A meta-analysis of the prognosis in patients with breast cancer with ipsilateral supraclavicular lymph node metastasis versus patients with stage IIIb/c or IV breast cancer

ObjectiveTo systematically evaluate the prognosis in patients with breast cancer with ipsilateral supraclavicular lymph node metastasis (SLNM) versus patients with stage IIIb/c or IV breast cancer, so as to provide evidence for clinical practice and research.MethodsComputer retrieval from PubMed, Cochrane Libratory, CNKI (China National Knowledge Infrastructure), CBM and Wanfang Database with the assistance of other retrieval tools. All the studies evaluating the prognosis in patients with breast cancer with ipsilateral supraclavicular lymph node metastasis versus patients with stage IIIb/c or IV breast cancer were collected. Quality assessment was performed for the included data based on the quality assessment criteria appropriate for this study. Meta-analysis was performed using RevMan 5.3 software.ResultsA total of four references (1277 patients) were included. Assessment of influences on prognosis: As compared to the stage IIIb/c group, the 5-year survival rate was slightly lower in the SLNM group (relative risk (RR) 0.79; 95% confidence interval (CI) 0.59–1.06; Z = 1.55, P = 0.12), but there was no statistical significance; in contrast, the 5-year survival rate was significantly increased in the SLNM group as compared to the stage IV group (RR = 2.70; 95%CI: 1.36–5.37; Z = 2.84, P = 0.005). As compared to the stage IIIb/c group, the 5-year disease-free survival rate was lower in the SLNM group (RR = 0.65; 95%CI: 0.40–1.05; Z = 1.75, P = 0.08); however, there was no statistical significance.ConclusionsIn patients with advanced breast cancer receiving combined therapy, the prognosis in patients with breast cancer with ipsilateral SLNM was significantly better than in those with stage IV breast cancer, and slightly worse than those with stage IIIb/c breast cancer. However, with the scarcity and poor quality of these observational studies, the long-term prognosis remains to be further verified in large-sample, high-quality studies.     

Advances in breast cancer screening modalities and status of global screening programs

Breast cancer (BC) is the most prevalent malignancy worldwide, and a continued upward trend has been predicted in the coming decades. Screening in selected targeted populations, which is effective in reducing cancer‐related mortality, has been widely implemented in many countries. This review summarizes the advances in BC screening techniques, organized or opportunistic BC screening programs across different countries, and screening modalities recommended by different academic authorities. Mammography is the most widely used and effective technique for BC screening. Other complementary techniques include ultrasound, clinical breast examination, and magnetic resonance imaging. Novel screening tests, including digital breast tomosynthesis and liquid biopsies, are still under development. Globally, the implementation status of BC screening programs is uneven, which is reflected by differences in screening modes, techniques, and population coverage. The recommended optimal screening strategies varied according to the authoritative guidelines. The effectiveness of current screening programs is influenced by several factors, including low detection rate, high false‐positive rate, and unsatisfactory coverage and uptake rates. Exploration of accurate BC risk prediction models and the development of risk‐stratified screening strategies are highly warranted in future research.     

SIAH2蛋白表达对评估乳腺癌患者预后的临床意义

目的测定乳腺癌组织、乳腺纤维腺瘤组织及癌旁正常组织中SIAH2蛋白的表达情况,分析SIAH2蛋白表达与乳腺癌的相关性,并探讨其对评估患者5年无瘤生存的临床意义。方法选取2009年11月至2011年5月乐山市人民医院收治的74例乳腺癌患者(34例乳腺浸润性导管癌以及40例乳腺导管内癌)为研究对象,通过蛋白定量检测74例乳腺癌组织、30例乳腺纤维腺瘤组织和21例癌旁正常组织中SIAH2蛋白的表达情况,分析其与乳腺癌的相关性及其与患者5年无瘤生存的关系。结果乳腺浸润性导管癌组织SIAH2蛋白条带灰度值(200.54±62.89)显著高于乳腺导管内癌组织(142.15±48.02)(P<0.05),且乳腺浸润性导管癌组织和乳腺导管内癌组织SIAH2蛋白条带灰度值均明显高于乳腺纤维腺瘤组织(90.67±35.68)和癌旁正常组织(82.18±34.10)(P<0.05);浸润性导管癌SIAH2阳性与腋窝淋巴结转移、肿瘤分期具有显著相关性(P<0.05)。生存分析显示,SIAH2阳性表达的乳腺癌患者5年无瘤生存期和生存率分别为(44.3±3.8)个月和69.2%,均明显低于SIAH2阴性表达的乳腺癌患者[(55.5±2.5)个月和91.4%](P<0.05)。Cox比例风险模型显示,肿瘤分期和SIAH2可能是乳腺浸润性导管癌患者5年无瘤生存的危险因素(P<0.05)。结论 SIAH2参与乳腺癌的发生、发展,检测其表达有助于乳腺癌的早期诊断,且可能预测乳腺癌患者5年无瘤生存。     

乳腺癌患者血清炎性因子、CTGF、Six1水平及临床意义分析

目的检测乳腺癌患者血清炎性因子、结缔组织生长因子(connective tissue growth factor,CTGF)、同源盒异型蛋白Six1水平,并分析其临床意义。方法将2013年8月至2016年8月本院收治的117例乳腺癌患者、89例乳腺良性疾病患者及70例健康体检者分别纳入乳腺癌组、乳腺良性疾病组、健康对照组,均为女性受试者。检测三组受试者血清白介素(interleukin,IL)-6、IL-8、IL-10、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、CTGF及Six1水平,并比较不同病理参数乳腺癌患者上述血清指标的差异,分析其临床意义。结果乳腺癌组患者血清IL-6、IL-8、TNF-α、CTGF、Six1水平均高于乳腺良性疾病组和健康对照组(P<0.05),IL-10水平低于乳腺良性疾病组和健康对照组(P<0.05);乳腺良性疾病组患者血清IL-6、IL-8、TNF-α、CTGF、Six1水平均高于健康对照组(P<0.05),IL-10水平低于健康对照组(P<0.05)。随着乳腺癌患者临床分期、组织学分级的增加及发生淋巴结转移,其血清IL-6、IL-8、TNF-α、CTGF、Six1水平均逐渐升高(P<0.05),IL-10水平逐渐下降(P<0.05)。肿瘤直径<2 cm患者与肿瘤直径≥2 cm患者的血清IL-6、IL-8、IL-10、TNF-α、CTGF水平比较均有显著差异(P<0.05)。Pearson相关性分析显示,IL-6、IL-8、TNF-α、CTGF、Six1水平间互相呈正相关(P<0.05),且均与IL-10水平呈负相关(P<0.05)。结论血清炎性因子及CTGF、Six1在乳腺癌的发生、发展中均扮演了重要角色,且各指标间具有显著相关性,检测乳腺癌患者血清上述指标变化对评估病情进展、指导治疗方案、评估预后均有一定参考价值。     

Clinical observation and therapeutic evaluation of intravenous pump of recombinant human endostatin combined with TP regimen in treating patients with advanced ovarian cancer

ObjectivesTo observe the curative effects and adverse reactions of recombinant human (rh)-endostatin injection combined with a TP regimen for treating patients with advanced ovarian cancer.MethodsFifty-four patients with pathologically confirmed ovarian cancer were randomly divided into a combined treatment (intravenous pump of rh-endostatin + TP regimen) group and a control (single chemotherapy) group, twenty-seven patients in each group. All patients were given a conventional CT examination. The level of vascular endothelial growth factor (VEGF), the size of tumor before treatment, after 2 cycles and after 4 cycles of treatment were determined for the comparison of curative effects and adverse reactions.ResultsThe effective rate was 37.0% (10/27) and disease control rate was 63.0% (17/27) in the combined treatment group after 2 cycles of treatment. The effective rate was 25.9% (7/27) and disease control rate was 63.0% (17/27) in the control group. The comparison between these two groups showed no significant differences (P > 0.05). The effective rate was 63.0% (17/27) and disease control rate was 92.6% (25/27) in the combined treatment group after 4 cycles of treatment. The effective rate was 29.6% (8/27) and disease control rate was 63.0% (17/27) in the control group. The effective rate and disease control rate between these two groups after 4 cycles of treatment showed significant differences (P < 0.05). The incidences of cardiovascular toxicity, myelosuppression, sore muscles and joints, alopecia and gastrointestinal reaction was not significantly different between two groups (P > 0.05).ConclusionThe pump delivery of rh-endostatin can down-regulate the expression of VEGF in ovarian cancer and has the better curative effect and slighter adverse reactions.     

不同年龄女性乳腺癌患者手术前后负面情绪和生存质量调查研究

目的调查不同年龄女性乳腺癌患者手术前后负面情绪和生存质量。方法选取2016年7月至2018年2月于本院行手术治疗的139例女性乳腺癌患者为研究对象,根据年龄分为青年组(<45岁,26例)、中年组(45～59岁,47例)及老年组(≥60岁,66例),分别于术前和术后6个月,采用汉密尔顿焦虑量表(Hamilton anxiety scale,HAMA)、汉密尔顿抑郁量表-24项(Hamilton depression scale 24 items,HAMD-24)、乳腺癌患者生命质量测定调查表(quality of life questionnaire-breast cancer module 23,QLQ-BR23)评估三组患者焦虑、抑郁状况及生存质量。结果三组患者文化程度比较差异有显著性(P <0.05)。三组患者术前躯体性焦虑、精神性焦虑评分、HAMD-24总分、QLQ-BR23功能维度和症状维度标准分比较差异均无显著性(P_均> 0.05)。术后6个月,三组患者躯体性焦虑、精神性焦虑评分及HAMD-24总分均显著高于本组术前(P_均<0.05),QLQ-BR23功能维度和症状维度标准分均显著低于本组术前(P_均<0.05),青年组患者躯体性焦虑评分、QLQ-BR23功能维度标准分均显著低于中年组和老年组(P_均<0.05),精神性焦虑评分和QLQ-BR23症状维度标准分均显著高于老年组(P_均<0.05),HAMD-24总分显著高于中年组和老年组(P_均<0.05)。结论女性乳腺癌患者术后负面情绪明显加重,生存质量显著降低,其中老年患者以精神性焦虑为主,应更加关注其不适症状;中青年患者以躯体性焦虑和抑郁为主,应更加关注其身体功能变化。     

氟比洛芬酯注射液联合硫酸吗啡缓释片治疗中、重度癌痛患者的效果分析

目的研究氟比洛芬酯注射液联合硫酸吗啡缓释片对中、重度癌痛患者疼痛及生活质量的影响。方法将本院94例中、重度癌痛患者随机分为观察组及对照组。观察组患者采取氟比洛芬酯联合硫酸吗啡缓释片治疗,对照组患者采取硫酸吗啡缓释片治疗。比较治疗后两组患者视觉模拟评分法(VAS)评分、欧洲癌症研究与治疗组织生活质量测定量表(EORTC QLQ-C30)评分及不良反应发生情况。结果治疗后观察组患者VAS评分明显低于对照组(P<0.01),疼痛控制率明显高于对照组(P<0.05)。两组患者EORTC QLQ-C30评分比较,观察组患者功能量表5项评分均高于对照组(P<0.05),且症状量表及单一症状量表中疼痛及失眠项目评分均低于对照组(P<0.01),总体健康量表评分明显高于对照组(P<0.01)。两组患者不良反应发生率比较无明显差异(P>0.05)。结论氟比洛芬酯注射液联合硫酸吗啡缓释片可有效改善中、重度癌痛患者的临床症状,提高患者生存质量,且不增加不良反应。     

术前肠内营养对老年乳腺癌患者围术期肠黏膜屏障功能、免疫功能和营养状况的影响

目的探究术前肠内营养对老年乳腺癌患者围术期肠黏膜屏障功能、免疫功能和营养状况的影响。方法将本院2014年8月至2017年10月收治的106例老年女性乳腺癌患者纳入本研究。采用随机数表法将入选患者分为观察组和对照组,每组各53例。两组患者术前均给予常规治疗和饮食干预,观察组患者在此基础上联合肠内营养支持治疗。比较两组患者干预前和术后7 d肠黏膜屏障功能、免疫功能和营养状况。结果观察组患者术后7 d血清降钙素原和D-乳酸水平均显著低于本组干预前和同期对照组(均P <0.05)。对照组患者术后7 d血清降钙素原和D-乳酸水平均显著高于本组干预前(均P <0.05),血清免疫球蛋白G、免疫球蛋白A、免疫球蛋白M、总蛋白、白蛋白水平和总淋巴细胞计数均显著低于本组干预前和同期观察组(均P <0.05)。观察组患者干预前和术后7 d免疫球蛋白G、免疫球蛋白A、免疫球蛋白M、血清总蛋白和白蛋白水平比较差异均无统计学意义(均P> 0.05)。两组患者干预前和术后7 d心理状态均无明显变化(均P> 0.05),且组间比较差异均无统计学意义(均P> 0.05)。结论术前肠内营养能够改善老年乳腺癌患者术后肠黏膜屏障功能,减轻手术创伤,改善应激所致免疫功能和营养状况变化,有望缩短患者住院天数、促进其早日康复,值得临床推广。     

Effects of adding tripterygium glycosides to angiotensin-converting enzyme inhibitors or angiotensin receptor blockers on albuminuria in patients with diabetic nephropathy

IntroductionTripterygium glycosides (TGs) have been widely used in China to treat diabetic nephropathy (DN); however, proof of their use is scarce. The present study aimed to evaluate the effectiveness and safety of adding TGs to angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs).MethodsBy searching Embase, MEDLINE, Cochrane Library, SINOMED, China National Knowledge Infrastructure, VIP Information/Chinese Scientific Journals, and WANFANG databases, we identified previous studies that met the specific selection criteria and included them in the meta-analysis. Analyses were performed using Review Manager (version 5.3).ResultsNine randomized controlled trials were included in the final meta-analysis. Patients were compared before and after treatment with ACE inhibitors or ARBs plus TGs, or ACE inhibitors or ARBs alone. The results revealed that treatment with ACE inhibitors or ARBs plus TGs resulted in significantly greater reductions in 24-h urinary total protein (UTP) levels (trial duration <2 months, mean difference [MD]: −0.25; 95% confidence interval [CI]: −0.32, −0.18; trial duration between 2 and 6 months, MD: −0.39; 95% CI: −0.44, −0.33; trial duration >6 months, MD: −2.09; 95% CI: −2.89, −1.29) compared with treatment using ACE inhibitors or ARBs alone. Additionally, ACE inhibitors or ARBs plus TGs showed better results after long-term administration. Treatment with ACE inhibitors or ARBs plus TGs resulted in significantly greater reductions in serum creatinine (SCr) compared with ACE inhibitors or ARBs alone (MD: −9.87; 95% CI: −13.76, −5.97).ConclusionIn patients with DN, adding TGs to ACE inhibitors or ARBs significantly lowered both the 24-h UTP and SCr levels. Therefore, ACE inhibitors or ARBs plus TGs might improve the treatment of DN in patients.     

Symptom frequency and development of a generic functional disorder symptom scale suitable for use in studies of patients with irritable bowel syndrome,fibromyalgia syndrome or chronic fatigue syndrome

ObjectivesTo describe the extent to which irritable bowel syndrome (IBS), fibromyalgia syndrome (FMS), and chronic fatigue syndrome (CFS) exhibit symptom overlap, and to validate a patient-derived, generic symptom questionnaire.MethodsA patient-derived 61-item symptom-frequency questionnaire was completed by participants recruited through IBS, FMS and CFS self-help websites. Principal axis factor analysis with oblimin rotation was performed separately for those reporting an IBS, FMS or CFS diagnosis.ResultsQuestionnaires were completed by 1751 participants of whom 851 reported more than one of the three diagnoses. Stomach pain on at least a weekly basis was reported by 79% of IBS, 52% of FMS, and 43% of CFS single diagnosis participants. Pain increasing the day after activity was reported by 32% of IBS, 94% of FMS, and 85% of CFS single diagnosis participants. Waking still tired at least once weekly was reported by 75% of IBS, 97% of FMS, and 95% of CFS single diagnosis participants. Exploratory factor analysis produced consistent results across all three diagnostic groups, the 61 items loading on 12 correlated factors with a single higher order factor on which all items loaded. Frequency analysis led to the rejection of one item (cold sores on or near lips), and freeform reporting by participants of additional symptoms identified an additional five, namely, restless legs, hair loss/brittle hair/thinning, dizziness/balance problems, blurred vision and urination problems.ConclusionsIBS, FMS and CFS are polysymptomatic spectrum disorders with a wide range of overlapping symptoms, many of which are unrelated to diagnostic criteria. Frequency analysis and factor analysis confirm the validity of using the same questionnaire across different diagnostic categories. The 65-item general symptom questionnaire (GSQ-65) is a valid generic symptom scale suitable for assessing the many different symptoms of people with IBS, FMS and CFS.