早期乳腺癌的诊断

乳腺癌是危害妇女健康的主要疾病 ,近 2 0年来对乳腺癌的治疗方法几经改进 ,生存期虽有明显延长 ,但其患病率在不断上升 ,死亡率仍无下降趋势。其根本原因是目前临床发现的乳腺癌多为中、晚期 ,真正早期乳腺癌发现比例甚少。探索如何早期诊断乳腺癌至关重要 ,早期发现 ,早期诊断 ,早期治疗是提高乳腺癌患者生存期关键的问题。本文就有关乳腺癌早期诊断进行综述。1　早期乳腺癌的含义　　早期乳腺癌以往多数学者把肿瘤直径 <2ｃｍ ,腋下淋巴结不可触及即相当于ＵＩＣＣ分期 1期的乳腺癌定为早期乳腺癌[1] 。目前是指ＴＮＭ分期处于Ｔ1期和部…     

115例乳腺癌患者社区随访资料分析

目的 探讨乳腺癌患者的年龄分布、病理分期、治疗方式等因素对生存情况的影响.方法 对上海市川沙镇1997-2007年确诊的115例乳腺癌患者社区随访资料进行分析.结果 乳腺癌发病高峰年龄为45～49岁,进行手术、化疗加内分泌治疗的生存率达90.32%.乳腺癌患者生存情况与确诊时病理分期有关,发现越早生存情况越好(x2=49.380 9,P＜0.001).结论 乳腺癌生存率与早期发现、早期诊断、早期治疗和治疗方式有着密切的关系.     

VDR与乳腺癌临床病理因素的关系

目的:研究维生素D受体(VDR)在乳腺癌组织中的表达,初步探讨维生素D受体与乳腺癌各病理类型、雌孕激素受体表达情况、肿瘤大小、患者年龄及临床分期的相关性。分析VD/VDR对乳腺癌治疗的意义。方法:采用免疫组化S-P法对65例乳腺癌组织及30例乳腺良性肿瘤组织进行维生素D受体标记。结果:4种病理类型的乳腺癌组织中VDR的表达有显著性差异(P<0.05),VDR的表达与雌、孕激素受体表达情况、肿瘤大小、患者年龄及临床分期无相关性。结论:在临床上检测VDR并应用VD的类似物进行乳腺癌治疗。     

早期乳腺癌治疗中保留乳房手术的临床效果观察

目的:研究分析早期乳腺癌治疗中保留乳房手术的临床效果.方法:2012年8月至2016年8月期间,对在本院进行保留乳房手术治疗的40例早期乳腺癌患者进行研究,设为观察组,并选取同期在本院进行保留胸大肌手术的早期乳腺癌患者40例作为对照组,所有患者均知情同意并自愿参加本次研究,比较观察组、对照组患者术后乳房外观和生活质量,分析两种治疗方法的效果.结果:观察组患者乳房外观优良率比对照组高,两组数据比较差异有统计学意义(P<0.05);观察组患者身体状况、心理精神状况、社交关系以及日常生活评分均比对照组高,两组数据比较差异有统计学意义(P<0.05).结论:早期乳腺癌治疗中保留乳房手术的临床效果较理想,临床应用价值较高,值得推广应用,但是临床应用时需要严格掌握手术适应证.     

趋化因子受体CCR9在人乳腺癌患者预后中的临床意义

目的探索趋化因子受体CCR9在乳腺癌患者中的预后意义,调查对乳腺癌患者的远端转移及预后是否有临床指导意义。方法通过59例乳腺癌患者的石蜡切片并对其趋化因子受体CCR9进行染色,对免疫组化结果进行其临床分期的相关性研究,并通过每一期癌和癌旁染色对比其临床意义,最后通过预后分析统计其CCR9对乳腺癌患者预后的临床指导意义。结果相比癌旁组织,乳腺癌组织的CCR9表达量显著升高,并随着临床分期的进展而显著升高,高表达CCR9的乳腺癌患者比低表达CCR9的乳腺癌患者的预后意义显著下降(P 0. 05)。结论趋化因子受体CCR9在乳腺癌患者高表达,并且显著影响其生存期,可以作为临床预后的指标之一。     

探讨早期腋窝清扫手术影响老年乳腺癌患者预后的具体情况

目的:重点探索早期腋窝清扫手术对老年乳腺癌患者预后造成的影响。方法:选取的研究对象是2011年1月初至2013年12月底在我院接受治疗的140例老年乳腺癌患者患者,分析患者的临床特点、临床资料及影响预后的因素。结果:分析单因素,淋巴结转移、肿瘤体积增大与疾病进展呈现正相关关系,激素治疗、辅助化疗与疾病进展呈现负相关关系。分析多因素,对照组和观察组疾病进展的风险没有显著差异,存在统计学意义(P0.05)。手术过后,两组老年乳腺癌患者的生活质量均获得了不同程度的改善,观察的生活质量改善程度显然优于对照组,存在统计学意义(P0.05)。结论:老年乳腺癌患者的病理特点和临床特点较为显著,在综合考虑的基础上,确定乳腺癌手术中是否放弃腋窝淋巴结清扫。     

乳腺癌化疗患者生活质量调查及影响因素分析

目的了解和分析乳腺癌化疗患者的生活质量。方法采用自填问卷和中国癌症患者化学生物治疗生活质量量表（QLQ-CCC）对98例接受化疗的乳腺癌患者进行调查,了解他们的生活质量及影响因素。结果化疗后乳腺癌患者生活质量总分提高,与化疗前比较差异有统计学意义（P〈0．01）。化疗后乳腺癌患者在生理方面、精神及心理方面、社会方面和其他方面评分都有所改善,差异有统计学意义（P〈0．01或〈0．05）。年龄、临床分期对化疗中和化疗后患者的生活质量影响显著（p〈0．01）;文化程度对化疗后患者的生活质量有显著影响（P〈0．01）。结论乳腺癌患者化疗过程中生活质量下降,化疗后临床分期早的患者生活质量优于临床分期晚的患者。     

乳腺癌患者手术前后血清CA153水平的变化

目的:为探讨血清CA153水平与乳腺癌分期和预后的关系。方法:采用ELISA法对74例乳腺癌患者手术前后血清CA153进行检测,同期检测了26例乳腺良性疾病患者及40例正常人血清CA153水平。结果:乳腺癌患者血清CA153明显高于乳腺良性疾病组和正常对照组,其术后20天血清CA153水平明显低于术前;乳腺癌患者血清CA153水平与临床分期密切相关,Ⅲ期患者明显高于Ⅰ、Ⅱ期,且术后20天仍保持在较高水平上。结论:血清CA153的表达水平与乳腺癌患者的临床分期和预后密切相关,可作为鉴别乳腺良、恶性疾病的一项参考指标。     

乳腺癌改良根治术治疗早期乳腺癌38例临床分析

目的：探讨乳腺癌改良根治术治疗早期乳腺癌的临床疗效及应用价值。方法：选取本院收治的早期乳腺癌患者作为研究对象,观察组38例采取乳腺癌改良根治术,对照组38例采取乳腺癌根治手术,比较两组患者的3年生存率、5年生存率、复发率、平均住院时间以及并发症发生情况。结果：3年生存率、5年生存率方面两组患者比较差异无统计学意义（P〉0.05）,乳腺癌复发率亦无差别。平均住院时间以及并发症发生情况方面观察组明显优于对照组,差异有统计学意义（P〈0.05）。结论：乳腺癌改良根治术联合化疗治疗早期乳腺癌在临床疗效方面与乳腺癌根治术相当,而在缩短住院时间、减少并发症以及提高患者生活质量方面则具有显著优势,临床在严格掌握其手术适应证的情况下,可考虑将其作为早期乳腺癌的首选治疗方法。     

PAK4在乳腺结构紊乱中的表达及与钼靶X线的相关性

目的：观察PAK4在乳腺结构紊乱组织中的表达,并探讨其与临床影像学在乳腺癌早期诊断中的相关性。方法：对2012年1月-2013年10月在东营市人民医院乳腺科住院手术的150例女性乳腺疾病患者进行了回顾性分析。本院病理科取得患者乳腺标本蜡块,部分患者争取患者同意后行穿刺取乳腺样本。采用HE染色和PAK4免疫组化染色,制作切片在光镜下观察。结果：非增生性病变与乳腺增生伴不典型增生和乳腺癌组进行两两比较,差异有统计学意义（P〈0.05）。乳腺增生伴不典型增生与乳腺癌比较差异有统计学意义（P〈0.05）。乳腺癌组中PAK4染色的表达与临床影像学钼靶与超声诊断呈正相关性。结论：提示PAK4与乳腺癌演进和转移密切相关,对结构紊乱的乳腺疾病有指导手术治疗的意义。     

How well do diagnosis-related group systems group breast cancer surgery patients? Evidence from 10 European countries

We analysed patient-level data (n = 72,235) from 563 hospitals in 10 European countries to assess the ability of national diagnosis-related group (DRG) systems to account for patient-level variation in cost or lengths of stay of breast cancer surgery patients against a standard set of patient characteristics, treatment and quality variables. We find that European DRG systems use very different types of classification variables and numbers of DRGs (range: 3-7) to classify these patients. In 6 of 10 countries, the set of patient characteristics, treatment and quality variables, which we were able to define across countries, perform better than the set of national DRGs in accounting for patient-level variation in resource consumption. Moreover, there appear to be factors that are consistently significant determinants of cost/length of stay of breast cancer surgery cases but are not, or at least not fully, considered in European DRG systems. Our results therefore raise concerns as to whether all systems rely on the most appropriate classification variables. In several countries, policymakers should reevaluate the appropriateness of their DRG algorithm for breast cancer surgery and of specific DRG weights.     

乳腺癌术后化疗患者的心理调查及分析

[目的]探讨乳腺癌术后化疗患者的心理特点,为临床治疗及护理工作提供科学依据。[方法]自制问卷调查表,对2007年6月～2009年12月某院住院接受化疗的68例乳腺癌患者分别进行心理调查。[结果]乳腺癌术后化疗患者普遍存在焦虑、恐惧、悲观等心理反应,年龄、受教育程度和经济状况不同,其心理障碍差异均具有统计学意义(P﹤0.05),患者随年龄的增大其心理障碍发生率降低,高学历患者心理障碍较为显著,患者经济状况越差,越易产生心理障碍。[结论]在乳腺癌术后化疗的过程中,患者易产生焦虑、恐惧、悲观心理等心理问题,医护人员应及时了解患者的心理活动,做好心理护理,改善患者生活质量,促进其尽快康复。     

Trastuzumab in early stage breast cancer: a cost-effectiveness analysis for Belgium

OBJECTIVES: Although trastuzumab is traditionally used in metastatic breast cancer treatment, studies reported on the efficacy and safety of trastuzumab in adjuvant setting for the treatment of early stage breast cancer in HER2+ tumors. We estimated the cost-effectiveness and budget impact of reimbursing trastuzumab in this indication from a payer's perspective. METHODS: We constructed a health economic model. Long-term consequences of preventing patients to progress to metastatic breast cancer and side effects such as congestive heart failure were taken into account. Uncertainty was handled applying probabilistic modeling and through probabilistic sensitivity analyses. RESULTS: In the HERA scenario, applying an arbitrary threshold of euro30000 per life-year gained, early stage breast cancer treatment with trastuzumab is cost-effective for 9 out of 15 analyzed subgroups (according to age and stage). In contrast, treatment according to the FinHer scenario is cost-effective in 14 subgroups. Furthermore, the FinHer regimen is most of the times cost saving with an average incremental cost of euro668, euro-1045, and euro-6869 for respectively stages I, II and III breast cancer patients whereas the HERA regimen is never cost saving due to the higher initial treatment costs. CONCLUSIONS: The model shows better cost-effectiveness for the 9-week initial treatment (FinHer) compared to no trastuzumab treatment than for the 1-year post-chemotherapy treatment (HERA). Both from a medical and an economic point of view, the 9-week initial treatment regimen with trastuzumab shows promising results and justifies the initiation of a large comparative trial with a 1-year regimen.     

Cost consequences of sentinel lymph node biopsy in the treatment of breast cancer. A preliminary analysis.

OBJECTIVES: To assess whether sentinel lymph node biopsy (SLNB), an alternative to axillary lymph node dissection in treating female breast cancer, affords any cost savings. METHODS: We profile cumulative treatment costs of 811 breast cancer patients, 555 of whom received SLNB. Univariate and multivariate statistical tests are used to appraise whether these cost profiles differ between SLNB and other patients. RESULTS: The statistical results are mixed. However, none supports the conjecture that SLNB necessarily lowers the cost of treating the average breast patient. CONCLUSIONS: SLNB may be cost-effective, but longer term costs and outcomes must be estimated before firm conclusions can be reached.     

Worse prognosis for older breast cancer patients

- The prognosis for older post-menopausal breast cancer patients is worse than for younger post-menopausal patients.- This applies to the relatively healthy patients taking part in randomized clinical studies, but is also the case for older breast cancer patients in the general population.- The worse prognosis may be explained by inadequate treatment, and possibly also by age-specific tumour and patient characteristics.- As older patients are rarely included in randomized trials, it is still insufficiently clear what constitutes adequate treatment for them.- It is therefore important to include more elderly patients in clinical studies into the effectiveness of breast cancer therapy.- An important aim is to allow correct assessment of which patients will die with, and which patients will die from breast cancer, so that treatment can be adjusted accordingly.     

兰州市3042例乳腺癌患者直接经济负担趋势分析

目的:分析兰州市3 042例乳腺癌患者直接经济负担的变化趋势,为有效控制医疗费用提供科学依据。方法:收集1996～2006年兰州市两家省级医院所有确诊的乳腺癌患者的病历资料,获取住院费用信息并分析直接经济负担趋势。结果:1996～2006年连续11年不同年龄组乳腺癌患者发病数量总体呈上升趋势,平均涨幅为9.21%。连续11年乳腺癌患者平均人均住院费用12 298.97元,平均住院33.97天,总体呈下降趋势,降幅分别为3.09%和2.80%;平均日均住院费用482.95元,涨幅为4.14%,其中2006年的平均住院日和日均费用为1996年的0.63倍和2.12倍;65岁以上乳腺癌患者的人均费用呈上升趋势。结论:35～45岁和>65岁组患者日均住院费用上升显著,提示兰州市乳腺癌患者的经济负担仍然较重。应逐步加强对高危人群乳腺癌的筛查。     

妊娠哺乳期乳腺癌8例临床分析

目的探讨妊娠哺乳期乳腺癌患者的临床特点、治疗方法和妊娠结局。方法回顾性分析2016年1月~2018年1月我院乳腺外科收治的8例妊娠哺乳期乳腺癌患者的临床资料,总结妊娠哺乳期乳腺癌的临床特点及妊娠结局。结果8例妊娠哺乳期乳腺癌患者中妊娠期乳腺癌5例,哺乳期乳腺癌3例;临床分期0期1例,Ⅱ期4例,Ⅲ期3例。5例妊娠期患者中期引产2例,早产剖宫产1例,足月顺产1例,足月剖宫产1例;8例妊娠哺乳期乳腺癌患者随访8~33个月,平均(20.5±7.5)个月,4例患者乳腺癌根治术后出现全身多发转移,其余4例患者未见复发和转移;共分娩新生儿3例,随访6~45个月未见异常。结论妊娠哺乳期乳腺癌预后较差,易复发,除胎儿因素外,其治疗原则与非妊娠期乳腺癌相同;应提高妊娠哺乳期乳腺癌早期诊断率,确诊后积极采取根治性手术,不建议常规治疗性终止妊娠,妊娠期可行手术或选择性化学治疗,以获得最佳妊娠结局。     

青年乳腺癌特点及预后

目的探讨青年乳腺癌的临床特点及与预后的关系.方法回顾性分析1997～2001年收治的50例青年乳腺癌患者的临床及病理资料.结果临床症状隐匿,误诊率高达50%.病理类型以浸润性癌占多数,达86%,激素受体阳性率低.治疗以改良根治术为主,占84%;多数同时行辅助治疗.3年总生存率76%,腋淋巴结阳性者3年生存率显著低于阴性者(P＜0.05).Ⅲ～Ⅳ期者3年生存率显著低于0～Ⅱ期者,(P＜0.05)结论青年乳腺癌易误诊,预后差.降低误诊率,加强预防工作有重要意义.     

Breast cancer in patients, 70 years or older

Over 30% of breast cancers are diagnosed after age 70. The incidence of breast cancer in the elderly has increased since 1960. Risk factors for breast cancer are a medical history without pregnancy, a first pregnancy after age 30 and the use of hormonal replacement therapy. The biology of breast cancer at advanced age indicates a relative slow, less aggressive and hormone dependent tumour growth. In spite of these favourable characteristics, the prognosis is not better than at middle age. Over 20% of older patients die from co-existing other diseases within 5 years after the diagnosis of breast cancer. This comorbidity, mostly cardiovascular or pulmonary, affects the possibilities and the outcome of treatment. Treatment of the primary tumour is performed according to the same guidelines as in younger patients. Indication exists for hormonal adjuvant treatment with tamoxifen in patients with oestrogen receptor positive tumours. Hormonal treatment is the treatment of choice in metastatic disease. Chemotherapy is given in patients with oestrogen receptor negative tumours and in patients with progressive hepatic or pulmonary metastases.     

Estimating treatment cost functions for progressive diseases: a multiproduct approach with an application to breast cancer

Using the theory of multiproduct cost functions, a treatment cost function is derived for diseases which progress through a number of stages. The output classes are conceived as the stages at detection of the disease, with the unit of output within each class being the treated case. The derivation clarifies the assumptions underlying various specific functional forms for the treatment cost function. An empirical application to the treatment of breast cancer is provided, producing evidence on an important issue in the economics of screening programs, viz. whether detection of breast cancer at an earlier stage results in treatment cost savings.