乳腺癌肿瘤标志物的研究和临床应用进展

乳腺癌是危及女性生命的恶性肿瘤之一 ,长期以来人们对乳腺癌的肿瘤标志物的研究非常重视 ,尤其近年来对癌基因、抑癌基因、各种异种蛋白及肿瘤抗原的深入研究 ,应用乳腺癌肿瘤标志物发现早期病变、预测肿瘤的预后、检测乳腺癌的转移复发、针对某些肿瘤标志物的药物开发和应用都取得了很大的进展。1　血清学肿瘤标志物1.1　ＣＡ15 3血清学肿瘤标志物ＣＡ15 3同ＣＥＡ一样 ,对乳腺癌诊断敏感性低 ,但是可作为监测乳腺癌手术后有无复发及治疗效果的一种方法 ,尤其对缺乏测量手段的转移病灶 (如骨转移 ) ,治疗后ＣＡ15 3值降低超过 2 5 %者…     

CA153、CA125、CEA联合检测在乳腺癌诊断中的应用价值

目的探讨CA153、CA125、CEA三项肿瘤标志物联合检测对乳腺癌早期诊断和鉴别诊断的应用价值。方法采用电化学发光免疫分析技术检测68例乳腺癌患者、38例乳腺良性病变者、30例健康人的血清中CA153、CA125、CEA含量,并分析阳性检出率和敏感性、特异性。结果乳腺癌患者血清CA153、CA125、CEA的含量高于健康人和良性病变者（均P〈0.01）。三项指标联合检测的敏感性和特异性为70.6%和84.9%,乳腺癌组与健康人及乳腺良性肿块组有显著性差异（P〈0.01）。结论 CA153、CA125、CEA三项肿瘤标志物联合检测能提高乳腺癌早期诊断的敏感性且有较好的特异性,具有一定的临床应用价值。     

多种肿瘤标志物检测在胆管癌诊断中的临床意义

目的 回顾性分析多种肿瘤标志物检测在胆管癌早期诊断中的意义.方法 选择近3年在西南医院全军肝胆外科研究所住院手术并经病理证实为胆管癌的患者165例,胆结石癌变患者25例.选择同期手术的胆结石患者36例和胆管狭窄患者46例作为对照组.回顾性分析其多种肿瘤标志物癌胚抗原(CEA)、CA125、CA153、CA242、CA19-9、甲胎蛋白(AFP)和铁蛋白(Ferritin)在各组中的升高情况及其与影像学检查结果的关系.结果 CA19-9在胆管癌的诊断中具有很高的敏感度和特异度(83.6％和96.3％),而CA242尽管在胆管癌中的敏感度和特异度不高,但其在胆结石癌变组中也有很高的敏感度(88％).多种肿瘤标志物联合使用能明显提高胆管癌的诊断敏感度和特异度,尤其是对胆结石癌变组的检测.与影像学检查相比,多种肿瘤标志物对胆结石早期癌变的敏感度远高于影像学检查.结论 多种肿瘤标志物在胆管癌早期诊断中具有重要的临床应用价值.尽管在肿瘤确诊方面,多种肿瘤标志物无法与影像学检查相比拟,但在胆结石早期癌变的诊断中,多种肿瘤标志物检测的价值却要明显优于影像学检查.     

胰腺癌血清肿瘤标志物的研究现状

胰腺癌的发病率在世界范围内呈逐年上升趋势,其早期诊断困难,手术切除率低,5年生存率仅为5%左右.改善胰腺癌不良预后的关键在于早期诊断和根治性切除.检测血清肿瘤标志物有助于胰腺癌的诊断、预后判断和治疗监测.尽管有一定的局限性,CA19-9仍是目前临床最常用的胰腺癌血清肿瘤标志物.近年来随着分子生物学技术的发展,不断有新的候选胰腺癌血清肿瘤标志物被发掘,如MIC-1、M2-PK、OPN和RCASl等.本文简要综述了胰腺癌血清肿瘤标志物的研究现状和进展.     

核基蛋白与膀胱肿瘤

早期诊断是膀胱肿瘤治疗的关键 ,核基蛋白 (NMPs)是膀胱肿瘤的一种新的肿瘤标志物 ,特异性高。本文分别从NMPs的基础研究 ,临床应用及与传统方法比较等方面进行综述 ,得出患者尿液中NMPs值测定在膀胱肿瘤的早期诊断中有重要价值。     

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近年来 ,随着肿瘤免疫机制及分子生物学研究的深入 ,对抗肿瘤免疫应答、细胞增殖、癌变、转移以及癌基因和抑癌基因之间的作用机制认识的进一步加深 ,许多早期诊断胰腺癌的血清及基因标志物已相继发现 ,同时 ,在胰腺癌的免疫基因治疗上也有了新的进展。1　胰腺癌标志物肿瘤标志物通常是指肿瘤组织自身产生的可反映肿瘤存在与生长的一类分子 ,其临床价值在于早期发现和诊断肿瘤 ,提示肿瘤的原发部位及严重程度 ,监测治疗效果并对预后作出判断。根据被检测物类型可分为血清学肿瘤标志物及基因肿瘤标志物。1 1　胰腺癌血清标志物常用的血清学肿…     

乳头溢液CA153检测的临床应用价值

目的探讨乳头溢液肿瘤标志物CA153检测对乳腺癌早期诊断和鉴别诊断的应用价值。方法采用电化学发光免疫分析技术检测36例乳腺癌患者、68例乳腺良性病变者、40例健康产妇的血清和乳头溢液（乳汁）CA153水平，进行敏感度、特异度计算及对比分析。结果乳腺癌患者血清、乳头溢液CA153的水平高于健康人和良性病变者（P均〈0．01）。乳头溢液CA153对于乳腺癌的敏感性为88．9％，特异性为88．9％。血清CAl53测定的敏感性为50．0％，特异性为95．4％。结论乳头溢液CA153测定对乳腺癌早期诊断有较高的敏感性，特异性稍低于血清，具有一定的临床应用价值。     

膀胱癌生物标志的研究进展

膀胱癌的诊断和术后复发的监测,长期以来一直是泌尿外科领域研究的重点.随着分子生物学技术的发展,许多膀胱肿瘤标志物被发现,为肿瘤的早期诊断、早期治疗和术后复发监测提供了新的思路与方法.熟悉和了解膀胱癌生物标志的研究进展,更好地选择高敏感性及特异性的膀胱肿瘤标志物运用于临床具有重要意义.     

核基蛋白与膀胱肿瘤

早期诊断是膀胱肿瘤治疗的关键,核基蛋白（NMPs）是膀胱肿瘤的一种新的肿瘤标志物,特异性高。本文分别从NMPs的基础研究,临床应用及与传统方法比较等方面进行综述,得出患者尿液中NMPs值测定在膀胱肿瘤的早期诊断中有重要价值。     

血浆蛋白质组学在乳腺癌早期诊断研究中的进展

血浆作为临床诊断及预后评估中的重要研究样品,其组成中蛋白及多肽类成分的分析成为寻找疾病标志物的重要途径。血浆蛋白质组学研究近年来成为国际蛋白质组学研究的热点。现就血浆蛋白质组学与乳腺癌早期诊断的肿瘤标志物的研究进展进行综述。     

Proliferation markers and survival in early breast cancer: a systematic review and meta-analysis of 85 studies in 32,825 patients

We have performed a systematic review and meta-analysis of proliferation markers (Ki-67, mitotic index (MI), proliferating cell nuclear antigen (PCNA) and thymidine or bromodeoxyuridine labelling index (LI)) with respect to survival in early breast cancer. Eighty-five studies involving 32,825 patients were analysed. Ki-67 (43 studies, 15,790 patients), MI (20 studies, 7021 patients), and LI (11 studies, 7337 patients) were associated with significantly shorter overall and disease free survival, using results from univariate and multivariate analyses from the individual studies. PCNA (11 studies, 2677 patients) was associated with shorter overall survival by multivariate analysis only, because of lack of data. There was some evidence for publication bias, but all markers remained significant after allowing for this. Ki-67, MI, PCNA and LI are associated with worse survival outcomes in early breast cancer. However, whether these proliferation markers provide additional prognostic information to commonly used prognostic indices remains unclear.     

骨转移生化指标在乳腺癌诊治中的应用

目的：介绍骨生化指标在乳腺癌骨转移诊治中的应用及价值。方法：分析总结近8年来国、内外关于骨生化指标在乳腺癌骨转移诊治中的应用研究。结果：破骨型生化指标氮端肽(NTX)与骨转移的相关性最好，Ⅰ型胶原碳端肽(ICTP)在乳腺癌骨转移诊治中比NTX更有价值；成骨型生化指标在乳腺癌骨转移诊治中的价值不大。结论：骨生化指标尚不能取代影像学及骨活检在乳腺癌骨转移诊治中的地位。     

Breast cancer management in low resource countries (LRCs): consensus statement from the Breast Health Global Initiative

The Breast Health Global Initiative (BHGI) brought together international breast cancer experts to discuss breast cancer in low resource countries (LRCs) and identify common concerns reviewed in this consensus statement. There continues to be a lack of public and health care professionals' awareness of the importance of early detection of breast cancer. Mastectomy continues to be the most common treatment for breast cancer; and a lack of surgeons and anesthesia services was identified as a contributing factor in delayed surgical therapy in LRCs. Where available, radiation therapy is still more likely to be used for palliation rather than for curative treatment. Tumor receptor status is often suboptimally performed due to lack of advanced pathology services and variable quality control of tissue handling and processing. Regional pathology services can be a cost-effective approach and can serve as reference, training and research centers. Limited availability of medical oncologists in LRCs often results in non-specialist providing chemotherapeutic services, which requires additional supervision and training. Palliative care is an emerging field in LRCs that requires investment in training and infrastructure development. A commitment and investment in the development of breast cancer care services by LRC governments and health authorities remains a critical need in LRCs.     

三阴乳腺癌的特征及治疗现状

目的探讨三阴乳腺癌的特征及治疗现状。方法以"三阴乳腺癌"、"特征"、"治疗"为关键词进行检索并筛选阅读相关文献进行综述。结果三阴乳腺癌是乳腺癌的一种特殊亚型,肿瘤细胞缺乏雌激素受体、孕激素受体及人类上皮细胞生长因子受体2,其临床特点及预后不同于其他类型的乳腺癌,发病年龄小、无病生存率及总生存率较低。目前尚缺乏针对三阴乳腺癌的治疗指南,多参照非三阴乳腺癌的治疗,主要包括外科手术治疗且保乳手术后推荐常规行放射治疗、全身化疗,靶向治疗正处于临床研究阶段。结论三阴乳腺癌是乳腺癌表现异质性特征之一,其间还存在着许多的不同点。为了改善三阴乳腺癌的预后,我们期待在将来的工作中发现更多对于三阴乳腺癌有意义的检测指标,便于制定出三阴乳腺癌个体化治疗方案。     

Tumour markers in gastric cancer

We still lack clinically useful tumour markers in gastric cancer. To be of clinical value markers should be elevated in the early stages of the disease, when surgery for cure is possible. However, tumour markers available today, like CEA, CA 19-9 and CA 50, mainly detect advanced gastric cancer, for which only palliative treatment is available. The use of tumour markers in the follow-up of radically operated patients seems to be of only academic interest, mainly because a recurrence of gastric cancer is incurable. The preoperative tumour marker level may have a prognostic value and may be clinically useful in selecting patients for adjuvant treatment. To elucidate this, prospective controlled trials are needed. A short review of tumour markers in gastric cancer will be presented.     

Adenoid cystic carcinoma of the breast.

Adenoid cystic carcinoma of the breast is a rare neoplasm, with only 140 cases having been reported to date. Data on 123 of these cases are reviewed herein and another case is presented in detail. Several features distinguish this type of breast cancer from more typical histologic types and suggest that it may have a unique tumor behavior. The prognosis appears to be favorable and the incidence of axillary lymph node involvement is lower. Distant metastases are uncommon, but they tend to occur without prior lymph node involvement. This lack of prognostic significance for negative axillary lymph nodes underscores the need for other prognostic markers in this disease and suggests that axillary dissection can be eliminated in most cases. Similarities to typical breast cancer include the incidence of local recurrence and the lack of effect of surgical treatment on distant metastases and overall survival. These data suggest that breast-conserving treatment may be applicable to adenoid cystic carcinoma.     

Is follow-up of breast cancer with CEA and CA 15-3 justified?]

The significance of the tumor markers CEA and CA 15-3 for the oncological follow-up of breast cancer was examined in a retrospective analysis of 274 patients. Only 45% of 225 patients with nonmetastatic breast cancer showed in a period of 3 years normal values for both markers. 123 patients with increased markers in the same period were without evidence of tumor progression. Neither marker is suitable for the diagnosis of a local recurrence. In 32 cases of distant metastasis CA 15-3 is more sensitive than CEA (88%/63%), with an increase of 3% in sensitivity when analysing both markers simultaneously. The cut off level of CA 15-3 is problematic, 25 U/ml or 40 U/ml can be used as a threshold for tumoral activity. The use of tumor markers in the follow-up is not really justified so long as the prognosis or mortality of a patient is not changed by starting therapy early.     

超声与钼靶摄片对乳腺癌早期诊断的意义

目的： 评估超声与钼靶摄片检查在乳腺癌早期诊断中的作用,以提高乳腺癌的早期筛查效率。 方法：收集乳腺癌早期诊断的女性患者528例临床资料,其中经B超查出隐匿性乳腺癌132例,经钼靶摄片查出乳癌病灶396例。比较两种检查方式获得初步诊断的乳腺癌患者的临床与影像学特征、手术方式与组织病理学特征、分子生物学标志物与分型的差异。 结果：两者比较显示,绝经前、年青、汉族（相对维吾尔族）女性及致密乳房组织和影像学BI-RADS 4级的乳腺癌超声检查较钼靶摄片更易检出（均P<0.05）;超声检查较钼靶摄片检出的患者更多实行保乳手术,且淋巴结转移阳性率较低,更易发现单发、直径≤1 cm、分化较好的乳腺癌及早期阶段的浸润性乳腺癌（均P<0.05）;超声检查对ER（+）、luminal A乳腺癌检出率高,而钼靶摄片对Her-2（+）、Her-2型乳腺癌检出率高（均P<0.05）。 结论：超声检查较钼钯摄片更容易发现致密乳房组织中的侵袭性与恶性程度较低的早期癌灶,对于检出不同分子分型的早期乳腺癌两者各有优势。故联合应用更利于乳腺癌患者早期筛查。     

AFP—L3、GP73及DLC-1在原发性肝癌中的研究进展

原发性肝癌由于缺乏特异性和灵敏度均高的标志物,确诊时已多属中、晚期,又由于缺乏有效治疗,因而预后差。近年来,肝癌相关基因和蛋白标志物大量涌现,本文就AFP—L3、GP73及抑癌基因DLC-1（deleted in liver cancer-1）与肝癌发生发展的关系进行阐述,为肝癌的早期诊断和判定预后提供一些新的线索。     

AFP-L3、GP73及DLC-1在原发性肝癌中的研究进展

原发性肝癌由于缺乏特异性和灵敏度均高的标志物,确诊时已多属中、晚期,又由于缺乏有效治疗,因而预后差.近年来,肝癌相关基因和蛋白标志物大量涌现,本文就AFP-L3、GP73及抑癌基因DLC-1(deleted in liver caneer-1)与肝癌发生发展的关系进行阐述,为肝癌的早期诊断和判定预后提供一些新的线索.