妊娠及哺乳期乳腺癌的治疗和预后

目的：总结70例妊娠及哺乳期乳腺癌的治疗和预后情况。其中Ⅰ期乳腺癌11例；Ⅱ期43例；亚期16例。结果：TNM分期、手术方式和治疗时间对病人的5年生存率有显著性意义（P＜0．05），是否终止妊娠则无显著性意义（P＞0．05）。本病治疗原则与一般乳腺癌相同，首选治疗方法是根治术或改良根治术，术后辅助放疗和化疗，其5年生存率分别为55．7％和74．3％，结论：终止妊娠不能提高病人生存率，目前尚无资料显示再次妊娠是否有害，Ⅰ期乳腺癌病人应在治疗2年后再考虑妊娠，Ⅱ、Ⅲ期乳腺癌病人预后较差，应避免再次妊娠或在治疗结束5年后再考虑妊娠。     

35例妊娠期乳腺癌临床病理特征及预后分析

目的 通过与非妊娠期乳腺癌（non-PABC）比较分析妊娠是否影响妊娠期乳腺癌（PABC）患者的生存。方法 回顾性分析PABC患者资料,对PABC病例按TNM分期、分子分型、发病年龄和诊断时年份与non-PABC病例进行1:2配对。Kaplan-Meier法分析无病生存期（DFS）和总生存期（OS）,Log rank检验进行比较。Cox多因素分析评估影响PABC预后的危险因素。结果 PABC组纳入35例患者（妊娠10例;产后一年内25例）,non-PABC组纳入70例患者。中位随访时间分别为68.5和70.7月。PABC组5年DFS为51.6%,non-PABC组为72.8%（χ²=4.72, P=0.029）;PABC组和non-PABC的5年OS相似（χ²=1.769, P=0.183）。Cox多因素分析显示妊娠是影响PABC患者DFS的独立危险因素（P=0.011）。结论 妊娠期乳腺癌复发风险高,有必要通过进一步研究以便更早期发现妊娠期乳腺癌,并采取干预措施来提高治疗效果。     

促甲状腺激素抑制疗法对甲状腺癌术后患者预后及癌周组织TIPE2、STAT3表达的影响

目的 探讨促甲状腺激素抑制疗法(TSHIT)对甲状腺癌手术患者预后的影响,及对切除癌组织周围组织中肿瘤坏死因子诱导蛋白8样蛋白2(TIPE2)、信号转导子和转录激活因子(STAT3)表达的影响.方法 选择88例甲状腺癌患者为研究对象.所有患者均行手术切除治疗,根据术后是否采用TSH抑制疗法将其分为对照组(47例)和观察组(41例).对照组采用甲状腺激素替代疗法,观察组采用促甲状腺激素抑制剂疗法.比较2组患者入组前、入组3个月、6个月后切除癌组织周围组织中TIPE2阳性细胞表达率、STAT3表达阳性率情况,比较2组患者入组前、入组后3个月、6个月血清游离甲状腺激素(FT4)、血清游离三碘甲状腺原氨酸(FT3)水平,比较2组患者入组后6个月、12个月、24个月、36个月肿瘤复发、转移率.结果 2组患者入组前年龄、性别、体重、体质量指数(BMI)、肿瘤病理类型、肿瘤分期、手术方式、血清FT3、FT4、切除肿瘤周围组织TIPE2、STAT3表达阳性率比较,差异无统计学意义(P＞0.05).2组患者入组治疗3个月后、6个月后,观察组切除癌组织周围组织中TIPE2阳性细胞表达率高于对照组(P＜0.05),STAT3表达阳性率明显低于对照组(P＜0.05);入组3个月、6个月对照组患者甲状腺激素T3、T4均低于观察组(P＜0.05).入组6个月、12个月2组患者肿瘤复发率或(和)转移率比较,差异无统计学意义(P＞0.05);入组24个月、36个月后,观察组肿瘤复发率或(和)转移率低于对照组(P＜0.05).结论 TSH抑制疗法对甲状腺癌手术患者术后甲状腺功能的稳定作用明显优于甲状腺激素替代疗法,并能有效抑制切除癌组织周围组织中STAT3的阳性表达率,提高TIPE2阳性细胞表达率.TSH抑制疗法对维持患者术后治疗效果,提高患者预后具有较高的临床价值.     

Behavior and Outcomes of Pregnancy Associated Breast Cancer

Introduction: Pregnancy Associated Breast cancer (PABC) is associated with poor prognosis and a decreased overallsurvival. A retrospective review was conducted to review the experience and outcome in a tertiary care hospital, and tocompare those seen in a matched group for year of diagnosis. Materials and Methods: This is a retrospective reviewof a prospectively collected breast cancer registry. The study was conducted in a tertiary care hospital in Riyadh, SaudiArabia from January to Decamber 2014 . Female patients with PABC were identified and matched with similar cohortof non-pregnant breast cancer patients that were diagnosed between 2001-2010. Clinical data including age, tumorbiology, clinical stage, follow up and outcomes (disease free survival, DFS) were analyzed and compared between thetwo groups using SAS 9.3 and R-2.14.1 Results: A total of 110 patients in Group 1 and 114 patients in Group II wereanalyzed. In both groups, the patient age ranged was between 20 to 45 years; the median follow up was 34 months inPABC and 54 months in non-pregnant cohort. PABC were statistically more likely to be triple negative (p value-0.05) anddiagnosed at advanced stage (stage 3 and 4) (p value-0.02). There was no difference in the occurrence of Her-2 positivedisease. In pregnant patients there was a 5-year survival rate of 65% compared to non-pregnant cohort of 82% with pvalue of 0.002 and DFS was also 47.5% versus 65.4% with a p value .002 which is statistically significant. Conclusion:Pregnancy associated breast cancer (PABC) is diagnosed at a more advanced stage and tends to be triple negative andthey are associated with a worse DFS and overall survival. Early detection during pregnancy may improve outcome.     

2型糖尿病合并甲状腺癌发生率及预后相关性研究

目的：探讨2型糖尿病合并甲状腺癌的发生率及预后相关性。方法回顾性分析300例2型糖尿病患者的临床资料,此外选取同期健康体检者290例作为对照组。对比分析两组血糖水平及血清游离三碘甲状腺原氨酸FT3、甲状腺激素、TSH及甲状腺癌发病率。单因素和logistic多因素分析甲状腺癌预后的相关因素。结果研究组患者血糖水平与对照组比较具有显著差异。研究组血清游离三碘甲状腺原氨酸FT3、甲状腺激素、TSH及甲状腺癌发病率明显高于对照组,差异具有统计学意义（ P＜0．05）。随访5年,研究组甲状腺癌7例,总患病率2．33％,随年龄的增加而逐渐升高,女性患病比例明显高于男性。女性甲状腺癌发病率高于男性,约是男性的3倍,甲状腺癌的发病年龄相对年轻,发病率随年龄的增长而上升。甲状腺滤泡状癌2例,嗜酸细胞甲状腺癌1例,甲状腺髓样癌2例,低分化甲状腺癌1例,甲状腺原发性鳞状细胞癌1例。单因素分析显示,手术方式、病理分型、淋巴结转移、肿瘤大小以及术后用药为甲状腺癌预后的相关因素。多因素分析显示,病理分型、淋巴结转移、肿瘤大小以及术后用药为甲状腺癌预后的相关因素。结论2型糖尿病患者血糖与甲状腺癌发病率存在密切相关性,病理分型、淋巴结转移、肿瘤大小以及术后用药为甲状腺癌预后的相关因素。     

巨噬细胞浸润对胃癌进展和预后的影响*

目的：研究胃癌标本中巨噬细胞浸润与临床病理特征和预后的关系。方法：采用免疫组化SP法检测收集武汉大学中南医院肿瘤科的37例胃癌标本,通过高倍视野下巨噬细胞计数分析巨噬细胞浸润程度与临床病理因素的关系,重点分析其与预后的关系。结果：巨噬细胞主要分布于胃癌癌巢与间质交界处和间质血管丰富处,尤其在基底膜结构破坏处。高倍视野下对浸润巨噬细胞计数,37例胃癌患者平均巨噬细胞计数为19.7 ± 8.9 个;29例无远处转移患者平均巨噬细胞计数为18.9 ± 8.3 个。年龄、病理类型、复发与否、有无淋巴结转移对巨噬细胞浸润程度无影响（P 均>0.05）;远处转移组巨噬细胞计数（22.6 ± 11.0 个）高于无远处转移组（18.9 ± 8.3 个）,但差异无统计学意义（P=0.090）;侵及浆膜者浸润巨噬细胞计数（21.6 ± 8.0 个）明显高于未侵及浆膜者（12.7 ± 9.2 个）,P=0.011;晚期胃癌组织巨噬细胞浸润程度（22.6 ± 8.1 个）明显高于早期胃癌组织（12.8 ± 7.1 个）,P=0.001。37例胃癌患者总体生存期（中位数19.0 个月）与病理类型、淋巴结转移状况无明显相关,但与侵及浆膜、远处转移和TNM分期相关（P 值分别为0.024、0.021 和0.009）。 无瘤生存期（中位数13.0 个月）也与侵及浆膜（P=0.038）、TNM分期（P=0.006）密切相关。巨噬细胞高密度患者中位生存期（13.0 个月）短于低密度者（40.5 个月）,但无显著性差异（P=0.056）。 高密度巨噬细胞患者中位无瘤生存期（9.5 个月）明显低于低密度患者（37.0 个月）,P=0.041。结论：巨噬细胞浸润促进胃癌进展,浸润程度越高,胃癌进展越快,患者预后越差。     

妊娠合并子宫颈癌的临床预后分析

目的　探讨妊娠合并子宫颈癌患者的临床特征。方法　对 5例妊娠合并子宫颈癌患者的临床资料进行回顾性分析。结果　 3例按前置胎盘保胎治疗延误诊断 ,5例妊娠合并宫颈癌发现均较晚 ,病情进展快 ,盆腔淋巴结均有转移 ,预后差。结论　妊娠期间阴道异常出血者应进行必要的盆腔检查 ,以早期诊断妊娠合并宫颈癌     

RAS Mutations in Thyroid Cancer

In recent years, our understanding of the genetic alterations underlying thyroid oncogenesis has greatly expanded. The use of molecular markers, including RAS, in the management of thyroid carcinoma is also increasing. This review summarizes the current literature surrounding RAS and discusses its potential as a diagnostic and prognostic indicator in the management of thyroid cancer.     

Oncogenesis of Thyroid Cancer

Thyroid neoplasms encompass a variety of lesions that range from benign adenomas to malignancies. These latter can be well-differentiated, poorly differentiated or undifferentiated (anaplastic) carcinomas. More than 95% of thyroid cancers are derived from thyroid follicular cells, while 2-3% (medullary thyroid cancers, MTC) originate from calcitonin producing C-cells. Over the last decade, investigators have developed a clearer understanding of genetic alterations underlying thyroid carcinogenesis. A number of point mutations and translocations are involved, not only in its tumorigenesis, but also as have potential use as diagnostic and prognostic indicators and therapeutic targets. Many occur in genes for several important signaling pathways, in particular the mitogen-activated protein kinase (MAPK) pathway. Sporadic (isolated) lesions account for 75% of MTC cases, while inherited MTC, often in association with multiple endocrine neoplasia (MEN) type 2A and 2B syndromes, constitute the remainder. However, non-MEN familial MTC may also occur. Advances in genetic testing have revolutionized the management of MTC, with prospects of genetic screening, testing and early prophylactic thyroidectomy. Ethical concerns of these advances are addressed.     

淋巴结检出数对Dukes'B期及C期大肠癌患者预后的影响

目的:探讨淋巴结检出数对Dukes'B期及C期大肠癌患者预后的影响。方法:回顾分析373例Dukes'B期及C期患者的临床病理特征与淋巴结检出数的关系,及不同淋巴结检出数对患者预后的影响。结果:全组患者淋巴结检出数为13.71±9.38枚,肿瘤部位、大小及肿瘤浸润深度是影响淋巴结检出数的主要因素,结肠癌患者淋巴结检出数为17.51±12.79枚,显著多于直肠癌患者的11.09±6.17枚(P=0.000)。淋巴结检出较少(0～10枚)的Dukes'B期大肠癌患者,其5年生存率仅为60.4%,而淋巴结检出较多(>10枚)的Dukes'B期患者,其5年生存率为74.5%,两者比较具有显著性差异(P=0.002)。但淋巴结检出数对Dukes'C期大肠癌患者的预后无影响(P>0.05)。将结、直肠癌患者分别分析表明,直肠癌患者淋巴结检出数<9枚,结肠癌患者淋巴结检出数<13枚时,其5年生存率显著降低(P<0.05)。结论:为保证分期的准确及指导适宜的术后辅助治疗,直肠癌患者术后至少应检出9枚淋巴结,结肠癌患者至少应检出13枚淋巴结。     

彩色多普勒超声对甲状腺腺瘤与甲状腺癌的鉴别诊断价值

目的：探讨彩色多普勒超声对甲状腺腺瘤与甲状腺癌的鉴别诊断价值。方法回顾性分析甲状腺腺瘤患者60例及甲状腺癌患者60例的超声资料,进行鉴别诊断分析。结果两组患者在结节数量、结节形态、结节边界、内部回声及后方回声方面进行比较,差异有统计学意义（P＜0．05）。甲状腺腺瘤患者最大峰值流速及阻力指数均显著低于甲状腺癌患者,差异具有统计学意义（P＜0．05）。甲状腺腺瘤患者血流分级以Ⅰ级为主（65．00％）,而甲状腺癌患者血流分级以Ⅲ级为主（51．67％）,两组患者在血流分级方面比较差异有统计学意义（P＜0．05）。结论彩色多普勒超声对甲状腺腺瘤与甲状腺癌的鉴别诊断具有重要的临床价值。     

Descriptive Epidemiological Analysis of Thyroid Cancer in the Saudi Population (2001-2013)

Objective: Thyroid cancer has one of the highest frequency rates among thyroid diseases, and ranks second for neoplasia in the Saudi female population. This paper concerns a comprehensive evaluation of increasing incidence trends and geographical distribution of different patterns of thyroid cancer among the Saudi Arabian population using the latest Saudi Cancer Registry (SCR) reports. Methods: The analysis included a total of 7,670 thyroid cancer cases (1604 male and 6066 female) which were recorded in the SCR files for the period between January 2001 and December 2013. Results: The overall incidence of thyroid cancer increased during the period from 2001 to 2013. The most common age group affected was 35–39 years in both sexes. Najran recorded the highest differences in thyroid cancer rates with increase between 2001 and 2013. Controversially, other regions like Tabuk and the Northern provinces recorded obvious decreases in rates of thyroid cancer among females. Conclusion: Thyroid cancer is the second most common cancer among females in Saudi Arabia with incidence peaks in both genders aged 35–39 years and increase overtall in the country from 2001 to 2013. The specific causes of this upward trend are unknown. Further clinical and epidemiological research must be conducted for clarification, with an emphasis of causes of the variation in thyroid cancer prevalence between regions in Saudi Arabia.     

淋巴管癌栓和淋巴结转移对胃癌术后生存率的影响

目的：探讨淋巴管癌栓与胃癌临床病理特点的关系。方法：比较淋巴管栓和淋巴结转移对胃癌预后的影响。结果：１）浸润深度及生长方式影响淋巴管癌栓的发生;２）只有在元淋巴结转移的条件下,淋这癌栓才会影响胃癌患者的预后。结论：淋巴结转移对一影响明显高于淋巴管癌栓。     

结节性甲状腺肿合并甲状腺癌诊治分析

目的　总结结节性甲状腺肿合并甲状腺癌的诊治经验。方法　回顾性分析 2 3例结节性甲状腺肿合并甲状腺癌的临床资料。结果　同期手术治疗结节性甲状腺肿患者 83 6例 ,合并甲状腺癌 2 3例 ( 2 .75 % ,2 3 /83 6)。病理检查结果示 :灶性癌变 3例 ,微小癌变 8例 ,乳头状癌 11例 ,乳头状癌并滤泡状癌 1例。所有患者均行术中快速冷冻病理检查 ,并根据病理检查结果采取不同的手术方式 ,术后长期服用甲状腺素片。结论　结节性甲状腺肿临床中常见 ,但并发甲状腺癌诊断困难 ,多为分化好的乳头状癌。结节性甲状腺肿的手术指征应放宽 ,术中快速冷冻病理检查有利于选择正确的手术方式 ,使治疗合理有效     

Lack of Association between Fingernail Selenium and Thyroid Cancer Risk: A Case-Control Study in French Polynesia

Background: Numerous studies have suggested that selenium deficiency may be associated with an increased risk for several types of cancer, but few have focused on thyroid cancer. Materials and Methods: We examined the association between post-diagnostic fingernail selenium levels and differentiated thyroid cancer risk in a French Polynesian matched case-control study. Conditional logistic regression models were used to estimate odds ratios and 95% confidence intervals. Results: The median selenium concentration among controls was0.76 μg/g. Significantly, we found no association between fingernail selenium levels and thyroid cancer risk after conditioning on year of birth and sex and additionally adjusting for date of birth (highest versus lowest quartile: odds-ratio=1.12, 95% confidence interval: 0.66-1.90; p-trend=0.30). After additional adjustment for other covariates, this association remained non-significant (p-trend=0.60). When restricting the analysis to thyroid cancer of 10 mm or more, selenium in nails was non-significantly positively linked to thyroid cancer risk (p-trend=0.09). Although no significant interaction was evidenced between iodine in nails and selenium in nails effect (p=0.70), a non-significant (p-trend =0.10) positive association between selenium and thyroid cancer risk was seen in patients with less than 3 ppm of iodine in nails. The highest fingernail selenium concentration in French Polynesia was in the Marquises Islands (M=0.87 μg/g) and in the Tuamotu-Gambier Archipelago (M=0.86 μg/g). Conclusions: Our results do not support, among individuals with sufficient levels of selenium, that greater long-term exposure to selenium may reduce thyroid cancer risk. Because these findings are based on post-diagnostic measures, studies with prediagnostic selenium are needed for corroboration.     

Genetic Aspects of Familial Thyroid Cancer

Familial thyroid cancer is rare, accounting for <10% of thyroid cancer cases. Activating germline point mutations in the RET proto‐oncogene are associated with multiple endocrine neoplasia types 2A, 2B, and familial medullary thyroid cancer (FMTC)—around 3% of thyroid cancer cases. Familial papillary thyroid cancer (PTC) and follicular thyroid cancer (FTC) have been identified as a distinct group of familial thyroid cancers. Sporadic nonmedullary thyroid cancer (NMTC) accounts for ～90% of all thyroid cancers—about 6% of NMTCs are familial (FNMTC). Although multiple endocrine neoplasia types 2A and 2B and FMTC are well characterized, very little is known about the genetic predisposition to PTC and FTC. In this paper, the genetic types of FMTC and FNMTC are reviewed and the clinical features and screening are outlined.     

乳腺癌化疗诱导闭经对预后的影响

目的：研究乳腺癌患者化疗诱导闭经（chemotherapy-induced amenorrhea,CIA）的出现对预后的影响,探讨其临床意义。方法：共有88例绝经前乳腺癌患者,全部接受术前4 个周期和术后4 个周期紫杉醇蒽环联合方案化疗,根据实体瘤治疗疗效评价方法即RECIST（response evaluation criteria in solid tumors）标准对新辅助化疗疗效进行评估,统计病理完全缓解（pathologiccomplete response,pCR ）的发生率。对患者进行随访,总结患者的无瘤生存（disease free survival,DFS）情况。分析患者CIA 的出现与新辅助化疗疗效及DFS 的关系。分析患者新辅助化疗疗效与CIA 的关系采用卡方检验,分析CIA 出现与患者无瘤生存率之间的关系应用Kaplan-Meyer 生存曲线。结果：88例患者经过化疗后共有64例患者出现CIA。新辅助化疗后,22例（25.0%）患者获得临床完全缓解（complete response,CR）,51例（58.0%）患者获得临床部分缓解（partial response,PR）,12例（13.6%）患者获得疾病稳定（stable disease ,SD）,3 例（3.4%）患者出现疾病进展（progressive disease ,PD）。 患者新辅助化疗的临床效果与CIA 是否出现并无相关性（P=0.104）。新辅助化疗后14例（15.9%）患者获得pCR ,CIA 组患者获得pCR 率（21.9%）要高于非CIA 组（0）,两者具有显著性差异（P=0.009）。 中位随访时间48个月,出现CIA 的患者中有4 例患者出现局部复发或转移,另外24例未出现CIA 的患者中有10例患者出现局部复发或转移,两组患者的DFS 具有显著性差异（P<0.05）。 结论：化疗诱导闭经的出现可能提示患者有更好的预后。     

Lack of Effects of HER-2/neu on Prognosis in Colorectal Cancer: a Meta-analysis

Background: The prognostic value of human epidermal growth factor receptor-2 (HER-2/neu) for survivalof patients with colorectal cancer (CRC) is still ambiguous. We therefore performed a meta-analysis to evaluateits prognostic significance. Materials and Methods: We searched the MEDLINE and EMBASE databases forpublished literature investigating associations between HER-2/neu status and overall survival of patients withCRC. A meta-analysis was performed using a DerSimonian-Laird model and publication bias was investigatedby Begg’s and Egger’s tests. Subgroup analysis was also conducted according to the study design type, studyquality score, cut-off value for HER-2/neu overexpression, publication region, patient number and publicationyear. Results: A total of 17 eligible studies involving 2,347 patients were identified for this meta-analysis. Thecombined hazard ratio (HR) was 1.31 (95% confidence interval (CI): 0.96-1.79), suggesting that HER-2/neuoverexpression was not significantly associated with overall survival of patients with CRC. However, subgroupanalysis revealed that HER-2/neu overexpression had an unfavorable impact on survival when the analysiswas restricted to subgroups of study quality score ≤ 5 (HR=1.56, 95%CI: 1.17-2.10), Asian patients (HR=1.74,95%CI: 1.22-2.49), patient number ≤ 106 (HR=1.57, 95%CI: 1.01-2.44), publication year before 2003 (HR=1.59,95%CI: 1.02-2.49), and prospectively designed study (HR=3.62, 95%CI: 1.42-9.24). The effect disappeared insubgroups of study quality scores > 5 (HR=0.69, 95%CI: 0.33-1.44), non Asian patients (HR=1.14, 95%CI:0.77-1.70), patients’ number > 106 (HR=1.07, 95%CI: 0.67-1.72), publication year after 2003 (HR=1.13, 95%CI:0.76-1.69), and retrospectively designed study (HR=1.22, 95%CI: 0.89-1.67). Conclusions: Our meta-analysissuggests that HER-2/neu overexpression might not be a significantly prognostic indicator for patients with CRC.Further studies are required to confirm these results.