Gail乳腺癌风险评估模型应用初探

目的：了解Gail乳腺癌风险评估模型在深圳市宝安区范围内评估乳腺癌高危人群的应用价值。方法：回顾性调查103例乳腺癌患者及317例正常对照组的年龄、乳腺疾病史、家族史、初潮年龄、初产年龄、乳腺活检情况、种族等资料,应用Gail乳腺癌风险评估模型回顾性评估5年前乳腺癌发病风险,并分析模型的诊断试验的价值。结果：乳腺癌组中98例及正常对照组中20例,经模型评估后提示有5年内乳腺癌发病高风险。Gail模型应用的诊断试验评价结果为灵敏度0.951,特异度0.937,阳性预测值0.831。结论：Gail乳腺癌风险评估模型对乳腺癌发病高风险人群的预测价值较高,可作为社区乳腺癌筛查发现高风险人群的工具之一。     

绝经前乳腺癌患者的风险因素及其与分子亚型的关系分析

目的 分析绝经前乳腺癌患者的风险因素及其分子亚型的关系。方法 240例行乳腺检查或治疗者,将其中120例绝经前乳腺癌患者作为病例组,另将120例乳腺良性疾病或行乳腺健康检查的绝经前人群作为对照组。比较两组的基本资料,分析乳腺癌分子亚型患病率,采用单因素及多因素Logistic回归分析绝经前乳腺癌及其分子亚型的危险因素。结果 两组性别、年龄、身高、文化程度及职业比较,差异无统计学意义(P>0.05)。病例组避孕药物服用史、超重/肥胖史和乳腺良性疾病史占比分别为80.0%、47.5%、15.8%,均高于对照组的47.5%、20.8%、5.8%,差异有统计学意义(P<0.05);两组健身运动、生育史、月经周期、月经量、饮酒、吸烟、乳腺癌家族史、放射性物质接触史比较,差异无统计学意义(P>0.05)。多因素Logistic回归分析显示,避孕药物服用史、超重或肥胖史和乳腺良性疾病为绝经前乳腺癌的独立危险因素(P<0.05)。根据乳腺癌患者术后免疫组化结果 ,乳腺癌分子亚型最常见的分子亚型为乳腺癌管腔上皮A型(Luminal A),占49.2%,预后较差的三阴性占20.8%...     

2694例知识女性绝经年龄的调查分析

目的调查上海城区知识女性自然绝经年龄的状况,分析初潮年龄及生育史对绝经年龄的影响。方法选取2009年来院体检的自然绝经的知识女性进行调查,调查内容包括初潮年龄、初产年龄、孕产次数、绝经年龄等。结果上海地区知识女性平均自然绝经年龄(49.86±4.1)岁。初产年龄越早、孕产次数越多,绝经年龄越晚。结论绝经年龄与初产年龄、孕产次数有关,与初潮年龄无明显关系。     

女性乳腺癌危险因素的调查与分析

目的调查分析女性乳腺癌的危险因素,为乳腺癌的防治提供依据。方法采用问卷调查方法,对川北医学院附属医院2005年1月至2010年12月260例女性乳腺癌患者临床资料进行调查。用SPSS17.0对调查数据进行分析。结果所调查患者中,发病年龄27～87岁,人工流产次数多、初产年龄晚、初潮闭经年龄早、有乳腺良性肿瘤史及乳腺癌家族史者所占比例相对较高,有人工流产史的女性患者数是未流产患者的2.56倍。结论人工流产次数多,乳腺良性肿瘤史及乳腺癌家族史是本地区女性乳腺癌的重要危险因素。     

温州市社区绝经后妇女骨质疏松症发生因素分析

目的初步了解温州市社区绝经后骨质疏松症（OP）的发生情况,并探讨年龄、初潮年龄、绝经年龄、绝经年限、生育次数、哺乳时间与绝经后OP发病的关系。方法对入选温州市两个社区的912例绝经后妇女进行定量超声骨密度测定、一般医学检查及问卷调查,了解OP的发生率,观察不同年龄、月经初潮年龄、生育次数、哺乳时间、绝经年龄及绝经年限的OP发生情况,并进行单因素卡方检验。将有意义的因素再纳入多因素Logistic回归分析,统计有意义的变量,给出OR值与95%可信区间。结果 912例绝经妇女年龄（61.6±6.7）岁,初潮年龄（16.0±1.8）岁,绝经年龄（50.0±3.8）岁,绝经年限（11.6±7.9）年。非骨质疏松者599例（65.7%）,骨质疏松者313例（34.3%）。多因素Logistic回归分析结果显示OP的危险因素是年龄与绝经年限。结论初潮年龄、绝经年龄、生育次数、哺乳时间与绝经后O P的发生无显著相关性,年龄和绝经年限是温州市社区绝经后妇女发生O P的独立危险因素。     

成年妇女1490例乳腺筛查结果分析

目的通过乳腺筛查对成年女性乳腺健康状况进行评估,并评价乳腺筛查在乳腺癌早期诊断中的价值。方法选择成年妇女1490例,由受检者本人填写妇女乳腺健康状况调查表,由乳腺专科人员进行乳腺触诊查体、高频彩色超声检查及高频钼靶X线片,根据3项检查结果作出总结报告,评估受检者乳腺健康状况。观察乳腺疾病患病情况及其年龄和职业分布情况。结果本组1490例妇女中,经病理学检查证实为乳腺癌6例（0.40%）,重度乳腺增生145例（9.73%）,乳腺纤维腺瘤39例（2.62%）,乳腺囊肿13例（0.87%）,乳房脂肪瘤3例（0.20%）,乳头异常溢液17例（1.14%）。乳腺疾病以40～44岁和大学老师职业中患病率最高。结论我国女性乳腺健康状况令人担忧,乳腺筛查可提高乳腺疾病诊断率,发现早期癌症,做到早发现、早诊断、早治疗,提高妇女的生存质量。     

散发性乳腺癌组织中BRCA1、BRCA2及P21^waf表达及临床意义

目的检测散发性乳腺癌组织中BRCA1、BRCA2及P21^waf的表达,探讨BRCA1、BRCAZ及P21^waf在乳腺癌发生、发展中的作用。方法采用免疫组化Envision法检测90例散发性乳腺癌组织及35例乳腺腺病组织中BRCA1、BRCA2及P21耐蛋白的表达。结果BRCA1在乳腺腺病及散发性乳腺癌组织中的表达率分别为97．14％（34／35）、71．11％（64／90）。BRCA1与组织学分级、肿瘤大小、淋巴结转移情况及患者年龄无相关性。BRCA2在二者中的表达率为91．43％（32／35）、73．33％（66／90）。BRCA2与患者年龄有相关性,与组织学分级、肿瘤大小和淋巴结转移情况无相关性。乳腺腺病组织中不表达P21^waf,在散发性乳腺癌组织中P21^waf表达率为57．78％（52／90）。BRCA1与P21^waf蛋白的表达无相关性（P〉0．05）。结论BRCA1、BRCA2及P21^waf蛋白异常表达可能在散发性乳腺癌的发生发展过程中起作用。     

乳腺癌易感基因1在散发性乳腺癌组织中的表达

目的 探讨乳腺癌易感基因（BRCA1）蛋白在散发性乳腺癌组织中的表达.方法 收集86例乳腺癌及癌旁组织、48例乳腺增生症手术标本,采用免疫组化S-P法检测BRCA1蛋白的表达情况.结果 BRCA1表达在乳腺癌、乳腺癌旁组织、乳腺增生症中的阳性率分别为11.6%（10/86）、16.3%（14/86）和100%（48/48）,三组间比较差异有统计学意义（P＜0.01）.结论 BRCA1蛋白异常表达在散发性乳腺癌发生发展过程中起着一定作用.     

乳腺癌患者血清胰岛素样生长因子-1及结合蛋白-3的变化及意义

目的探讨乳腺癌患者血清胰岛素样生长因子-1（IGF-1）、胰岛素样生长因子结合蛋白-3（IGFBP-3）和两者比率的变化及临床意义。方法80例良性乳腺肿瘤和135例乳腺癌患者术前采集空腹血分离血清-30℃冻存，用ELISA法测定标本的IGF-1和IFGBP-3浓度，用免疫组化法检测乳腺癌标本nm23基因。结果乳腺癌和良性乳腺肿瘤两组间IGF-1浓度和IGF-1：IFGBP-3呈高度显著差异（P〈0．01）．而IGFBP-3差异无显著意义（P〉0．05）。乳腺癌患者绝经前后IGF-1差异有显著意义（P=0．04），绝经前或有淋巴结转移的乳腺癌患者IGF-1：IGFBP-3明显高于绝经后或无淋巴结转移的乳腺癌患者。nm23阳性和阴性的乳腺癌之间血清IFGBP-3浓度差异有显著意义（P=0．01），但IGF-1浓度差异无显著意义。结论检测血清IGF-1、IGFBP-3有助于筛选和确定乳腺癌高危患者，从而有利于早期诊断及判断预后。     

乳腺肿块248例临床分析

目的 观察乳腺肿块的诊断及病理特征. 方法 回顾性分析248例乳腺肿块患者的临床资料. 结果 乳腺良性肿瘤222例（89.5%）,乳腺恶性肿瘤（均为乳腺癌,均为35岁以上）26例（10.5%）;乳腺良性肿瘤中乳腺纤维瘤128例（51.6%,15～24岁105例）、乳腺增生症49例（19.7%,35～44岁43例）、乳腺发育症23例（9.3%,均为14岁以下）、乳腺脂肪瘤8例（3.2%）、乳腺慢性炎症7例（2.8%）、导管内乳头状瘤7例（2.8%）. 结论 乳腺肿块主要以良性病变为主,但对于35岁以上患者应警惕乳腺癌的可能.     

Should tamoxifen be used in breast cancer prevention?

Breast cancer is the most commonly diagnosed cancer in women. The risk of developing breast cancer can be lowered by maintaining a healthy bodyweight and avoiding long-term use of combined estrogen and progestogen replacement after menopause. However, many women are at an increased risk of developing breast cancer secondary to age, early menarche, a family history of breast cancer or a personal history of benign breast disease. These women may now be offered tamoxifen as a chemoprevention therapy. Five years of tamoxifen treatment results in a reduction in the relative risk of developing estrogen receptor-positive breast cancer of 48%. This benefit outweighs the risk of tamoxifen-related adverse events for many healthy women. However, the benefit-risk ratio of tamoxifen chemoprevention varies for individual women. The randomized clinical trials evaluating standard-dose tamoxifen versus placebo as chemoprevention therapy are reviewed and analyzed to determine which particular women are most likely to benefit and least likely to experience a tamoxifen-related adverse event. Tamoxifen decreases the risk of breast cancer associated with aging, having a first-degree relative with disease, and a personal diagnosis of atypical ductal hyperplasia or lobular carcinoma in situ. Women who have had a hysterectomy and are at low risk of a thromboembolic event have a decreased risk of adverse effects associated with tamoxifen therapy. The strengths and weaknesses of the Gail model (frequently used to assess an individual's risk of developing invasive breast cancer over the next 5 years) are highlighted. A method for assessing the benefit-risk ratio for an individual woman is presented. Alternative breast cancer chemoprevention strategies are considered, including the use of aromatase inhibitors. This article discusses the pros and cons of these various preventive therapies and concludes that at this time, tamoxifen remains the gold standard for breast cancer prevention.     

基于Caprini血栓风险评估模型对妇科恶性肿瘤相关静脉血栓形成的风险预测

目的 探究Caprini血栓风险评估模型以及新建立的模型对妇科恶性肿瘤相关静脉血栓(VTE)形成的风险预测价值.方法 选取2015年1月-2020年6月湖南省肿瘤医院妇科恶性肿瘤并发VTE的患者161例,依据1:2的比例抽取同期322例妇科恶性肿瘤患者为对照组.收集两组患者的临床资料,分析影响妇科恶性肿瘤相关VTE发生...     

Cytochrome P450 CYP1B1 and catechol O-methyltransferase (COMT) genetic polymorphisms and breast cancer susceptibility in a Turkish population

Epidemiological studies indicate that most risk factors for breast cancer are related to reproductive and hormonal factors. Estrogen has been proposed to trigger breast cancer development via an initiating mechanism involving its metabolite, catechol estrogen (CE). Because of the important role of cytochrome P450 1B1 ( CYP1B1) and catechol O-methyltransferase ( COMT) in mammary estrogen and carcinogen metabolism, we examined the CYP1B1 and COMT genes to determine whether genetic variations could account for inter-individual differences in breast cancer. In this case-control study, we determined CYP1B1 and COMT genotypes in 84 breast cancer patients and 103 healthy unrelated women controls from a Turkish population. In the case of CYP1B1, we genotyped CYP1B1*3 (L432 V) allele. We found that carriers of the CYP1B1*3 allele were more frequent among breast cancer patients with adjusted odds ratio (OR) for age, age at menarche, age at first full-term pregnancy, body mass index (BMI) and smoking status of 2.32 (95% confidence interval 1.26-4.25) associated with the allele. However, this allele appeared to be a significant factor for susceptibility only in patients with a BMI greater than 24 kg/m(2). Menopausal status did not appear to affect susceptibility. In the case of COMT, there was no significant difference in susceptibility for breast cancer development between patients with low activity COMT-L (V158 M) allele and high activity COMT-H allele, and susceptibility was not affected by menopausal status, BMI or CYP1B1 genotype. We conclude that the CYP1B1* 3 allele appears to be a factor for susceptibility to breast cancer in Turkish women especially those with a BMI greater than 24 kg/m(2).     

Effects of glutathione-S-transferase polymorphisms on the risk of breast cancer: A population-based case–control study in Pakistan

Cancer is widely accepted as one of the major health issues. Diet composition and exposure to environmental genotoxic and carcinogenic agents such as polycyclic aromatic hydrocarbons (PAHs) are among the causative factors for various types of cancers, including breast cancer. Low penetrance genes including glutathione S transferases (GST) in association with environmental factors can contribute greatly in the development of breast cancer. We were interested to investigate the association of the polymorphisms of GSTM1, GSTT1, GSTP1 and GSTO2 with the risk of breast cancer in the Pakistani population. One hundred women visiting the Department of Radiology and Oncology, Nishter Hospital, Multan with pathologically confirmed breast cancer, and 100 healthy volunteers from central Pakistan were enrolled in the present study. The strength of the association of various factors with breast cancer was measured by calculating odd ratios (ORs) which were determined by logistic regression. All P values cited are two-sided; differences resulting in a P value of less or equal to 0.05 were declared statistically significant. The Hardy Weinberg equilibrium was tested for the genotype proportions in the control group, as a measure of quality control. Those aged 36–45, in menopause or with a history of cancer in the family had a significantly higher prevalence of breast cancer compared with controls. The frequency of GSTM1 and GSTT1 was similar in both control and patients suggesting no association with the risk of cancer development, however GSTM1 and GSTT1 were significantly linked with the risk of breast cancer in smokers and in women with a history of breast cancer in the family respectively. Similarly women homozygous for GSTP1 or GSTO2 and with a history of breast cancer, or in menopause, were at greater risk of breast cancer than wild type or heterozygotes. Our data suggest that genetic differences in some GST genes may be linked with an increased susceptibility to breast cancer. Furthermore it also gives an insight into the interaction between the GST polymorphisms and pre-menopausal diagnosis of breast cancer.     

女性月经生育因素与乳腺癌关系的Meta分析——10个病例对照研究的综合分析

本文应用Meta—analysis方法对国内10个有关女性月经、生育因素与乳腺癌关系的病例对照研究进行了定量综合分析。文中介绍了固定效应模型和随机效应模型方法并进行了数据分析。结果无生育者患乳腺癌的综合OR(95％可信限)为1.65(1.26—2.16);初潮年龄越小、月经周期越短、初婚年龄越大、初产年龄越高、生育次数越少、哺乳时间越短患乳腺癌的OR值上升,存在剂量反应关系。另对方法和结果进行了讨论和解释。     

一种基于体内CTC捕获的CellCollector®技术对乳腺癌患者分层的价值

目的　探讨基于CellCollector®技术捕获的循环肿瘤细胞（CTC）用于筛选转移风险较高的乳腺癌患者的可能性。方法　入组60例原发性乳腺癌患者为乳腺癌组,其中Ⅰ期16例、Ⅱ期29例、Ⅲ期11例、Ⅳ期4例。通过CellCollector®进行至少1次外周血CTC检测,并随访4～19个月。同时入组10例健康女性志愿者作为对照组,仅进行1次CTC检测。分析不同年龄、绝经情况、TNM分期、分子分型、Ki-67表达程度患者CTC阳性率的差异。结果　乳腺癌组基线CTC检出率为73.33%;Ⅰ~Ⅳ期检出率分别为43.75%、82.76%、81.82%和100%,不同临床分期下CTC检出率差异有统计学意义。不同年龄、是否绝经、不同分子分型及Ki-67表达程度患者CTC检出率差异均无统计学意义。24例行2次CTC检测。4例疾病进展患者中,1例CTC数目增多;20例无疾病进展患者中,3例CTC数目增加。CTC数目动态变化与疾病进展不存在相关性。结论　CellCollector®体内CTC检测技术在非转移性乳腺癌中检出率较高,为CTC筛选转移风险较高的乳腺癌患者提供了可能。     

The impact of body mass index and type 2 diabetes on breast cancer: current therapeutic measures of prevention

Epidemiological data have suggested a possible relationship between obesity, diabetes mellitus and cancer risk, particularly breast cancer. We set out to investigate the effect of body mass index and diabetes mellitus on the presence of breast cancer in the Apulian population. We selected 1,663 women affected with primary breast cancer and 4,702 control patients. All patients with breast cancer underwent surgical excision of the tumor and their tumors were histologically confirmed. The prevalence of type 2 diabetes (8%) in the women affected by breast cancer was significantly higher than in the control group (5%) (p<0.05). The majority of the diabetic women affected by breast cancer had a BMI value >25, both in premenopause and in postmenopause. With respect to BMI, the non-diabetic patients with breast cancer in postmenopause showed the same pattern as the diabetic ones. Instead, among the women in premenopause a higher percentage (55%) of patients with a BMI <24.9 was found (p<0.01). In the Apulian population, the presence of both type 2 diabetes and elevated values of BMI (that is in a condition of hyperinsulinemia) were found to enhance the frequency of breast cancer.     

老年晚期肺癌并发急性非大面积肺栓塞的高危因素分析

目的 分析老年晚期肺癌急性非大面积肺栓塞的高危因素。方法 选择2016年1月至2019年5月在长沙市第三医院治疗的老年肺癌病人220例作为研究对象,根据是否合并急性非大面积肺栓塞,分为肺癌组和合并肺栓塞组。统计肺癌病人合并急性非大面积肺栓塞的发生情况,采用单因素分析影响老年晚期肺癌急性非大面积肺栓塞的相关因素;采用多因素logistic回归分析影响老年晚期肺癌急性非大面积肺栓塞的危险因素。调查因素包括性别、年龄、体质量指数（BMI）、吸烟史、手术史、肺栓塞病史、病理类型、肿瘤分期（tumor node metastasis classification,TNM）、中心静脉穿刺置管、辅助化疗、血红蛋白、D-二聚体、癌胚抗原。结果 纳入的老年晚期肺癌病人220例中,合并急性非大面积肺栓塞62例,发生率为28.18%。经单因素分析结果显示,两组性别、年龄、BMI、手术史、肺栓塞史、中心静脉穿刺置管、D-二聚体和癌胚抗原水平比较差异无统计学意义（P>0.05）;两组有吸烟史（38.46%比61.54%）、病理类型腺癌（44.19%比55.81%）、TNM分期Ⅳ期（43.42%比56.58...     

289 例Luminal B 型乳腺癌患者预后的相关因素分析

目的探讨Luminal B型乳腺癌患者预后的影响因素。方法收集2015年1月—2016年12月我院收治的289例Luminal B型乳腺癌患者的临床及随访资料,对血小板/淋巴细胞比值(PLR)、红细胞体积分布宽度(RDW)行受试者工作特征(ROC)曲线分析,计数资料采用χ^2检验及Fisher确切概率法,Kaplan-Meier法绘制生存曲线,组间比较采用Log-rank检验,预后分析采用COX多因素回归模型。结果高、低PLR组乳腺癌患者的无病生存率(DFS)分别为82%(77/94)、94.9%(185/195),高、低RDW组乳腺癌患者DFS分别为85.3%(139/163)、97.6%(123/126)。单因素分析显示,生育史、腋窝淋巴结、病理分期、脉管癌栓、PLR、RDW、辅助化疗、内分泌治疗是影响Luminal B型乳腺癌患者预后的危险因素(P<0.05)。COX多因素分析显示,生育史、RDW、辅助化疗、内分泌治疗是影响Luminal B型乳腺癌患者预后的独立危险因素(P<0.05)。结论Luminal B型乳腺癌术前RDW测定具有一定的预测价值,RDW升高可提示预后不良;无生育史或首次生育年龄≥35岁的Luminal B型乳腺癌患者复发风险较高。