% (6/170). The shine-through effect of the primary injection site and failure to visualize a blue lymph node were the main reasons for technical failure. Most of these cases occurred during our learning curve of the procedure. The possibility of failure to get the SLN should be explained to patients before surgery. Axillary lymph node dissection (ALND) should be done if selective SLN dissection is not successful.      

Increased use of adjuvant regional radiotherapy for node-positive breast cancer in British Columbia

This study was to determine if the use of regional radiotherapy (RT) changed in British Columbia after publication of new randomized trial data in 1997. Women with pathologic T1-3N1, nonmetastatic breast cancer treated with a mastectomy or breast-conserving surgery (BCS) were included. The use of regional RT was compared in two cohorts: cohort 1, July 1, 1995-June 30, 1997 (n = 834); and cohort 2, July 1, 1998-June 30, 2000 (n = 1072). All p-values were two-sided. Adjuvant systemic therapy was given to 96% and 95% of women in cohorts 1 and 2, respectively. Forty-five percent of cohort 1 and 48% of cohort 2 had BCS. Regional RT was received by 44% of cohort 1 and 66% of cohort 2 (p < 0.001). Eighty-eight percent and 90% of women with four or more positive nodes in cohorts 1 and 2 received regional RT, respectively. For women in cohorts 1 and 2 with one to three positive nodes, regional RT use increased from 32% to 54% after mastectomy, and from 23% to 59% after BCS, respectively (p < 0.001 for both). Publication of randomized trials and a coordinated guideline implementation process in British Columbia was associated with a significant increase in the use of regional RT in women with one to three positive nodes.     

临床T1、T2 N0 M0乳腺癌腋窝淋巴结转移状况研究的意义

目的 探讨临床T1、T2、 N0、M0.乳腺癌腋窝淋巴结转移状况及临床意义.方法 结合原发肿瘤位置、年龄、病理等,分析了276例临床T1、T2 N0M0乳腺癌患者腋窝淋巴结转移情况及意义.结果 临床T1 N0M0.腋淋巴结转移率低于T2 N0M0乳腺癌患者(P=0.027),乳腺中央区与外下象限乳腺癌发生腋淋巴结转移明显高于其他部位肿瘤(P=0.004);乳腺外侧象限肿瘤腋窝下组淋巴结转移率高于其他部位肿瘤组(P=0.000);乳头中央区和内侧象限乳腺癌腋上组淋巴结转移高于乳腺外侧象限肿瘤(P=0.000).非特殊型癌发生淋巴结转移明显高于早期癌和其他类型(P-0.001).9例单纯癌6例发生2组以上腋淋巴结转移.90例发生腋淋巴结转移的病例中,>50岁者62例(68.9%)发生腋淋巴结转移,≤50岁者28例(31.1%)发生腋淋巴结转移(P=0·000).发现"跳跃式"转移病例2例(0.7%),均为临床T2 N0M0患者,肿瘤位于乳头中央区1例,外下象限者1例.其中浸润型导管癌1例,单纯癌1例.结论 研究临床T1、T2 N0M0乳腺癌腋窝转移淋巴结分布情况对开展SLNB及制定合理的治疗方案有一定指导价值.     

1～2枚前哨淋巴结阳性乳腺癌患者中非前哨淋巴结转移的影响因素分析

目的分析1~2枚前哨淋巴结(SLN)阳性乳腺癌患者的临床病理因素与非前哨淋巴结(nSLN)转移的关系。方法回顾性分析2012年1月至2015年12月期间广州医科大学附属第二医院乳腺外科1~2枚SLN阳性且同时行腋窝淋巴结清扫的118例早期浸润性乳腺癌患者临床病理资料,分别应用x~2检验及Logistic回归进行单因素及多因素分析。结果 nSLN未转移(nSLN-)组患者64例,nSLN转移(nSLN+)组患者54例。单因素分析显示nSLN转移与肿瘤大小、脉管癌栓、SLN转移比例有关(P=0.001,P=0.030,P=0.002),但与年龄、绝经状态、病理类型、肿瘤位置、核分级、SLN转移数目、ER、PR、C-erBb-2、Ki67无关(均P0.05)。多因素分析显示肿瘤大小、脉管癌栓、SLN转移比例均为nSLN转移的独立影响因素(OR分别为3.159,2.425,2.258,均P0.05)。结论肿瘤大小≥2 cm、脉管癌栓、SLN转移比例≥2、3均为1~2枚SLN阳性乳腺癌患者nSLN转移的独立不良影响因素。     

Quantitative lymph node evaluation as an independent marker of long-term prognosis in stage III rectal cancer

Background: The prognostic significance of lymph node evaluation is not well described for rectal cancer due to a lack of reproducibility in nodal counts and variable use of adjuvant and neoadjuvant therapy. The aim of this study was to examine the role of quantitative lymph node evaluation as an independent marker of prognosis in stage III rectal cancer. Methods: New Zealand Cancer Registry data were retrieved for consecutive patients with rectal cancer from January 1995 to July 2003. Cases with node‐negative tumours, distant metastases, death within 30 days of surgery and incomplete data fields were excluded. Three nodal stratification systems were investigated – Total Number of Nodes examined (TNN), Absolute number of Positive Nodes (APN) and Lymph Node Ratio (LNR). Univariate and Cox regression analyses were performed with 5‐year all‐cause mortality as the primary end point. Results: The study identified 895 stage III rectal cancer cases. The mean APN and LNR were significantly higher in patients who died within 5 years. An increasing APN or LNR was associated with a significant increase in 5‐year mortality. The APN and LNR were also powerful predictors of 5‐year mortality after correcting for other factors using Cox regression. The TNN was of no prognostic significance. Conclusions: Both the APN and LNR are highly effective at independently predicting and stratifying 5‐year mortality in stage III rectal cancer. The significant predictive value of the LNR is likely to be a reflection of the APN rather than one functioning in autonomy, given that the TNN was of no prognostic significance.     

乳腺癌癌周淋巴管密度对腋淋巴结转移状态的影响

目的探讨乳腺癌患者癌周组织中淋巴管密度（1ymphaticvesseldensity,LVD）与同侧腋淋巴结转移数量及转移水平的关系。方法对接受乳腺癌改良根治术的浸润性乳腺癌95例,采用D2—40单克隆抗体免疫组织化学法检测乳腺癌癌灶周边组织微淋巴管,计数LVD,分析其与同侧乳腺癌腋淋巴结转移的关系。结果95例乳腺癌癌周组织LVD与腋淋巴结转移数量呈正相关（r=0．856）,与腋淋巴结转移水平亦有显著相关性（r=0．664）。结论乳腺癌组织中癌周淋巴管密度与乳腺癌的淋巴结转移数目及淋巴结转移水平密切相关。     

Role of expression of cell cycle inhibitor p27 and MIB-1 in predicting lymph node metastasis in male breast carcinoma

Tumor expression of the proliferation marker (MIB-1) and the cell cycle-related protein (p27) may predict the biologic behavior of various human tumors. The purpose of this study was to evaluate the role of p27 and MIB-1 expression in predicting lymph node metastasis in male breast carcinomas (MBCs). We studied 67 patients with invasive MBC who had undergone modified radical mastectomy. Pathologic lymph node status was correlated with the p27 protein and the MIB-1 proliferation index. These factors were studied immunohistologically by standard methods. Men in this study ranged from 36 to 92 years of age (mean, 63 years); 43 (64%) were T1 lesions, and 24 (36%) were T2 lesions. Twenty-nine patients (43%) had positive nodes. p27 was expressed in 43 tumors (64%) and MIB-1 in 13 tumors (19.4%). Tumors with positive p27 showed positive lymph nodes in 10 cases (23%). In contrast, p27-negative tumors had positive lymph nodes in 18 cases (75%). Tumors positive for MIB-1 show positive lymph nodes in 11 cases (85%). However, when MIB-1 was negative, only 16 patients (30%) had positive lymph nodes. Multivariate logistic regression analysis confirmed the utility of MIB-1 overexpression in predicting lymph node metastasis ( p < 0.0006). Also, decreased p27 protein expression strongly correlates with lymph node metastasis ( p < or = 0.0001). Furthermore, when p27 was negative and MIB-1 was positive, 100% of the patients had positive lymph nodes. In contrast, when p27 was positive and MIB-1 was negative, only 12% of patients had positive lymph nodes. The reduced expression of the p27 protein and the overexpression of the MIB-1 proliferation index in this study show a significant correlation in predicting lymph nodes metastasis in MBCs.     

乙酰脱氢酶1在乳腺癌前哨淋巴结中的表达及临床意义

目的 探讨乙醛脱氢酶1(ALDH1)在乳腺癌前哨淋巴结中的表达及其临床意义。方法收集2021年05月至2022年05月在茂名市人民医院行乳腺癌手术患者的临床资料,釆用免疫组织化学染色法检测乳腺癌转移的前哨淋巴结（n=26）和未转移的前哨淋巴结（n=29）中ALDH1的表达情况,分析前哨淋巴结中ALDH1的表达情况与原发灶临床病理特征及预后指标之间的关系。结果 乳腺癌转移前哨淋巴结和未转移前哨淋巴结中ALDH1阳性表达率分别为76.9%(20/26)、17.2%(5/29),转移前哨淋巴结中ALDH1阳性表达率显著高于未转移前哨淋巴结（P<0.01）。将乳腺癌前哨淋巴结中ALDH1的表达情况与原发灶的组织学分级、临床分期、肿瘤直径、雌激素受体、孕激素受体、人类表皮生长因子受体2、Ki-67的表达情况及分子分型进行差异性分析,显示均无统计学意义（P>0.05）,但与患者的年龄有关（P<0.05）;将ALDH1的表达情况与腋窝淋巴结转移情况以及与术后病理明确性质的前哨淋巴结的准确性进行差异性分析,显示具有统计学意义（P<0.01）。结论 乳腺癌前哨淋巴结中ALDH1表...