三阴型乳腺癌的临床病理特征及预后分析

目的 探究三阴型乳腺癌的临床病理特征及预后.方法 按照免疫组化将2011年3月～2015年7月接收的304例乳腺癌患者给予乳腺癌根治术,对照组(n =262)为非三阴型乳腺癌,研究组(n=42)为三阴型乳腺癌.比较两组患者的病理特征、无瘤生存和复发转移等.结果 研究组发病年龄低于对照组,乳腺癌阳性家族史、乳腺癌分级分期...     

脑转移癌近距离放射治疗配合外照射治疗的临床分析

目的 探讨立体定向近距离放射治疗配合外照射治疗脑转移癌的方法及疗效。方法 自1994年4月～1999年4月，采用立体定向后装近距离放射治疗配合外照射治疗脑转移癌19例(均为肺癌恼转移，孤立或两个病灶)。近距离治疗剂量为25～35Gy／10～12次／7～10d。全脑外放疗剂量为30～40Gy／3～4周。结果 总缓解率为84．2％(16／19)。一年局部控制率为60．0％(6／10)。中位生存11个月。随诊期内未出现严重并发症。结论 近距离放射治疗配合外放疗能够改善脑转移癌病人的生存质量及生存期。不会增加严重放射性并发症的发生率。     

脑转移癌近距离放射治疗配合外照射治疗的临床分析

目的 探讨立体定向近距离放射治疗配合外照射治疗脑转移癌的方法及疗效。方法 自1994年4月～1999年4月，采用立体定向后装近距离放射治疗配合外照射治疗脑转移癌19例(均为肺癌脑转移、孤立或两个病灶)。近距离治疗剂量为25～35Gy／10～12次／7～10d。全脑外射疗剂量为30～40Gy／3～4周。结果 总缓解率CR PR为84．2％(16／19)。一年局部控制率为60．0％(6／10)。中位生存11个月。随诊期内未出现严重并发症。结论 近距离放射治疗配合外放疗能够改善脑转移癌病人的生存质量及生存期，不会增加严重放射性并发症的发生率。     

不同分子分型乳腺癌的超声造影特征临床分析

目的 探讨不同分子分型乳腺癌超声造影检查的特点表现。方法 选取100例乳腺癌患者,依据Ki-67、人表皮生长因子-2(HER-2)、孕激素受体(PR)以及雌激素受体(ER)表达情况,将乳腺癌划分成HER-2过表达型、三阴型、Luminal A型、Luminal B型,其中Luminal A型以及Luminal B型统称为管腔上皮型。观察不同分子分型患者超声造影特点和时间-强度曲线定量参数。分析病理检查结果情况、不同分子分型患者超声造影特点;对比不同分子分型患者超声造影特点。结果 病理检查结果提示7例为浸润性小叶癌、2例为导管内癌、91例为浸润性导管癌。19例为HER-2过表达型、21例为三阴型、18例为Luminal A型、42例为Luminal B型。超声造影检查结果提示,在HER-2过表达型方面,四周存在穿入血流、增强后范围扩大、内部有灌注缺损、增强后边界不清晰、高增强占比分别是68.42%、94.74%、73.68%、84.21%、89.47%;在三阴型方面,增强后范围扩大、增强后边界清晰、高增强占比依次是95.24%、95.24%、95.24%;在Luminal A型方面,四周...     

乳腺癌脑(脊)膜转移的MRI诊断分析

目的 分析并总结乳腺癌脑(脊)膜转移的MRI特征,提高对乳腺癌脑(脊)膜转移的认识和诊断准确率.方法 对27例经临床或病理证实的乳腺癌脑(脊)膜转移患者进行头或(和)脊椎MRI平扫及增强扫描,将脑(脊)膜转移分为3型,Ⅰ型为硬膜蛛网膜型,Ⅱ型为软膜蛛网膜型,Ⅲ型为混合型脑膜转移,对各型表现进行分析.结果 在27例患者中,Ⅰ型12例,Ⅱ型11例,Ⅲ型4例;伴有颅骨和(或)头皮转移3例;27例中有15例平扫可见病灶(55.6％),其中软脑脊膜型转移的显示率最低(36.4％),MRI增强扫描能显示所有异常强化的脑(脊)膜转移灶(100％).结论 MRI已成为乳腺癌脑(脊)膜转移检出的一种重要诊断方法,尤其是增强扫描在该病的诊断中起着重要的作用.     

三阴型乳腺癌的超声和临床病理特征

目的 通过对三阴型乳腺癌(TNBC)超声和临床病理特征进行评估,并与非TNBC(non-TNBC)进行比较,总结分析TNBC的超声和临床病理特点,以期为TNBC的临床诊断提供超声依据.方法 收集解放军总医院第五医学中心南院区于2019年1月至2020年9月经超声引导下穿刺活检病理证实的316例乳腺癌患者(其中三阴型乳腺...     

青年女性不同分子亚型乳腺癌MR I特征表现

目的 探讨40岁以下青年女性不同分子亚型乳腺癌的MRI特征.方法 回顾分析经病理证实的102例青年女性(年龄≤40岁)乳腺癌患者的MRI表现.患者均行乳腺动态对比增强磁共振成像(DCE-MRI),其中65例并行扩散加权成像(DWI),根据2013年第5版乳腺影像报告和数据系统(BI-RADS)对MRI特征进行描述,分析...     

脑转移癌放射治疗后致迟发型放射性脑病1例

<正>1临床资料患者男性,61岁,因"肺癌术后5年,渐进性智能减退2年余",于2014年2月13日入兰州军区兰州总医院。2009年1月,因"肺肿物"行左肺上叶切除术,术后规律化疗4个周期。2010年11月,患者出现头痛、恶心、呕吐,头颅MRI提示右侧顶枕叶脑转移癌(图1a)。遂于2010年11月18日至12月8日期间,先后15次行全脑放射治疗(单次放射治疗剂量250 Gy),同步进行吉非替尼靶向治疗,并给予甘露醇脱水。放射治疗后,头痛逐渐消失,动态观察MRI见右侧顶枕叶转移癌体积缩小,周围水肿减轻,但双侧侧脑室     

基于超声和临床特征决策树模型预测乳腺癌分子亚型

目的：建立不同亚型浸润性乳腺癌的超声决策树预测模型,并分析模型的临床价值。方法：回顾并分析420例经病理学检查证实的浸润性乳腺癌患者,其中管腔A(Luminal A,LA)型患者137例、管腔B(Luminal B,LB)型患者157例、人表皮生长因子受体2过表达（human epidermal growth factor receptor 2 over-expression,HER2+）型患者61例和三阴性乳腺癌（triple-negative breast cancer,TNBC）型患者65例。使用方差分析和Fisher精确概率检验统计分析患者的超声特征和临床特征,将差异有统计学意义的特征纳入决策树模型以预测乳腺癌分子亚型。采用受试者工作特征（receiver operating characteristic,ROC）曲线的曲线下面积（areaundercurve,AUC）评价模型的预测效果。结果：对于4种乳腺癌分子亚型,找到7种差异有统计学意义（P<0.05）的临床和超声特征：临床分期、肿瘤最大径、肿瘤内部回声变化、肿瘤后方回声变化、钙化形态、钙化部位、有无转移性淋巴结。L...     

Radiographic evaluation of therapeutic response in bony metastases of breast cancer

Response to chemotherapy was evaluated in 50 previously untreated patients with bony metastases of breast cancer. Lytic metastases respond in a definite sequence: sclerotic rim, filling-in, uniformly blastic, uniform fading. Increase in size of lytic areas or destruction in previously responding areas signals worsening. Mixed metastases are considered as beginning with a sclerotic rim. Response is otherwise similar. Particular attention is paid to the lytic areas. Blastic metastases are considered as beginning at the uniformly blastic stage. Progression is marked by a volumetric increase in blastic change or destruction in blastic regions. Change occurs slowly. Review of multiple studies is often necessary to reach the correct conclusion and clinical history is necessary.     

三阴乳腺癌受体表型转化情况对乳腺癌患者临床预后的影响

目的 评价乳腺癌患者雌激素受体(ER)、孕激素受体(PR)和人表皮生长因子受体2(HER-2)的表达及复发前后受体表型的转化情况对解救治疗疗效及临床预后的影响.方法 纳入解放军307医院1994年9月-2011年11月收治乳腺癌患者211例,根据ER、PR和HER-2受体表型转化情况分为3组.A组(n=20):原发肿瘤灶为三阴乳腺癌(ER、PR和HER-2表达均为阴性,TNBC),复发转移后转化为非TNBC;B组(n=73):原发肿瘤灶为非TNBC,复发转移后转化为TNBC;C组(n=118):原发肿瘤及复发转移灶均为TNBC.对患者的一般资料进行总结,分析复发转移情况、解救治疗疗效及临床预后.结果 全组211例患者复发转移时中位年龄52(22 ～ 78)岁,以单发转移为主,首发转移最常见的部位依次为淋巴结、骨和皮肤.A、B、C三组患者的中位无病生存期分别为34.0、25.0、20.0个月.B、C组一、二、三线解救治疗的临床有效率显著高于A组(P=0.030、0.003、0.001),但A组在解救内分泌治疗中的临床获益率显著高于B、C组.211例患者的中位随访时间为68(20～127)个月.A、B、C三组复发后中位生存期分别为63.1、33.7、25.8个月(P=0.000),中位总生存期分别为156.7、67.8、47.4个月(P=0.000).结论 乳腺癌患者复发前后ER、PR和HER-2受体表型转化可影响临床预后,在制定解救治疗方案时应对ER、PR和HER-2受体的表达情况进行检测.     

难治性脑转移瘤的立体定向放射外科治疗策略及进展

脑转移瘤是发病率高、临床治疗难度大且预后较差的颅内常见恶性疾病,特别是其中的难治性脑转移瘤（大体积、多发、复发的转移瘤）常规治疗难以达到理想预后。立体定向放射外科（SRS）与常规治疗方式相比具有精准度高、单次照射剂量大、对周围组织损伤低等优势,已逐渐成为脑转移瘤患者治疗的首选方案。SRS治疗难治性脑转移瘤具有较好的效果,可有效抑制肿瘤增殖,提高患者的生活质量。SRS联合手术、化疗、分子靶向治疗及免疫治疗等方案可以提高难治性脑转移瘤患者的肿瘤局部控制率,但是否改善患者的预后尚存在争议,且联合治疗的不良反应也应引起关注。因此,本文就SRS治疗难治性脑转移瘤的治疗效果及联合治疗的策略及进展等方面进行文献报道综述。     

肺癌脑转移44例治疗分析

目的比较不同治疗方法对肺癌脑转移的疗效。方法对44例肺癌脑转移患者资料进行回顾性分析。根据治疗方法的不同分为单纯放疗组23例(全脑放疗10例,立体定向放疗13例),全脑放疗或立体定向放疗联合全身化疗(放疗+化疗)组17例,对症治疗组4例,比较其生存期和生存率。结果 单纯放疗组的中位生存期为8.3个月,1年生存率为17.4%;放疗+化疗组中位生存期为13.2个月,1年生存率为52.9%;对症治疗组的中位生存期为1.7个月,1年生存率为0%。放疗+化疗组比单纯放疗及对症治疗组具有更好的疗效(P<0.05)。结论放疗联合化疗是肺癌脑转移患者比较有效的治疗方法,可延长生存期。     

Radiation therapy for brain metastases from breast cancer by histological classification

One hundred thirteen patients with metastatic brain tumor from breast cancer who were treated with external irradiation between 1989 and 1997 at Cancer Institute Hospital were studied. The patients were all histopathologically proven to have invasive ductal carcinoma (scirrhous type 54 cases, papillotubular type 18, solid-tubular type 41). The patients were evaluated for efficacy and histopathological subtypes. The time interval between the diagnosis of breast cancer and brain metastases was 53.6 months for the scirrhous type, 75.0 months for the papillotubular type, and 35.5 months for the solid-tubular type. The time interval between the diagnosis of initial distant metastases and brain metastases was 14.3 months for the scirrhous type, 22.5 months for the papillotubular type, and 12.5 months for the solid-tubular type. Efficacy rates (CR + PR) for external irradiation of the brain metastases were 40.0% for the scirrhous type, 66.7% for the papillotubular type, and 36.6% for the solid-tubular type. The papillotubular type had a favorable efficacy rate compared with the other two types. Median survival time (MST) from the start of treatment for brain metastases and one-year survival rate were 5 months and 11.1% for the scirrhous type, 7 months and 41.5% for the papillotubular type, and 4 months and 28.3% for the solid-tubular type, respectively. No statistically significant difference between survival rates was observed among the histopathological types. Univariate analysis showed performance status, number of metastatic tumors, and existence of extracranial metastases without bony metastasis to be significantly related to prognosis. Multivariate analysis showed only extracranial metastases without bony metastases to be related to prognosis.     

Repetitive transarterial chemoembolization (TACE) of liver metastases from gastric cancer: Local control and survival results

Objective

To evaluate the local tumor control and survival data after transarterial chemoembolization with different drug combinations in the palliative treatment of patients with liver metastases of gastric cancer.

Materials and methods

The study was retrospectively performed. 56 patients (mean age, 52.4) with unresectable liver metastases of gastric cancer who did not respond to systemic chemotherapy were repeatedly treated with TACE in 4-week intervals. In total, 310 chemoembolization procedures were performed (mean, 5.5 sessions per patient). The local chemotherapy protocol consisted of mitomycin alone (30.4%), mitomycin and gemcitabine (33.9%), or mitomycin, gemcitabine and cisplatin (35.7%). Embolization was performed with lipiodol and starch microspheres. Local tumor response was evaluated by MRI according to RECIST. Survival data from first chemoembolization were calculated according to the Kaplan–Meier method.

Results

The local tumor control was: complete response in 1.8% (n = 1), partial response in 1.8% (n = 1), stable disease in 51.8% (n = 29) and progressive disease in 44.6% (n = 25) of patients. The 1-, 2-, and 3-year survival rate from the start of chemoembolization were 58%, 38%, and 23% respectively. The median and mean survival times were 13 and 27.1 months. A Statistically significant difference between patients treated with different chemotherapy protocols was noted (ρ = 0.045) with the best survival time in the mitomycin, gemcitabine and cisplatin group.

Conclusion

Transarterial chemoembolization is a minimally invasive therapy option for palliative treatment of liver metastases in patients with gastric cancer.     

三阴性乳腺癌X线征象及临床病理分析

目的：探讨三阴性乳腺癌(TNBC)的 X 线表现,提高对其诊断水平。方法收集经病理学及免疫组化证实的 TNBC 105例,分析 X 线表现及临床病理。结果(1)TNBC 中主要病理类型为浸润性导管癌(64例,61.0%),其次为髓样癌(24例,22.9%)。(2)本组 TNBC 的 X 线征象主要表现为肿物(82例,78.1%),其中边缘清晰者占46.3%;肿物合并钙化者占24.4%。(3)本组 TNBC患者中出现钙化者少见,分布主要表现为区域性或簇状,而形态以恶性及可疑恶性钙化为主。(4)本组 TNBC 中浸润性导管癌与髓样癌的 X 线征象,在肿瘤的形态、边缘差异有统计学意义(P <0.05)。结论(1)TNBC X 线表现为边缘清晰的类圆形肿物。(2)髓样癌在 TNBC 中所占比例较大,其 X 线表现为边缘清晰肿物。(3)TNBC 较少发生钙化,钙化形态主要表现为可疑恶性及恶性。     

A simple survival score for patients with brain metastases from breast cancer

Background and purpose

Personalized cancer treatment considers the patient’s survival prognosis. Therefore, it is important to be able to estimate the patient’s survival time, particularly in a palliative situation such as brain metastasis. This study aimed to create and validate a survival score for patients with brain metastasis from breast cancer, which is the second most common primary tumor in these patients.

Patients and methods

Data of 230 patients treated with whole-brain radiotherapy (WBRT) alone for brain metastasis from breast cancer were retrospectively analyzed. Patients were assigned to a test (n?=?115) or a validation group (n?=?115). According to the results of the multivariate analysis of the test group, Karnofsky Performance Score and extracranial metastases were included in the scoring system. The score for each factor was obtained from the 6-month survival rate (in %) divided by 10. Total scores represented the sum of these scores and were 4, 7, 9, or 12 points. Three prognostic groups were formed.

Results

The 6-month survival rates in the test group were 10?% for 4–7 points, 55?% for 9 points, and 78?% for 15 points (p?<?0.001). In the validation group the corresponding 6-month survival rates were 11, 54, and 75?%, respectively (p?<?0.001). The comparisons between the prognostic groups of the test and the validation group did not show significant differences.

Conclusion

This simple survival score appears valid and reproducible. It can be used to estimate the survival time of patients with brain metastasis from breast cancer receiving WBRT alone.     

Strontium-89 for palliation of pain from bone metastases in patients with prostate and breast cancer

We have used strontium-89 chloride (⁸⁹Sr) for the palliative treatment of metastatic bone pain. Seventy-six patients (50 males with prostate carcinoma and 26 females with breast cancer) were treated with 148 MBq of ⁸⁹Sr. Sixteen patients were retreated, receiving two or three doses; the total number of injected doses was consequently 95. The Karnofsky performance status was assessed and pain and analgesia were scored on scales of 9 and 5 points, respectively. The efficacy of ⁸⁹Sr was evaluated at 3 months of treament. Three levels of response were considered: good – when there was an increase in the Karnofsky status and a decrease in the pain score (equal to or higher than 4) or analgesic score (equal to or higher than 1); partial – when there was an increase in the Karnofsky status and a decrease in the pain score (2 or 3 points) without significant changes in the analgesic score; no response – if no variation or deterioration in these parameters was observed. In prostate cancer patients, the response was good in 64% of cases and partial in 25%, and there was no response in the remaining 11%. In breast cancer patients, the response was good in 62% of cases and partial in 31%, and there was no response in the remaining 8%. Duration of the response ranged from 3 to 12 months (mean 6 months). In the patients who were retreated the effectiveness was as good as after the first dose of ⁸⁹Sr. A decrease in the initial leucocyte and platelet counts was observed after the 1st month of treatment, with a gradual partial to complete recovery within 6 months. It is concluded that ⁸⁹Sr is an effective agent in palliative therapy for metastatic bone pain in patients with prostate or breast carcinoma. If required, retreatment can be administered safely and with the same efficacy as is achieved by the first dose. Received 13 March and in revised form 6 June 1997