T2N0M0乳腺癌治疗方法的选择

探讨Ｔ２Ｎ０Ｍ０乳腺癌治疗方法的选择。方法回顾分析７０２例Ｔ２Ｎ０Ｍ０乳腺癌的淋巴结转移情况、手术方式和辅助治疗的效果。结果Ｔ２Ｎ０Ｍ０乳腺癌临床检查淋巴结假阴性率为３５．２％。各种手术方式在淋巴结阴性时生存率相似。辅助放疗可降低局部复发，辅助化疗在淋巴结转移超过４只者可提高生存率。结论Ｔ２Ｎ０Ｍ０乳腺癌病灶≤３ｃｍ可作改良根治术，病灶＞３ｃｍ且位于中央或内侧应同时清除内乳淋巴结。术后应根据不同情况选择不同的辅助治疗。     

T0乳腺癌8例

Ｔ０乳腺癌是指临床上乳腺和腋窝均无可触及的结节且无远处转移证据的乳腺癌，相当于Ｔ０Ｎ０Ｍ０，属临床前期病变或早期乳腺癌［１］。现将我院从１９８０年９月～１９９８年４月收治的Ｔ０乳腺癌８例报告如下：临床资料全组８例均为女性，发病年龄３０～６４岁，平均年...     

T_0乳腺癌

Ｔ＿０乳腺癌严淑清，刘寿福青岛市肿瘤医院外科（青岛市２６６０４２）报告我院从１９７９～１９９３年检出Ｔ０乳腺癌８例。触不到肿块的Ｔ０乳腺癌常属早期癌或临床前期病变，是指乳腺和腋下均无可触及的结节，且无远处转移证据的乳腺癌，相当于Ｔ０Ｎ０Ｍ０。全组８例...     

T1～4N0M0期非小细胞肺癌根治术后是否需要辅助治疗

目的　探讨非小细胞肺癌（ Ｎ Ｓ Ｃ Ｌ Ｃ） Ｎ０ Ｍ０ 期根治术后不同病理及不同 Ｔ 分期的转归及治疗。方法　行根治术后病理为 Ｎ Ｓ Ｃ Ｌ Ｃ 的 Ｔ１ ～４ Ｎ０ Ｍ０ 期３５４ 例。男性２８５ 例,女性６９ 例。鳞癌１９１例,腺癌１６３ 例。鳞癌中 Ｔ１ Ｎ０ Ｍ０ 期２７ 例, Ｔ２ Ｎ０ Ｍ０ 期１３４ 例, Ｔ３ Ｎ０ Ｍ０ 期２８ 例, Ｔ４ Ｎ０ Ｍ０ 期２ 例。腺癌中 Ｔ１ Ｎ０ Ｍ０ 期４２ 例, Ｔ２ Ｎ０ Ｍ０ 期１０８ 例, Ｔ３ Ｎ０ Ｍ０ 期１０ 例, Ｔ４ Ｎ０ Ｍ０ 期３ 例。结果　全组５ 年生存率为５３ ．７ ％ ,鳞癌为５９ ．７ ％ ,腺癌为４６ ．６ ％ 。鳞癌中 Ｔ１ Ｎ０ Ｍ０ ～ Ｔ４ Ｎ０ Ｍ０ 期５ 年生存率分别为７０ ．４ ％ ,６４ ．９ ％ ,２８ ．６ ％ 及０／２（ Ｐ＜ ０ ．０５） ;局部复发率分别为１４ ．８ ％ ,９ ．７ ％ ,２１ ．４ ％ 及０／２（ Ｐ＞ ０ ．０５） ;远地转移率分别为１１ ．１ ％ ,２３ ．９ ％ ,５０ ．０ ％ 及２／２（ Ｐ＜ ０ ．０５） 。腺癌中 Ｔ１ Ｎ０ Ｍ０ ～ Ｔ４ Ｎ０ Ｍ０ 期５ 年生存率分别为６１ ．９ ％ ,４４ ．４ ％ ,２０ ．０ ％ 及０／３（ Ｐ＜ ０ ．０５） ;局部复发率     

对鼻咽癌国际抗癌联盟（UICC）分期标准的评价和修改意见

本文回顾性分析自１９５８年４月到１９８４年１０月收治的１９３０例初程放疗的鼻咽癌患者的疗效。按照ＵＩＣＣ分期标准，Ｔ＿１Ｎ＿０、Ｔ＿２Ｎ＿０、Ｔ＿３Ｎ＿０和Ｔ＿４Ｎ＿０的５年生存率分别为９４．７％、７７．１％、５９．３％和３８．６％（统计学上有明显差异）。颈转移性淋巴结大小，单侧或双侧，上、下颈或锁骨上区受侵，淋巴结活动或固定有明显不同的预后。根据这些因素，将Ｎ分期分为４级。改变ＵＩＣＣ分期组合，将Ｔ＿（０－２）Ｎ＿１Ｍ＿０列为Ⅱ期，Ｔ＿（０－３）Ｎ＿２Ｍ＿０列为Ⅲ期，把Ｔ＿４或Ｎ＿３组成的Ⅳ期和Ｍ＿１组成的Ⅳ期分别列为Ⅳ＿ａ和Ⅳ＿ｂ期，这样各期病例的分布比例及各期病例预后的差别更能反映实际，也更为合理。     

２９３例乳腺癌患者术后预后因素分析

目的：探讨２９３例乳腺癌患者月经情况、术后Ｔ分期、Ｎ分期、受体、术后放疗、化疗及内分泌治疗等因素对患者无病生存时间及总生存时间的影响。方法：收集我院２００２～２００６年２９３例乳腺癌患者术后的完整随访资料,选择可能对乳腺癌术后患者预后产生影响的非重复特征因素,包括月经情况、术后病理的Ｔ分期、Ｎ分期、受体的免疫组化分型、术后放疗、化疗及内分泌治疗,采用Ｃｏｘ风险回归模型分析影响无复发生存率（ＲＦＳ）和总生存率（ＯＳ）的预后因素。对具有统计学意义的独立预后因素进行分层分析及Ｋａｐｌａｎ Ｍｅｉｅｒ生存曲线分析。结果：本组病例中Ｎ分期是影响患者ＲＦＳ及ＯＳ的独立因素,相对危险度（ＯＲ）分别为１.４５３（９５％ＣＩ：１.０９６～１.９２６,Ｐ＜０.０１）、１.４５８（９５％ＣＩ：１.０９９～１.９９３,Ｐ＜０.０１）。对Ｎ分期进行分层分析及Ｋａｐｌａｎ Ｍｅｉｅｒ生存曲线分析表明,Ｎ０期患者的ＲＦＳ及ＯＳ优于Ｎ１～Ｎ３期患者（Ｐ＜０.０５）,而Ｎ１～Ｎ３期患者之间ＲＦＳ及ＯＳ无差异（Ｐ＞０.０５）。结论：乳腺癌术后患者Ｎ分期与患者的预后有关,淋巴结阴性患者的预后好于淋巴结阳性患者预后,建议对淋巴结阳性患者加强术后辅助治疗。     

应用“数学模型”预测临床T1—2N0M0乳腺癌患者腋窝巴结转移情况的研究

建立一个数学模型,预测临床Ｔ１－２Ｎ０Ｍ０乳腺癌患者腋窝淋巴结转移情况。方法：Ｃ地２５６例行根治术乳腺癌患者进行回顾性研究,按腋窝淋巴结转移情况分为两组,行多因素Ｌｏｇｉｓｔｉｃ回归分析及判别分析。结果Ｌｏｇｉｓｔｉｃ多元回归分析提示微淋巴管浸润、肿瘤大小、肿瘤部位、癌周浸润、间质浸润等５个指标为腋窝淋巴结转移的高危因素;据高危因素所建立的判别函数,阴性预测值高达８８．９％,阳性预测值７１．８％,     

贲门癌并发出血的外科治疗近期观察

目的 探讨并发出血的贲门癌外科治疗的意义。方法 ２８例经纤维胃镜及组织病理学检查证实的贲门癌病人均有便血或（和）呕血症状；手术切除２７例，仅开胸探查１例，其中因大出血急诊手术者３例，结果 本组无手术死亡；术后发生吻合口迟发大出血和吻合口狭窄各１例，均治愈。术后肿瘤ＴＮＭ分期属于Ｔ１Ｎ０Ｍ０￣Ｔ３Ｎ１Ｍ０者共２３例。术后近期生活质量满意。结论 贲门癌易诱发上消化道出血；出血并不表示肿瘤一定有外侵和广     

ＨＤＡＣ１和ＤＮＭＴ１蛋白在乳腺癌中的表达及临床意义

目的　探讨乳腺癌组织中组蛋白脱乙酰基酶１（ＨＤＡＣ１）和ＤＮＡ甲基转移酶１（ＤＮＭＴ１）的表达及临床意义。方法　应用组织芯片和免疫组织化学ＳＰ法检测１０５例乳腺癌组织和３７例癌旁组织中ＨＤＡＣ１和ＤＮＭＴ１蛋白的表达情况并分析其与ＥＲ、ＰＲ之间的关系。结果　（１）ＨＤＡＣ１蛋白在１０５例乳腺癌中的阳性表达率为６４.７6％,在癌旁组织中的阳性表达率为３５.１４％,两组差异有统计学意义（Ｐ＜０.０１）;ＤＮＭＴ１蛋白在乳腺癌中的阳性表达率为５５.２４％,在癌旁组织中的阳性表达率为２４.３２％,两组差异有统计学意义（Ｐ＜０.０１）;（２）ＨＤＡＣ１和ＤＮＭＴ１蛋白的表达与患者年龄、瘤体大小、组织学类型、组织学分级、腋窝淋巴结转移、临床分期均无相关性（Ｐ＞０.０５）;（３）乳腺癌组织中ＨＤＡＣ１和ＤＮＭＴ１蛋白在ＥＲ或ＰＲ阴性乳腺癌组织中的表达分别高于其在ＥＲ或ＰＲ阳性乳腺癌组织中的表达（Ｐ＜０.０１）。ＨＤＡＣ１与ＤＮＭＴ１蛋白表达具有一定的相关性。结论　乳腺癌组织中ＨＤＡＣ１和ＤＮＭＴ１蛋白过表达与肿瘤发生发展密切相关。     

原发小细胞膀胱癌5例报告和文献复习

目的：报告５例小细胞膀胱癌治疗结果,复习相关文献,探讨小细胞膀胱癌临床特点,手术、化疗和放疗在小细胞膀胱癌治疗中的作用。方法：我院从１９７９～１９９９年收治５例小细胞膀胱癌患者,其中Ｔ１Ｎ０Ｍ０１例,接受双髂内动脉导管化疗;Ｔ２Ｎ０Ｍ０１例,行膀胱切除术加术后放疗;Ｔ３Ｎ０Ｍ０１例,仅行膀胱切除术;Ｔ４Ｎ０Ｍ０２例,１例经放疗、动脉导管化疗后行探查术,另１例术前放疗后膀胱切除术加术后全身化疗。结果     

The role of tumor receptor status in choosing adjuvant therapy for breast cancer patients of reproductive age]

Estrogen (ER) and progesterone (PR) receptor levels were assayed in primary tumor samples from 271 premenopausal patients suffering T1,2N1M0 (stage II) breast cancer. Four clinical groups were identified according to steroid receptor levels in which results of adjuvant treatment (chemotherapy or complex treatment) were assessed. ER and PR positivity was associated with longer disease-free and overall survival. Adjuvant hormone therapy proved beneficial in ER+PR+ tumor patients. The latter group was also characterized by a lower relapse rate, particularly, in those aged over 40. It is recommended that: (1) T1,2N1M0 breast cancer patients be given adjuvant chemotherapy whatever tumor receptor status, (2) these patients should not be given adjuvant hormone therapy unless tumor receptor status has been established since prophylactic oophorectomy and subsequent hormone therapy are not justified for operable breast cancer, (3) complex therapy be administered to premenopausal patients aged over 40 years with ER+PR+ tumors only, and (4) PR-positivity be considered a good predictor of hormone sensitivity of cancer.     

肿瘤浸润淋巴细胞在cT1N0M0期乳腺癌淋巴结转移中的预测价值

 目的 探讨cT1N0M0期乳腺癌患者肿瘤浸润淋巴细胞（tumor-infiltrating lymphocyte,TIL）与淋巴结转移的相关性, 以及TIL密度在预测患者前哨淋巴结转移 （sentinel lymph node metastasis,SLNM） 中的价值。方法 回顾性分析2008年1月至 2016年12月于本院接受手术治疗的cT1N0M0 期乳腺癌患者的临床资料。术前在活检标本中进行 TIL 密度的组织病理学评估。采用多因素logistic回归以及受试者工作特征（ROC）曲线分析TIL预测SLNM的价值。结果  共153例cT1N0M0期乳腺癌患者纳入分析, 其中30例（19.6%）患者发生SLNM。TIL密度与雌激素受体（ER）状态（P<0.001）、孕激素受体（PgR）状态（P=0.003）、人表皮生长因子受体2（HER2）状态（P=0.029）、Ki67表达（P=0.025）、核分级（P=0.026）相关。多因素logistic回归显示, TIL密度（OR=1.40,95%CI：1.15~1.71,P=0.001）是影响cT1N0M0期乳腺癌SLNM的独立因素, 其ROC曲线下面积（AUC）为0.755 （95%CI：0.680~0.830,P<0.001）。结论 TIL密度与cT1N0M0期乳腺癌SLNM密切相关, 可能是SLNM潜在的预测指标。     

Predicting aggressive outcome in T1N0M0 breast cancer

Despite the excellent overall prognosis, unpredictable breast cancer recurrences and deaths also occur among T1N0M0 patients. We have evaluated clinically applicable methods for identifying aggressive outcome in T1N0M0 breast cancer. The material is based on aggressive T1N0M0 invasive ductal and lobular carcinomas diagnosed in Turku University Hospital and Jyv?skyl? Central Hospital, Finland, during 1987-1997. We studied all the T1N0M0 breast cancers that had led to recurrency or death (n=21, 95% T1cN0M0) during the follow-up period (4-14 years). The study is based on statistical analyses of matched case-control data in which the prognostic factors of each individual patient with aggressive disease were compared with control patients (n=45) individually matched by tumour size, age at diagnosis, histological type of tumour and length of follow-up. The cancer cases were examined for clinically applicable conventional and immunohistochemical pathologic prognostic factors. High Ki-67 immunopositivity was the strongest prognosticator of breast cancer death or recurrence in T1N0M0 breast cancer. Also, high p53 immunopositivity, low oestrogen receptor immunopositivity and Her-2/neu oncogene amplification by chromogen in situ hybridisation were reliable indicators of unfavourable outcome. Our statistical methods also allowed us to determine for the present material a range of clinical significance for each immunohistochemical prognostic feature with the associated relative risk for breast cancer death and recurrence. The paper suggests guidelines for predicting aggressive outcome in T1N0M0 breast cancer.     

Sustained complete response in lung metastasis of breast cancer by goserelin--report of two cases

We report two patients with lung metastasis of breast cancer who had durable complete responses (CR) with goserelin. The first patient was a 48-year-old woman diagnosed with left breast cancer (T1N0M0, Stage I) at the age of 40, for which she underwent mastectomy. The tumor was estrogen receptor (ER) and progesterone receptor (PgR) positive. She received tamoxifen for 2 years as adjuvant therapy. After 8 years and 7 months, a lung metastasis was found by chest X-p, and treatment with goserelin was started. After 11 months of this treatment a CR was achieved, and the response lasted 3 years and 5 months. The second patient was a 38-year-old woman with a diagnosis of lung metastasis. She underwent right mastectomy at the age of 29 for breast cancer (T2N1M0, Stage IIB), and the tumor was ER and PgR positive. She received tamoxifen and doxifluridine for 2 years as adjuvant therapy. Eight years and 6 months after the mastectomy, a lung metastasis was found by chest X-p, and goserelin treatment was started. After 8 months of this treatment, chest X-p and CT revealed a complete regression of the lung metastasis, and response lasted 1 years and 7 months. Serum estradiol levels were suppressed below 10 pg/ml during the treatment in both patients. These results indicate the usefulness of LH-RH agonist in the treatment of recurrent breast cancer.     

Amplification of erbB2 and erbB2 expression are superior to estrogen receptor status as risk factors for distant recurrence in pT1N0M0 breast cancer: a nationwide population-based study.

PURPOSE: To assess the relative importance of 10 prognostic factors in pT1N0M0 breast cancer (< or =2 cm in diameter, node negative). EXPERIMENTAL DESIGN: Women diagnosed with breast cancer in Finland from 1991 to 1992 were identified from the files of the Finnish Cancer Registry, and individual clinicopathological data were collected from the hospital case records of women living in five regions comprising about one-half of the Finnish population. Of the women with minimum required information available (n = 2842), 852 had unilateral pT(1)N(0)M(0) cancer. The median follow-up time was 9.5 years, and only 5% had received systemic adjuvant therapy. Estrogen receptor (ER), progesterone receptor, erbB2, p53, and Ki-67 expression was determined from tumor tissue microarrays using immunohistochemistry, and the erbB2 (HER-2) amplification status was determined using chromogenic in situ hybridization. RESULTS: Primary tumor size < or =5 mm and histological grade 1 were associated with 100 and 95% (95% confidence interval, 92-98%) 9-year distant disease-free survival, respectively, whereas strong erbB2 expression or the presence of >20% Ki-67-positive cells was associated with >20% risk. ER and progesterone receptor values obtained from the hospital case records or tumor microarrays showed weaker association with outcome than the erbB2 status. Small (< or =10 mm) erbB2-negative cancers were associated with >90% 9-year distant disease-free survival, irrespective of histological grade. CONCLUSIONS: Prognosis of pT(1)N(0)M(0) breast cancer is generally well defined by the histological grade and primary tumor size. The erbB2 status was superior to ER as a prognostic factor in these tumors.     

T1N0M0乳腺癌临床病理特征和预后分析

目的：探讨T1N0M0乳腺癌患者的临床病理特征与预后关系。方法：收集2003-01-01-200912-31广东省妇幼保健院乳腺病防治中心住院治疗的137例T1N0M0乳腺癌患者的资料,回顾性分析临床病理特征与预后的关系。结果：共收治934例I～ⅢA期乳腺癌患者,其中T1N0M0乳腺癌137例,占14．7％。137例T1N0M0乳腺癌患者中有33例（24．1％）为T1mic,42例（30．7％）为T1a～T1b,62例（45．2％）为T1c。肿瘤大小与组织学分级（P=0．001）有关,与年龄（P=0．526）、ER／PR（P=0．371）、HER-2（P=0．624）、手术方式（P=0．479）和术后辅助化疗（P=0．066）无明显相关性。中位随访47个月,5例患者复发转移,其中1例患者死于肝转移,5年无病生存期（disease-freesurvival,DFS）为96．4％,5年总生存期（overallsurvival,OS）为99．3％。在单因素分析中,T1N0M0乳腺癌的5年DFS与肿瘤组织学分级（P=0．010）和ER／PR状态（P=0．043）有关,而与年龄（P=0．217）、肿瘤大小（P=0．880）、HER-2状态（P=0．769）、手术方式（P=0．477）和有无化疗（P=0．560）无关;在多因素分析中,仅肿瘤组织学分级是5年DFS的独立影响因素,P=0．045。组织学分级G1、G2和G3患者的5年DFS分别为100．0％、96．3％和84．2％,伴有组织学分级非G3患者的5年DFS（98．3％）优于伴有组织学分级G3（84．2％）的患者,P=0．005;G2（96．3％）和G1（100．0％）患者5年DFS差异无统计学意义,P=0．109。结论：肿瘤组织学分级是T1N0M0乳腺癌的5年DFS独立影响因素,肿瘤组织学分级高的患者预后差。肿瘤组织学分级可为T1N0M0乳腺癌的辅助化疗决策提供参考依据。     

Locoregional recurrence of pT3N0M0 breast cancer after mastectomy is not higher than that of pT1‐2N0M0: An analysis for radiotherapy

The purpose of this study was to investigate the value of post‐operative radiotherapy in the treatment of pT3N0M0 breast cancer after mastectomy. We analyzed the clinical data of 1390 patients with pT1‐3N0M0 breast cancer who were admitted and treated from 1998 to 2007 at the Sun Yat‐sen University Cancer Center. All patients underwent mastectomy and did not receive radiotherapy. The locoregional recurrence‐free survival, distant metastasis‐free survival and overall survival of different T stages of breast cancer were compared. The median follow‐up duration was 72 months. The 10‐year locoregional recurrence‐free survival patients with pT1N0, pT2N0 and pT3N0 breast cancers were 95.3, 91.9 and 93.6%, respectively (χ² = 2.550, P = 0.279). The 10‐year distant metastasis‐free survival rates of patients with pT1N0, pT2N0 and pT3N0 breast cancers were 88.1%, 81.0% and 78.4%, respectively (χ² = 8.254, P = 0.016). The 10‐year overall survival rates of patients with pT1N0, pT2N0 and pT3N0 breast cancers were 91.9%, 83.5% and 73.0%, respectively (χ² = 12.403, P = 0.002). Univariate analyses failed to identify any prognostic factors for locoregional recurrence in pT3N0 patients. Multivariate analysis showed that the T stage had no effect on locoregional recurrence. The locoregional recurrence rate in patients with pT3N0M0 breast cancer who underwent mastectomy and did not receive postoperative radiotherapy was not higher than that in patients with pT1‐2N0M0 breast cancer who received the same treatment, suggesting that routine adjuvant post‐operative radiotherapy should not be recommended in this patient population.     

Is leptin a mediator of adverse prognostic effects of obesity in breast cancer?

PURPOSE: Leptin, an adipocyte-derived cytokine that is elevated in obesity, has been associated with carcinogenesis, tumor migration and invasion, enhancement of angiogenesis, and increased aromatase activity. It has been suggested that leptin may mediate adverse prognostic effects of obesity in breast cancer. PATIENTS AND METHODS: Four hundred seventy-one women with surgically resected T1-3, N0-1, M0 breast cancer were studied. Leptin was assayed in stored fasting blood specimens obtained before adjuvant therapy. Women were followed prospectively for distant disease-free survival (DDFS) and overall survival (OS). RESULTS: Patients ranged from 26 to 74 years of age, and staging was as follows: T1 = 262, T2 = 151, T3 = 23, TX = 35, N0 = 323, and N1 = 148. Estrogen receptor was positive in 286 patients, and progesterone receptor was positive in 259 patients. One hundred forty-five patients received adjuvant chemotherapy, 146 received adjuvant tamoxifen, 46 received both, and 134 received neither. Mean leptin was 15.2 +/- 10.1 ng/mL. Univariately, leptin was associated with OS (overall P = .049; P = .014 postmenopausal). Leptin was not associated with DDFS overall or in any menopausal subgroup (P > or = .19). In multivariate Cox modeling, leptin was not significantly associated with DDFS or OS (P = .11 and 0.075, respectively). Adjustment for insulin or body mass index further reduced the association of leptin with outcome. CONCLUSION: Although leptin is strongly correlated with obesity and insulin, we could not show that it is independently associated with prognosis in early-stage breast cancer. Because we cannot rule out modest prognostic effects, we recommend additional research to explore this potential association, particularly in postmenopausal women.     

78例乳腺癌改良根治术后pT3N0M0期患者放疗价值探讨

目的 探讨乳腺癌改良根治术后病理分期为T₃N₀期患者的术后放疗价值。方法 回顾分析1997-2014年收治的乳腺癌改良根治术后患者资料,筛选标准为女性、术后病理提示浸润性癌、肿瘤最大径>5 cm且腋窝淋巴结未见转移、未接受新辅助化疗及内分泌治疗,且无远处转移及其他第二原发癌。78例符合条件。40例(51%)接受术后放疗,67例(86%)接受辅助化疗。Kaplan-Meier法计算DFS、OS及LRR率,组间差异用Logrank法检验。结果 中位随访时间79个月(6~232个月),5年OS、DFS和LRR分别为89%、87%和2%。放疗组与未放疗组患者5年DFS分别为84%与91%(P=0.641),5年OS分别为84%与96%(P=0.126),5年LRR分别为0%和5%。仅ER/PR状态、分子分型影响患者DFS (P=0.002、0.031)。未放疗组有1例患者出现胸壁复发。结论 乳腺癌改良根治术后T₃N₀M₀期患者LRR率较低,仅ER/PR状态及分子分型影响患者DFS。在有效系统全身治疗基础上术后病理T₃N₀患者可能不需全部接受胸壁+锁骨上野放疗,但仍需大样本病例证实。