乳腺癌保乳治疗的临床研究

目的探讨早期乳腺癌保乳综合治疗的疗效及可行性。方法将189例Ⅰ、Ⅱa期乳癌患者前瞻性非随机分为两组：（1）保乳组：92例行乳腺区段切除加腋窝淋巴结清扫术;（2）对照组：97例行乳癌改良根治术。两组术后均给予相同方案的放疗、化疗和内分泌治疗,术后进行定期随访,并进行美容评估。结果本组178例得到随访,随访率94.2%,中位随访时间为78个月。局部复发：保乳组3例,对照组1例。保乳组3年存活率97.7%,5年存活率94.1%,远处转移率7.9%。对照组3年存活率97.8%,5年存活率90.8%,远处转移率7.9%,两组局部复发和远处转移差异均没有统计学意义,两组3、5年生存率差异应用log-rank检验无统计学意义（P〉0.05）。COX比例风险模型分析发现年龄、ER、PR情况不是影响生存的风险因素,TNM分期与生存率有关。85.5%患者对保乳手术的美容效果满意。结论对早期乳癌使用保乳综合治疗可达到传统根治术相当的治疗效果,应作为早期乳癌的首选治疗方法。     

乳腺癌新辅助治疗后外科处理策略

目前手术仍是乳腺癌治疗的重要手段,但患者生存获益显然更得益于多学科综合治疗。新辅助治疗的出现改变了传统的首选手术及大范围切除模式,并且在外科治疗的几个重要里程碑,如保乳手术、前哨淋巴结活检等方面都起到了重要的作用,其作为乳腺癌治疗的地位愈加重要。然而,目前仍有许多有争议的问题缺乏证据支持,如新辅助治疗合理人群及方案的选择、新辅助治疗对手术时机选择的影响等。人们对新辅助治疗后未获益的群体还缺乏关注,这提醒我们,在清醒地认识到新辅助治疗优势的同时,还需规避其在乳腺癌预防及治疗过程中带来的不利影响,合理地应用新辅助治疗,进一步优化乳腺癌治疗模式。     

老年人大肠癌125例外科治疗体会

目的探讨70岁以上老年人大肠癌病人的外科治疗方法。方法回顾性分析我们于2000年10月~2005年12月手术治疗的125例70岁以上大肠癌病人的临床资料。结果全组围手术期死亡2例,术后死亡2例。术后出现并发症34例。1年生存率为85%,3年生存率为49%。结论老年人大肠癌的外科治疗复杂、风险高,除个体化的手术治疗外,应同步治疗及预防并存疾病的术后发作,降低术后死亡率和并发症的发生率。     

乳腺癌外科治疗发展趋势

乳腺癌是女性最常见的恶性肿瘤之一，其发病率近年居高不下。外科治疗在乳腺癌治疗中地位显著，自1894年HMsted创立乳腺癌根治术后百余年间，经历了扩大根治术和改良根治术的尝试和修正，而最大的变革无疑是20世纪后30年间迅速发展的保乳治疗，使外科治疗从“可以耐受的最大治疗”模式转变至“最小有效治疗”的模式。Fisher提出“乳腺癌一开始就是一种全身性疾病，原发灶和区域淋巴结的处理方式不会影响病人的生存率”的假说，得到多个临床试验的证实，也成为保守手术的立论基础．保守治疗从星星之火．遂成燎原之势．     

乳腺癌手术的历史演变

1　乳腺肿瘤的原始手术时代公元前 30 0 0年～公元前 2 5 0 0年 ,ＥｄｗｉｎＳｍｉｔｈ描述乳腺凸出物与乳腺囊肿和炎症区别的记载为乳腺病变最早的医学记载。公元前 6 0 4年～公元前 377年 ,希腊外科医生Ｌｅｏｎｉｄｅｓ首先发现乳头凹陷是乳腺癌的一个重要体征 ,并主张外科手术治疗乳腺癌 ,而且首先实施了乳腺肿瘤的切除[1] 。自 2世纪持续到 19世纪的中叶 ,此阶段认为局部疾病以局部切除为主。切除病变的计划性差 ,没有麻醉 ,手段残酷 ,效果不好。手术死亡率极高 ,短期复发率达 90 %以上。也认识到乳腺癌不是一个局限性疾病 ,但病变发展…     

青年期乳腺癌的处理

临床上,青年期乳腺癌往往指年龄<35岁的病人.乳腺癌可发生在任何年龄段,不同年龄段病人发生的乳腺癌其生物学特性不尽相同.一般情况下,罹患乳腺癌的年龄越小,肿瘤的生物学行为越差,病人的预后就越不良.     

老年乳腺癌的临床病理特点和治疗

目的 探讨老年乳腺癌的临床病理特点和治疗方式以及影响治疗的因素.方法 收集2002年1月至2006年12月65岁以上乳腺癌患者647例的临床资料,将患者按年龄分成65～69岁组、70～74岁组和75岁以上组,全组患者占同期手术治疗乳腺癌患者的13.4%.本组主要病理类型为浸润性导管癌,占79.3%(513/647).合并其他系统慢性疾病者占54.7%(354/647).采用改良根治术者554例,占85.6%.接受术后辅助化疗者233例,占36.0%.比较三组患者的临床病理特点及治疗方式.结果 较高年龄组患者的黏液腺癌和其他病理类型较多见,Her2/Neu(+++)比例较低,合并其他系统慢性疾病者较多;采用相对保守的手术方式比例较高,接受术后辅助化疗的比例较低,接受术后单纯内分泌治疗的比例较高.结论 老年乳腺癌具有特殊的临床和病理生物学特点,接受的治疗方式与年龄相关.     

区域动脉化疗治疗中晚期乳腺癌

作者自１９９０年以来，采用术前化疗、根治或姑息性手术、术中动脉插管皮下埋藏输液器、术后定期给药区域动脉化疗的方法治疗Ⅲ～Ⅳ期乳腺癌患者２３例。结果显示本疗法具有安全、简便、副作用小而易于被患者接受的优点。     

老年男性同时性双侧原发性乳腺癌1例

患者男，82岁，已婚。2003年6月5日入院。患者20年前曾行右乳肿块切除术，术后恢复良好，具体病理不清。8年前发现右侧乳房外下象限与左乳头下各一肿块，花生米大小，患者未重视，双侧肿物逐渐增大，近3个月来肿物生长较快，现右侧肿物长至约鸡蛋大小，左侧乳头下长至约核桃大小。既往健康，无睾丸炎、肝炎及血吸虫病史，家族中无乳腺癌患者，体查：双侧乳房增大，     

综合治疗老年人腰椎间盘突出症

腰椎间盘突出症是引起老年人腰腿痛最常见的原因之一,如何应用综合疗法,减轻患者痛苦,提高疗效是值得探讨的,现将我科１９９５～１９９８年老年患者２１７例疗效总结如下：１临床资料２１７例,男１１５例,女１０２例;年龄６０～８４岁,平均６４７岁,病程１０～...     

老年乳腺癌患者掌控感现状的调查分析

目的探讨老年乳腺癌患者掌控感现状及其与焦虑、抑郁情绪的关系,为临床心理护理提供参考。方法采用一般资料调查问卷、生活掌控感量表、医院焦虑抑郁量表对123例老年乳腺癌患者进行问卷调查。结果老年乳腺癌患者掌控感总分(15.11±3.78)分,均分(2.16±0.54)分;家庭关系、文化程度、疾病认知是老年乳腺癌患者掌控感的影响因素;掌控感与焦虑、抑郁情绪呈负相关(均P0.01)。结论老年乳腺癌患者掌控感水平偏低,临床护理人员应多种举措并举促进其掌控感的发展。     

Adjuvant treatment of elderly breast cancer patients

Increasing age is the major risk factor for breast cancer. About half of all new breast cancers and more than half of breast cancer deaths in affluent nations occur in women 65 years and older. Endocrine therapy with aromatase inhibitors or tamoxifen is appropriate adjuvant therapy for older women with life expectancies of greater than 5 years and hormone receptor positive tumors. The greatest benefit of adjuvant chemotherapy is in elders with hormone receptor negative, node positive, or high-risk node negative tumors. The effect of co-morbidity on survival must be factored into all adjuvant therapy decisions and newer validated tools can accurately estimate non-breast cancer related survival. Age bias still exists and results in frequent undertreatment of older women and compromised survival. Elders remain under-represented in clinical trials and should be encouraged to participate. Health care providers as well as government leaders and patients need to be educated on cancer in elders.     

Prognostic factors in elderly patients with breast cancer

Background

Breast cancer (BC) remains principally a disease of old ages; with 35-50% of cases occurring in women older than 65 years. Even mortality for cancer increases with aging: 19.7% between 65 and 74 years; 22.6% between 75 and 84 years; and 15.1% in 85 years or more.The study was aimed to investigate specific predictive factors for elderly patients so to select the best way to treat and follow these patients.

Methods

A search was performed on Medline, Embase, Scopus using the following Key words: Breast cancer, Breast neoplasms, Aged, Elder, Elderly, Eldest, Older, Survival analysis, Prognosis, Prognostic factors, Tumor markers, Biomarkers, Comorbidity, Geriatric assessment, Axilla, Axillary surgery. 3029 studies have been retrieved. Paper in which overall or disease free survival were not end points, or age class was not well defined, or the sample was too small, were excluded. At last 42 papers fulfilled the criteria.

Results and discussion

Lack of screening and delay in diagnosis may be responsible for the minor improvement in survival observed in elderly respect to younger breast cancer patients. Predictive factors are the same and must be assessed with the same attention reserved to younger women.

Conclusions

Most of elderly patient are fit to undergo standard treatment and can get the same benefits of younger women. Nevertheless it is possible that some older women with early breast cancer can be spared too aggressive treatments. Geriatric assessment and co-morbidities can affect the prognosis modifying surveillance, life expectancy and compliance to therapies. They can thus be useful to select the better treatment, either surgical or radio or hormone - or chemo-therapy.

     

Time trends in the outcome of elderly patients with breast cancer

Abstract:  Mortality rates for breast cancer are improving in most countries. Life expectancy is also improving, and as age is the major risk factor for the development of breast cancer, we sought to determine whether survival of elderly women with breast cancer has improved over the past 20 years in our institution. In a retrospective study using a prospectively maintained database, we identified 950 women aged ≥70 years diagnosed with breast cancer between 1980 and 2000. Overall survival of patients was compared between two different time cohorts—those diagnosed from 1980 to1990 and from 1991 to 2000—and between three age cohorts, 70–74, 75–79, and 80+ years. In all age groups, advanced stage, the need for mastectomy, and having chemotherapy were associated with a worse outcome on univariate analysis. Endocrine therapy (tamoxifen) was given to 60–70% of all age groups. After adjustment for clinical stage, we found no significant improvement in survival between the two time cohorts in any age groups. Compared with an age-matched group in the general population, these elderly breast cancer patients have a 62% increased risk of death. The results are likely to reflect lack of data to promote treatment guidelines. More clinical trials for older women are needed, if the benefits of recent advances in the management of this disease are to be extended to the over 70s. These data should, however, act as a benchmark for future audits.     

Primary breast cancer in the elderly

Objectives

With respect to breast cancer in the elderly, to define “old” in the context of comorbidity and physiologic rather than chronologic age. In addition, after discussion of factors influencing decisions regarding screening, stage at presentation and treatment decisions, to present an approach to the treatment of primary breast cancer in the elderly, taking into account quality of life, expected outcomes and cost-effectiveness.

Data sources

A review of the medical literature from 1980 to 1996, using the MEDLINE database and 2 relevant studies from The Henrietta Banting Breast Centre Research Programme at Women’s College Hospital, Toronto.

Study selection

A large number of breast cancer studies that might provide a better understanding of primary breast cancer in the elderly.

Data synthesis

The studies reviewed demonstrated that the annual incidence of breast cancer increases with age, along with a longer life expectancy for women. There appears to be a delay in presentation for elderly women with breast cancer, related in part to patient and physician knowledge. Biennial mammography and physical examination are effective in women aged 50 to 74 years, but compliance with screening recommendations decreases with age. Although treatment goals are the same for women of all ages, most treatment decisions are based on studies that seldom include women over 65 years of age. Physicians tend to underestimate life expectancy and older women are less likely to seek information. Breast conserving surgery, partial mastectomy and even axillary dissection can be carried out under local anesthesia with little physiologic disturbance, but unless axillary dissection is required to make a treatment decision, it may be foregone in clinically node-negative elderly women. The role of adjuvant radiotherapy in the elderly is not yet well established; tamoxifen is the usual adjuvant systemic therapy given to older women. For those who are truly infirm, tamoxifen alone can be considered. Studies to date do not clarify whether breast cancer in older women runs a more or less favourable course. However, locoregional recurrence appears to decrease with age. Deaths from competing causes are a confounding issue.

Conclusions

It is imperative to develop a coherent strategy for the treatment of primary breast cancer in the elderly that takes into account functional status and quality of life. Clinical trials must include older women and there must be good clinical trials designed specifically for older women.     

Factors influencing prognosis in elderly patients with primary breast cancer

A retrospective analysis was performed on 260 elderly and 294 middle-aged patients with primary breast cancer. Cox regression analysis showed that the classic prognostic factors, such as negative lymph node status, small tumour size and positive oestrogen receptor (ER) status, were favourable indicators of survival and were similar in both the elderly and the middle-aged. When the elderly and middle-aged were considered together, older age (favourable) and the presence of association disease (detrimental) were additional significant prognostic factors. It is concluded that a physically fit elderly woman in the present study had a more favourable survival outlook than a younger counterpart with similar tumor size, lymph node and ER status and should be given the best available treatment based on tumour characteristics and not on age alone.     

Locally advanced breast cancer in the elderly

The data concerning the influence of old age and locally advanced stages on breast cancer treatment and outcome are lacking or sparse. The authors reviewed treatment modalities in women over 65 years old with locally advanced breast cancer. The purpose of the study is to determine if differences in treatment modalities, clinical stage and pathological type influence the outcome. For patients with locally advanced disease but without over evidence of metastatic disease, radical surgical procedures should be attempted. Most study results confirm that loco-regional therapy and adjuvant chemohormonotherapy is feasible and safe even for older patients.