乳腺癌脑转移预后风险分析

目的:分析乳腺癌脑转移患者的预后危险因素,选择最佳治疗方案.方法:记录从2003年1月1日至2011年1月1日大连医科大学附属第二医院收治的共计64例明确诊断为乳腺癌脑转移患者的临床病例资料,通过Kaplan-Meier法行生存分析,筛选影响患者生存时间的单因素及Cox多因素回归分析影响患者脑转移的独立预后因素.结果:Luminal型、HER2过表达型和TNBC型患者中位总生存时间分别是52、37、21个月,中位脑转移发展时间分别是31、28、18个月,脑转移后中位生存时间分别是12、6、4个月,差异均有统计学意义.治疗方法上全脑放射治疗、内分泌治疗可明显延长脑转移患者中位生存时间(P=0.002和P=0.027).接受联合治疗的患者中位生存时间大于单一治疗者(P=0.045).HER2过表达的患者,脑转移前后接受赫塞汀治疗均可获益.多因素分析显示:组织学分级、首发脑转移均与预后负相关;KPS评分、放疗、内分泌治疗以及联合治疗和预后正相关.结论:组织学分级、KPS评分、首发脑转移、脑部放疗、内分泌治疗以及联合治疗均是影响乳腺癌脑转移的独立预后因素.建议选择以全脑放疗为主的联合治疗.HER2过表达的患者建议选择靶向治疗.     

Identification of subgroups with favorable prognosis in breast cancer.

The prognostic significance of 16 factors was investigated in a series of 311 women with unilateral, invasive breast carcinoma without distant metastases (M0) and treated with mastectomy. The series consisted of 93% of such cases diagnosed histologically in the city of Turku, Finland, from 1980 to 1984. Mitotic count, histological and nuclear grades, extent of tumor necrosis, axillary nodal status (pN), tumor size (pT), estrogen and progesterone receptor (PR) contents, and S-phase fraction were the most powerful single factors (p = 0.0001 or less). Axillary node negative cancers with no or only spotty tumor necrosis (92% of all pN0 cases) were associated with a 96% 5-year survival rate corrected for intercurrent causes. Among the axillary node positive cases the combination of high PR content (greater than 60 fmol/mg protein) and a low mitotic count could identify a subgroup with a 96% 5-year corrected survival rate (25% of all pN+ cases). It is concluded that both pN0 and pN+ breast cancer contain identifiable subgroups with greatly different prognosis.     

Clinicopathologic features and prognosis for Wilms' tumor patients with metastases at diagnosis

Comparisons were made between 236 Wilms' tumor patients with metastasis to the lungs and/or liver at initial diagnosis who were registered on the National Wilms' Tumor Study (NWTS) during 1969 to 1983, and 1755 patients who did not have overt metastases at diagnosis. Patients with evidence of regional spread of disease beyond the kidney, especially if to the renal vein or lymph nodes, were much more likely to have overt metastases present at diagnosis than those with apparently localized disease. The presence of metastases was also correlated with age at diagnosis, ranging from 1% among infants younger than 1 year of age to 24% for those aged 6 years or older. The percentage of tumor deaths for patients with metastases at diagnosis (Stage IV) and a primary tumor of favorable histology (FH) declined from 29% at 2 years postdiagnosis on the first therapeutic trial (NWTS-1) to 9% for the most recent one (NWTS-3), and is now comparable to that for patients without metastases but with nonresectable local invasion at diagnosis (Stage III). The local extent of disease also influenced the survival outcome for Stage IV/FH patients. Survival was poor for those with anaplastic or sarcomatous (unfavorable) histology, regardless of local staging or trial. There was no difference in survival according to metastatic site (liver +/- lung vs. lung only) if present prior to treatment. By contrast, patients who developed liver metastases during or after treatment had an especially poor chance for survival as compared with those who developed lung deposits at those times.     

Breast cancer diagnosis and prognosis in women augmented with silicone gel-filled implants

From 1981 through 1988, 35 patients with prior augmentation mammoplasty were treated for breast carcinoma. Thirty-two patients had unilateral infiltrating carcinomas; three had noninvasive (in situ) lesions. Thirty-four of 35 (97%) lesions were palpable. One noninvasive cancer was occult, discovered mammographically in the absence of physical findings. Prebiopsy mammography was performed in 29 patients with palpable masses and failed to reveal an abnormality in 12 patients, a false-negative rate of 41%. Fifteen patients were treated with mastectomy; the remaining 20 with breast preservation. Thirty-two patients underwent axillary node dissection; 15 (47%) patients had lymph node metastases. There have been seven (20%) recurrences: one local and six metastatic. Four (11%) patients have died. The median follow-up time is 48 months. Women, previously augmented with silicone gel-filled implants, who develop breast cancer are similar in terms of nodal positivity and prognosis, to nonaugmented breast cancer patients who present with palpable masses. When compared with nonaugmented women whose cancers were found with screening mammography, augmented patients with breast cancer present with a higher percentage of invasive lesion and involved axillary lymph nodes, resulting in a poorer prognosis.     

Breast lymphoma: favorable prognosis after treatment with standard combination chemotherapy

PURPOSE: This paper is to determine the clinicopathological features and outcome of patients with breast lymphoma seen at a single institution. PATIENTS AND METHODS: We have reviewed data on 14 patients with breast lymphoma seen at our institution from 1990 to 2003. RESULTS: All patients were female, with a median age of 47.6 years. Diffuse large B-cell lymphoma (DLBCL) was observed in 9 cases, while follicular, Burkitt's, small lymphocytic, MALT and T-cell lymphoma were observed in 1 case each. 5 patients (35.7%) had stage IE disease, 6 patients (42.9%) had stage IIE disease and 3 patients (21.4%) had stage IV disease. Standard CHOP with or without rituximab was given to all patients with aggressive breast lymphoma (n = 10), while 1 patient with Burkitt's lymphoma received a CHOP-based regimen. The 3-year actuarial survival estimate among all 11 patients with aggressive breast lymphoma was 73%. Among those with localized disease, the estimated 3-year survival was 90%. The actuarial 3-year overall survival (OS) estimate for the entire cohort of 14 patients was 76.9%. CONCLUSION: Our results indicate that breast lymphoma is not associated with an inferior outcome when treated with standard CHOP-based chemotherapy.     

Prognostically favorable abdominal breast cancer metastases with stomach involvement

BACKGROUND: Abdominal metastases with stomach involvement are rare in breast cancer. The median disease free interval from the time of breast cancer diagnosis to gastric metastasis is usually very long. Treatment is generally palliative, and expected survival time is less than 1 year. CASE REPORT: A 59-year-old woman with breast cancer developed diffuse abdominal metastases involving stomach, abdominal lymph nodes, and omentum 9 years after she underwent mastectomy and adjuvant chemotherapy. The histopathologic diagnosis found by stomach specimen examination was invasive lobular carcinoma, and the cells expressed high levels of estrogen and progesterone receptors. The abdominal metastases were treated with surgery, postoperative chemotherapy, and further hormonal therapy. This was successful, and the patient has been in remission for more than 3 years. CONCLUSION: Once the definitive diagnosis of breast cancer metastases to the abdomen including the stomach is established, treatment that targets systemic breast cancer must be initiated. Our patient's extended survival time suggests that surgical treatment could be considered for selected patients.     

初诊同侧锁骨上淋巴结转移乳腺癌综合治疗疗效

目的 探讨应用新辅助化疗+手术+放疗治疗初诊为锁骨上淋巴结转移乳腺癌患者疗效。方法 回顾分析1999-2013年肿瘤医院收治的65例女性乳腺癌患者的病历资料。全部患者均经初诊病理结果确诊为乳腺癌,且经病理或影像学检查证实为锁骨上淋巴结转移、无远处转移及其他第二原发癌,完整接受术前化疗+手术+术后放疗方案。采用Kaplan-Meier法计算总生存(OS)、无进展生存(PFS)及锁骨上淋巴结复发(SCFR)率,Logrank法检验差异。结果 中位随访时间66个月(6~137个月)。65例患者中5例患者治疗后锁骨上淋巴结复发。全组患者5年SCFR、OS、PFS率分别为9%、72%、50%。术前化疗后锁骨上淋巴结完全缓解是影响OS因素,是否完全缓解患者5年OS率分别为81%和54%(P=0.035)。初诊锁骨上淋巴结大小 (短径≤1 cm、>1 cm)为5年SCFR(分别为0%、21%,P=0.037)和5年OS(分别为86%、56%,P=0.001)的高危因素。结论 对于初诊为锁骨上淋巴结转移的乳腺癌患者,完整接受术前化疗+手术+术后放疗方案治疗后的OS率较高,锁骨上区放疗可获得良好的肿瘤局部控制。     

Prognostic factors and survival according to tumour subtype in women presenting with breast cancer brain metastases at initial diagnosis

BackgroundThe presence of brain metastases at the time of initial breast cancer diagnosis (BMIBCD) is uncommon. Hence, the prognostic assessment and management of these patients is very challenging. The aim of this study was to analyse the influence of tumour subtype compared with other prognostic factors in the survival of patients with BMIBCD.MethodsWe evaluated women with BMIBCD, reported to Surveillance, Epidemiology and End Results program from 2010 to 2013. Patients with other primary malignancy were excluded. Univariate and multivariate analyses were performed to determine the effects of each variable on overall survival (OS).ResultsWe included 740 patients. Median OS for the whole population was 10 months, and 20.7% of patients were alive at 36 months. Tumour subtype distribution was: 46.6% hormone receptor (HR)+/HER2−, 17% HR+/HER2+, 14.1% HR−/HER2+ and 22.3% triple-negative. Univariate analysis showed that the presence of liver metastases, lung metastases and triple-negative patients (median OS 6 months) had worse prognosis. The HR+/HER2+ subtype had the longest OS with a median of 22 months. In multivariate analysis, older age (hazard ratio 1.8), lobular histology (hazard ratio 2.08), triple-negative subtype (hazard ratio 2.25), liver metastases (hazard ratio 1.6) and unmarried patients (hazard ratio 1.39) had significantly shorter OS.ConclusionsAlthough the prognosis of patients with BMIBCD is generally poor, 20.7% were still alive 3 years after the diagnosis. There were substantial differences in OS according to tumour subtype. In addition to tumour subtype, other independent predictors of OS are age at diagnosis, marital status, histology and liver metastases.     

Long-term survival of patients with supraclavicular metastases at diagnosis of breast cancer.

BACKGROUND: Patients with supraclavicular metastases at diagnosis of breast cancer were classified between 1987 and 2002 as having stage M(1) breast cancer according to the tumor-node-metastasis (TNM) system. The 2003 edition of the TNM staging guidelines has classified such patients as having stage IIIC disease. To determine relative prognosis, we compared long-term survival in a population-based cohort of patients with isolated supraclavicular metastases (nodal-M(1)) to outcomes of patients with stage IIIB or M(1) (other) disease at presentation. MATERIALS AND METHODS: Among patients with breast cancer and known tumor stage referred to the British Columbia Cancer Agency from 1976 to 1985, 336 IIIB, 233 M(1), and 51 nodal-M(1) patients were identified. Actuarial overall and breast cancer-specific survival rates were determined to 20 years. RESULTS: Overall survival at 20 years was 13.2% for nodal-M(1) cases (95% confidence interval [CI], 5% to 26%), 9.4% for IIIB cases (95% CI, 6% to 14%), and 1.3% for M(1) (other) cases (95% CI, 0.4% to 3.5%; log-rank P <.0005). Overall survival was similar between nodal-M(1) and IIIB cases (P =.27). Breast cancer-specific survival at 20 years was 24.1% for nodal-M(1) cases (95% CI, 13% to 37%), 30.2% for IIIB cases (95% CI, 23% to 38%), and 3.9% for M(1) (other) cases (95% CI, 2% to 8%; log-rank P <.0005). Breast cancer-specific survival was significantly different for nodal-M(1) cases compared with either IIIB or M(1) (other) cases (P =.008 for both). CONCLUSION: Patients with supraclavicular metastases at diagnosis have significantly better outcomes than patients with M(1) (other) disease and overall survival similar to patients with IIIB disease. Reclassification as stage IIIC is appropriate for patients with breast cancer who present with supraclavicular nodal metastases alone.     

术后首发肺转移的三阴性乳腺癌临床病理特点及预后因素分析

目的:分析和探讨术后首发肺转移的三阴性乳腺癌患者的临床病理特点,以及可能影响生存的预后因素。方法:对71例术后首发肺转移三阴性乳腺癌患者的临床资料进行回顾性分析,通过COX分析影响总生存的预后因素。结果:71例术后首发肺转移三阴性乳腺癌患者中以浸润性导管癌为主（97.2%）,术后中位无病间期为14.4个月,发生肺转移后的1、2、3年生存率分别为81.7%、45.1%、16.7%。单因素分析显示,新辅助治疗、原发肿瘤大小、淋巴结转移状态、临床分期、一线化疗最佳疗效、肺转移灶数目与预后相关（P＜0.05）。多因素分析显示,是否行新辅助治疗和肺转移灶数目是术后首发肺转移患者的独立预后因素（P＜0.05）。结论:术后首发肺转移三阴性乳腺癌患者术后无病间期短,远期生存率较低,是否行新辅助治疗和肺转移灶数目是影响术后首发肺转移患者转移后总生存期的独立预后因素。     

有助于t(8;21)急性髓细胞白血病的诊断和预后判断的免疫表型特征

 t(8;21)核型急性髓细胞白血病（AML）是临床常见类型白血病,更多见于FAB分型M2型。由于21号染色体上的AML1基因和8号染色体上的ETO基因发生融合,而产生AML1-ETO融合蛋白。t(8;21) AML具有独特的免疫表型,这些独特的免疫表型特征不仅有助于t(8;21) AML的诊断,而且决定了t(8;21) AML的预后     

Distinctive microRNA signature is associated with the diagnosis and prognosis of acute leukemia

MicroRNAs (miRNAs) are of great importance in pathogenesis, diagnosis and prognosis of acute leukemia (AL). We studied five AL-related miRNAs to confirm the significance of these miRNAs in AL. Samples tested included acute myeloid leukemia (AML), 107 cases; acute lymphoblastic leukemia (ALL), 40 cases. Five AL-related miRNAs: miR-128, let-7b, miR-223, miR-181a and miR-155 expression were detected by qRT-PCR. Analysis showed that miRNA-128 expression was significantly higher in ALL (P?相似文献   

Breast cancer and spider telangiectasias at diagnosis and its relation to histopathology and prognosis: a population-based study

Angiogenesis is one of the hallmarks of breast cancer. The status of angiogenesis is important in therapy choice. Spider telangiectasias (telangiectasias) may reflect an increased ability to form vessels. Our first aim was to identify patient and tumor characteristics associated with the occurrence of telangiectasias at the time of breast cancer diagnosis. The second aim was to study the overall survival in relation to the occurrence of telangiectasias at the time of breast cancer diagnosis. A standardized questionnaire was used to interview 1682 consecutive breast cancer patients about risk factors between 1980 and 2009. Occurrence of telangiectasias at the time of breast cancer diagnosis on the upper thorax, head, and/or neck was recorded by one physician. In the cohort, 93 women (5.5%) had telangiectasias. Occurrence of telangiectasias was positively associated with weight, odds ratio (OR) 1.02 (95% confidence interval (CI) 1.00–1.05) per kg, ever-use of oral contraceptives OR 2.67(CI 1.55–4.63) and hormone replacement therapy OR 2.68(CI 1.63–4.39), and negatively associated with parity OR 0.45(CI 0.25–0.79). Telangiectasias were not present in patients with comedo breast cancer. Patients with occurrences of telangiectasias diagnosed before the age of 50 had a statistically non-significant worse overall survival, whereas the patients with occurrences of telangiectasias diagnosed at age 50 or after had a statistically significant better overall survival (P interaction = 0.016). The relationship between the occurrence of telangiectasias and the overall survival in the older patient-group was independent of ever-use of HRT. Hormonal risk factors for breast cancer were associated with the occurrence of spider telangiectasias. The occurrence of telangiectasias may reflect the angiogenic status of the tumor. We hypothesize that telangiectasias could be used as selection criteria for anti-angiogenic therapy in younger breast cancer patients. Therefore, patients with comedo breast cancers maybe a group that may benefit less from anti-angiogenic therapy.     

青年人肺癌临床特点及预后分析

目的探讨186例青年人肺癌的临床特点及预后分析。方法选择2001年2月至2011年2月间我院收治的186例青年肺癌患者作为观察组,选择同期住院的180例老年肺癌患者作为对照组。比较两组患者的半年、1年和2年生存期及两组临床特点的差别。结果观察组女性患者比例(47.8%)显著高于对照组(22.8%,P<0.05);观察组与对照组TNM分期Ⅳ期患者比例分别为71.5%和63.3%,差别有统计学意义(P<0.05);观察组腺癌比例(69.9%)显著高于对照组(51.1%,P<0.05);观察组半年、1年及2年生存率分别为71.0%、61.3%和44.6%,对照组为70.6%、60.6%和43.3%,差别无统计学意义(P>0.05)。结论青年肺癌病理分型以腺癌常见,女性及TNM分期Ⅳ期患者比例高于老年患者,年龄与患者生存率未见显著相关。     

乳腺癌骨髓转移的临床特征和预后分析

目的 探讨乳腺癌骨髓转移患者的临床特征、治疗和预后.方法 回顾性分析23例乳腺癌骨髓转移患者的临床资料,其中5例患者接受对症治疗,1例患者接受内分泌治疗,14例患者接受化疗序贯内分泌治疗,3例患者接受化疗.分析23例乳腺癌骨髓转移患者的临床特征,包括相关症状、血常规、肝肾功能、碱性磷酸酶(ALP)和乳酸脱氢酶(LDH),以及患者的治疗和生存情况等.结果 23例乳腺癌骨髓转移患者中,12例在内分泌维持治疗期出现血常规中一系或三系降低;7例因骨转移,常规行骨穿刺检查;2例化疗后血小板(PLT)持续降低;2例出现不规则发热.Luminal A型2例,Luminal B型15例,三阴性5例,HER2过表达型1例.23例乳腺癌患者诊断骨髓转移时均伴有其他部位转移:骨23例,区域或远端淋巴结转移8例,肝和肺各7例,脑、胸膜和皮下各2例,对侧乳腺、卵巢和脑膜各1例.15例患者不同程度的贫血,10例患者不同程度的PLT下降,21例患者不同程度的LDH升高.23例乳腺癌骨髓转移患者的中位总生存期(OS)为0.92年.接受化疗的患者中位OS为1.78年,明显长于未接受化疗患者的0.08年,差异有统计学意义(χ2=23.427,P<0.01).多因素分析显示未接受化疗是乳腺癌骨髓转移预后的独立影响因素(P<0.05).结论 乳腺癌骨髓转移多见于Luminal B型,化疗可以明显改善患者的生存情况.     

Flow-cytometric analysis of colorectal cancer with hepatic metastases and its relationship to metastatic characteristics and prognosis

Studying the DNA ploidy patterns of 52 primary tumors, diploid tumors accounted for 48.1% and aneuploid tumors for 51.9%. Out of 31 patients with liver metastases, 35.5% had diploid tumors and 64.5%, aneuploid tumors. Heterogeneity (difference in DNA ploidy pattern between the primary lesion and liver metastases) was found in 20% of the patients examined. In 28 of the patients, the liver metastases were unresectable, and their prognoses were such that the 1- and 2-year survival rates from the diploid tumors were 42.9 and 14.3%, respectively, while 1-year survivors from aneuploid tumors died within 2 years. In resected cases of hepatic metastases, the DNA ploidy pattern of the metastatic lesions did not correlate with the metastasis period, extent of spread or number of lesions. The recurrence rate of aneuploid tumors in the residual livers was 50%, which was slightly higher than the rate of 36.4% for diploid tumors. The prognoses in patients with diploid tumors were significantly better than those in patients with aneuploid tumors: 5-year survival was 71.1% in diploid tumor patients, compared with 21% in aneuploid tumor patients.     

Breast self examination and breast cancer stage at diagnosis

The relationship between breast self examination (BSE) and breast cancer stage at diagnosis was examined in 616 women aged 15-59 years. Differences in tumour characteristics between those not practising BSE and those practising but not taught were small and inconstant. However, women who had both practised and had been taught BSE had more favourable tumours than the non-practising group. The difference was most marked in terms of tumour size and the involvement of axillary nodes. The proportions of women in the non-BSE and taught-BSE groups with each characteristic were respectively: size less than or equal to 2 cm 33% and 45%, T1 clinical stage 27% and 42%, and N0 pathological stage 37% and 50%. This advantage to taught-BSE women persisted after adjustment for the identified confounding factors of age, social class and oral contraceptive use. The likely impact on breast cancer mortality is difficult to assess, although the potential benefit of the lead time gained must not be ignored when assessing the costs and benefits of BSE.