情绪调节不良对化疗后三阴性乳腺癌患者认知功能影响及应激相关激素水平的变化

目的探讨情绪调节不良对化疗后三阴性乳腺癌患者认知功能的影响与应激相关激素水平的变化。方法采用问卷调查法调查并纳入符合入组标准的178例河南中医药大学第一附属医院血液肿瘤科门诊以及病房就诊的化疗后三阴性乳腺癌患者的相关资料,采用艾森克人格问卷N维度量表评估筛选典型情绪稳定型患者(82例,情绪稳定组)和典型情绪不稳定型患者(96例,情绪不稳定组),采用蒙特利尔量表评估2组患者的认知功能,采用酶联免疫吸附试验检测2组患者应激相关激素水平。结果情绪不稳定组患者认知功能评分为(19.80±2.07)分,明显低于情绪稳定组的(27.17±0.75)分,差异有统计学意义(t=18.301,P<0.001)。情绪不稳定组视空间与执行、注意、语言、延迟回忆、定向等认知域得分明显低于情绪稳定组,差异均有统计学意义(Z=3.624,P<0.001;Z=4.196,P<0.001;Z=4.532,P<0.001;Z=4.572,P<0.001;Z=3.453,P=0.001)。情绪不稳定组血清促肾上腺皮质激素、去甲肾上腺素水平分别为(28.06±1.51)、(6.21±0.84)pg/mL,均明显高于情绪稳定组的(26.40±1.68)、(3.15±0.67)pg/mL,差异均有统计学意义(t=16.424,P<0.001;t=29.257,P<0.001)。结论长期情绪调节不良可导致化疗后三阴性乳腺癌患者认知功能下降,而应激相关激素水平的改变可能是其机制之一。     

淋巴结阴性的早期三阴性乳腺癌不同辅助治疗策略的预后分析

背景与目的早期三阴性乳腺癌(triple-negative breast cancer,TNBC)是否进行术后辅助化疗仍存有争议.本研究探讨不同术后辅助治疗策略对淋巴结阴性的早期TNBC预后的影响.方法 我们对本研究中心的乳腺癌数据库进行病例筛选,根据术后是否进行辅助治疗,将淋巴结阴性的浸润性TNBC患者分为3组:4次...     

三阴性乳腺癌化疗进展

三阴性乳腺癌作为乳腺癌的一种特殊亚型,对内分泌治疗和现有靶向治疗无效,并且通常复发较早、进展迅速、预后较差。现就三阴性乳腺癌的分子分型及其临床价值、化疗药物和化疗方案以及化疗和潜在的新靶点药物联合方面的最新进展作一综述。     

年龄因素对三阴性乳腺癌患者预后的影响

目的:分析三阴乳腺癌患者低年龄组（<35岁）和高年龄组（≥35岁）临床病理学特征及生存状态,探讨低年龄组预后的独立影响因素。方法:收集2002年1 月至2004年12月本院收治的543 例可手术三阴性乳腺癌患者的临床资料,回顾性分析低年龄组及高年龄组临床病理学特征及生存情况。采用SPSS13.0 统计软件进行分析,取P<0.05有统计学意义。结果:低年龄组占可手术三阴性乳腺癌患者的7.96%。与高年龄组相比,临床分期Ⅲ期患者占37.21%（P=0.027）,肿瘤直径>5cm者占 39.53%（P=0.000）,组织学分级Ⅲ级的患者占37.21%（P=0.015）,腋窝淋巴结阳性者占62.79%（P=0.012）,术后进行放疗的患者占53.49%（P=0.010）,5?年内出现复发转移的患者占44.19%（P=0.000）,5 年无进展生存率53.49%（P=0.000）及总生存率67.44%（P=0.000）均与高年龄组有统计学差异。单因素和多因素分析结果显示,肿瘤大小、组织学分级及淋巴结状态既是影响三阴乳腺癌患者低年龄组预后的因素也是独立的危险因素。结论:三阴性乳腺癌低年龄组具有肿瘤体积大、恶性程度高、容易转移复发、病期晚、预后差的特点,探索新的更有效的治疗手段将成为今后的研究热点。      

三阴性乳腺癌新辅助化疗药物研究进展

摘 要：三阴性乳腺癌是一种侵袭性强、复发率高、易发生远处转移、预后较差且具有高度异质性的乳腺癌亚型。新辅助化疗是三阴性乳腺癌系统治疗中的重要手段。蒽环联合紫杉一直是三阴性乳腺癌新辅助化疗的常用化疗方案。近年来多项研究发现,某些细胞毒药物在三阴性特定亚型乳腺癌中表现出较好的治疗敏感性,且具有不错的临床疗效。全文就三阴性乳腺癌新辅助化疗药物研究进展进行综述。     

三阴性乳腺癌化疗后前瞻性记忆损害特征分析

目的 有关不同分子分型的乳腺癌患者化疗后前瞻性记忆(prospective memory,PM)损害是否存在差异,目前尚不清楚.本研究探讨三阴性乳腺癌(triple negative breast cancer,TNBC)患者化疗后基于事件的PM(event-based prospective memory,EBPM)与基于时间的PM(time-based prospective memory,TBPM)损害特征.方法 收集2013-01-01-2015-09-30安徽医科大学第二附属医院肿瘤中心接受化疗的乳腺癌化疗后患者244例.其中TNBC 80例,非三阴性乳腺癌(non-triple negative breast cancer,NTNBC) 164例.建立EBPM与TBPM的认知神经心理学试验范式,分别进行化疗前后的PM测查.结果 与NTNBC患者相比,TNBC患者化疗后EBPM得分0.89±0.86,明显低于NTNBC组的2.59±0.90,差异有统计学意义,Z=-10.61,P＜0.01;TNBC和NTNBC患者化疗后TBPM得分别为4.65±0.83和4.80±0.92,差异无统计学意义,Z=-1.48,P＞0.05.结论 乳腺癌患者化疗后存在不同程度的PM障碍,且TN-BC较NTNBC患者EBPM损害更为显著.     

铂类药物用于三阴性乳腺癌的新辅助化疗

三阴性乳腺癌(triple-negative breast cancer,TNBC)作为乳腺癌的一个亚型,其复发率较高而总生存率低。尽管其对于包含蒽环类和紫衫类药物为基础的新辅助化疗方案反应显著,但预后较差。目前尚未发现专门的分子及化疗药物作用靶点。铂类并非是治疗三阴性乳腺癌的常规用药,本文对铂药物用于三阴性乳腺癌新辅助化疗的现状进行综述。     

三阴性乳腺癌辅助化疗预后生物标志物的研究进展

三阴性乳腺癌（triple-negative breast cancer,TNBC）具有组织学分级高、临床分期晚、侵袭性强、易发生转移等特点。由于缺乏有效的治疗靶点,传统化疗仍是TNBC患者主要的治疗选择。作为高度异质性疾病,TNBC需要更为精确的预测生物标志物。组学技术的发展及临床试验的实施为辅助化疗预后生物标志物带来新的探索,涵盖基因、蛋白及微环境成分等不同维度,也包括多分子的联合分析应用。本文将对TNBC辅助化疗预后生物标志物及其潜在分子机制与未来发展方向进行综述。      

三阴性乳腺癌和非三阴性乳腺癌临床特征及预后的比较分析

目的比较三阴性乳腺癌和非三阴性乳腺癌临床特征及预后。方法对我院2003年-2010年期间住院治疗的560例乳腺癌患者临床资料进行回顾性分析。比较三阴乳腺癌及非三阴乳腺癌的3年、5年生存率及临床特征的差别。结果三阴乳腺癌患者的3年生存率及5年生存率为85.5%和73.3%,显著低于非三阴乳腺癌患者（95.1%和88.0%,P<0.05）;三阴乳腺癌患者复发率和远行转移率显著高于对照组（P<0.05）;三阴乳腺癌患者发病年龄较轻,肿瘤体积较大,与非三阴乳腺癌患者相比差异有统计学意义(P<0.05);Cox多因素分析结果显示：是否为三阴性、肿瘤大小是影响患者预后的独立影响因素。结论三阴性乳腺癌有独特的临床病理特征,易发生复发及转移,预后差。     

三阴性乳腺癌含铂类新辅助化疗的研究进展

乳腺癌居于我国女性恶性肿瘤的首位,其中三阴性乳腺癌占15%~20%。三阴性乳腺癌由于不表达雌激素受体(estrogen receptor,ER)、孕激素受体(progesterone receptor,PR)和人表皮生长因子受体2(human epidermal growth factor receptor 2,HER2),因此不能获益于内分泌治疗及曲妥珠单抗的靶向治疗。目前主要的治疗方法是化疗,并推荐以蒽环及紫杉类化疗方案为主,但其预后并没有得到很好的改善。含铂类化疗方案可明显提高三阴性乳腺癌患者的PCR,延长患者的无病生存期及总生存期,改善预后。作者对目前三阴性乳腺癌含铂类新辅助化疗方案的研究进展予以综述,希望为临床制定三阴性乳腺癌的新辅助化疗方案提供参考。     

化疗联合安罗替尼治疗晚期三阴性乳腺癌的疗效和安全性

目的:探讨化疗联合安罗替尼治疗晚期三阴性乳腺癌的疗效和安全性。方法:选取2018年6月至2018年12月我院肿瘤科收治的30例晚期乳腺癌患者为研究对象,根据入组标准和排除标准进行随机分组,对照组给予化疗联合安慰剂治疗6周期,实验组给予化疗联合安罗替尼胶囊（12 mg,qd）治疗6周期,比较两组的临床疗效和安全性。结果:实验组和对照组患者的ORR分别为66.7%和46.7%（P=0.043）,并且中位PFS分别为7.5月和3月（P=0.073）。常见不良反应为乏力、中性粒细胞减少症、高血压症、手足综合征、高甘油三酯血症。其中实验组III-IV级不良反应主要为中心粒细胞减少症（26.7%）和高血压症（13.3%）,调整剂量后患者耐受性好。结论:化疗联合安罗替尼治疗晚期三阴性乳腺癌可明显提高患者的客观缓解率,且安全性较好,值得临床推荐。     

Prospective evaluation of cognitive function in patients with early breast cancer receiving adjuvant chemotherapy

Aim: To assess cognitive function prospectively in women with early breast cancer before, during and after the administration of adjuvant chemotherapy. Methods: Between May 2000 and November 2001, 35 assessable patients were entered into the study. Thirty‐one received oral cyclophosphamide, methotrexate and 5‐fluorouracil (CMF) and four received epirubicin and cyclophosphamide followed by CMF ((cyclophosphamide, methotrexate and 5‐fluorouracil)). Testing consisted of the completion of a battery of neuropsychological and psychological inventories and was performed prior to chemotherapy and repeated after 3 (n = 31) and 6 months (n = 30) of chemotherapy and also 6 months after the completion of chemotherapy (n = 27). Results: Prior to chemotherapy a proportion of the patients already exhibited some evidence of impairment of cognitive function. However, on completion of chemotherapy, the neuropsychological scores for short‐term verbal memory and verbal learning were significantly lower than prior to, or 6 months after chemotherapy. In all other domains, cognitive function either remained constant or even appeared to improve. Symptom scales showed that fatigue, nausea and vomiting, constipation and diarrhea were worst half way through the chemotherapy. Quality of life scales indicated that functioning was best after completion of chemotherapy. Conclusion: Patients with early breast cancer may have impaired cognitive function before chemotherapy. Although transient deteriorations in verbal memory and verbal learning were observed on completion of chemotherapy, overall, cognitive function did not decline. It is likely that practice effects influenced our findings.     

三阴性乳腺癌组织中TOPK的表达及其与新辅助化疗治疗反应和预后的相关性

目的:探讨T-LAK细胞起源的蛋白激酶（TOPK）在三阴性乳腺癌（TNBC）组织中的表达和作用,研究TOPK表达与新辅助化疗（NACT）治疗反应和预后的关系。方法:收集66例采用多西他赛+表柔比星+环磷酰胺（TEC）NACT方案的TNBC患者治疗前后的组织学标本,用免疫组化的方法检测TOPK和Ki-67的表达,采用Miller-Payne（MP）系统评估治疗反应,并对患者的无进展生存期（PFS）进行生存分析。结果:MP分级较低（1-3级）的患者组织中的TOPK阳性率高于MP分级较高（4-5级）的患者,在NACT治疗中TOPK阳性患者的预后不佳。同时发现MP 1-3级患者在NACT后组织中TOPK表达升高,而MP 4-5级患者NACT后组织中TOPK表达降低。NACT治疗后组织中TOPK升高的患者的PFS较TOPK降低者差。接受者操作特性曲线（ROC）结果表明,NACT前后患者组织中TOPK表达变化对预后的评估准确性更高。结论:TNBC组织中TOPK水平高的患者对NACT治疗反应不佳,并且预后较差。TOPK表达水平可能提示TNBC的NACT治疗反应和预后。     

Clinical efficacy of local targeted chemotherapy for triple-negative breast cancer

Background

The aim of the study was to evaluate the clinical efficacy of superselective intra-arterial targeted neo-adjuvant chemotherapy in the treatment of estrogen receptor (ER)-negative, progesterone receptor (PR)-negative, and human epidermal growth factor receptor 2 (HER2)-negative (triple-negative) breast cancer.

Patients and methods.

A total of 47 triple-negative breast cancer patients (29 at stage II, 13 at stage III and 5 at stage IV) were randomly assigned to two groups: targeted chemotherapy group (n=24) and control group (n=23). Patients in the targeted chemotherapy group received preoperative superselective intra-arterial chemotherapy with CEF regimen (C: cyclophosphamide [600 mg/m²]; E: epirubicin [90 mg/m²]; F: 5-fluorouracil [600 mg/m²]), and those in the control group received routine neoadjuvant chemotherapy with CEF. The duration of the treatment, changes in lesions and the prognosis were determined.

Results

The average course of the treatment was 15 days in the targeted chemotherapy group which was significantly shorter than that in the control group (31 days) (P<0.01). The remission rate of lesions was 91.6% in the targeted chemotherapy group and 60.9% in the control group, respectively. Among these patients, 9 died within two years, including 2 (both at IV stage) in the targeted chemotherapy group and 7 (2 at stage II, 4 at stage III and 1 at stage IV) in the control group.

Conclusions

As an neoadjuvant therapy, the superselective intra-arterial chemotherapy is effective for triple-negative breast cancer, with advantages of the short treatment course and favourable remission rates as well as prognoses.     

Response and long-term effect of patients with triple-negative breast cancer receiving neo-adjuvant anthracycline-based chemotherapy

OBJECTIVE The breast cancer lack of expression of estrogen receptor （ER）, progesterone receptor （PR）, and human epidermal growth factor receptor 2 （HER-2） is defined as the Triple-negative breast cancer （TNBC）. Our purpose is to compare the response and long-term effect of the TNBC and non-TNBC patients receiving neo-adjuvant anthracycline-based chemotherapy, and to investigate the mechanisms of TNBC affecting the survivals. METHODS Data of long-term follow-up （median, 5.4 years） of 326 patients who received neo-adjuvant chemotherapy with anthracycline-based regimen, during a period from 2000 to 2003, were analyzed. Expressions of ER, PR, HER-2, P53, Ki-67 and E-cadherin were determined using immunohistochemical staining method. A multivariate Cox regression analysis was used to analyze independent prognostic factors affecting the relapse-free survival （RFS） and overall survival （OS） rates. Clinical effects of the neo-adjuvant anthracycline-based chemotherapeutic regimen and the RFS and OS rates were compared between the patients with TNBC and non-TNBC, and the correlations among the triplenegative phenotype （TNP）, tumor grading and the expressions of P53, Ki-67 and E-cadherins were analyzed. RESULTS TNP, TNM staging, histological grades, clinical response of the neo-adjuvant chemotherapy and pathological complete remission （pCR） rate were the independent prognostic factors affecting the survival rates. Furthermore, 70 （21.5%） of the 326 patients suffered TNBC. Compared with the subjects in non-TNBC group, the patients with TNBC had a significantly higher pCR rate （P = 0.046） and clinical response rate （P = 0.037）, but also decreased 5-year RFS （P = 0.001） and OS （P = 0.004） rates. The RFS and OS rates were not improved in the TNBC patients who achieved a clinical remission after the neo-adjuvant chemotherapy. The triple-negative phenotype was positively correlated with the level of P53, Ki-67 expression （P = 0.007, P = 0.028）, but negatively correlated with level of E-cadherin （P = 0.034）. CONCLUSION Both clinical remission rate and pCR rate of the TNBC patients receiving neo-adjuvant anthracycline-based chemotherapy are high, however, the long-term effect is poor. The mechanism may relate to a strong potential of proliferation and invasive metastasis, as well as lack of an effective therapeutic target in the TNBC patients.     

The influence of erythropoietin on cognitive function in women following chemotherapy for breast cancer

Objective: Cognitive dysfunction is a potential side effect of chemotherapy, and erythropoietin might be protective. A previously reported study compared quality‐of‐life in women undergoing chemotherapy for breast cancer who were randomized to receive epoetin‐alfa or standard care. Here, we report a non‐randomized sub‐study in which cognitive function of participants was evaluated at 12–30 months after chemotherapy. Methods: The primary endpoint was the proportion of women with moderate–severe cognitive impairment, as measured by the High Sensitivity Cognitive Screen (HSCS). Subjects also completed the Revised Hopkins Verbal Learning Test (HVLT‐R), the Functional Assessment of Cancer Therapy—Fatigue (FACT‐F) and FACT‐G self‐report questionnaires for fatigue and quality‐of‐life, and the Hospital Anxiety and Depression Scale. Results: Of 278 patients receiving adjuvant treatment in the primary study, 87 participated in the sub‐study: 45 had received epoetin‐alfa and 42 standard care. Groups were well matched for age and type of chemotherapy. Eight patients (9%) had moderate–severe cognitive dysfunction by the HSCS: six of them in the epoietin‐alfa group (not significant). There were no significant differences in the HVLT‐R, or in fatigue, but patients who had received epoetin‐alfa reported better quality‐of‐life. Conclusion: This study failed to demonstrate a protective effect of epoetin‐alfa against the development of delayed cognitive dysfunction after chemotherapy. Copyright © 2008 John Wiley & Sons, Ltd.     

晚期三阴乳腺癌挽救治疗进展

三阴乳腺癌约占全部乳腺癌病例的15％,具有恶性程度高,进展快,生存期短和预后较差的临床特点.因此近些年来,三阴乳腺癌受到越来越多的国际肿瘤学界的关注.化疗是晚期三阴乳腺癌治疗的核心,但目前没有统一标准的化疗方案.另外,靶向治疗是晚期三阴乳腺癌一个较有前途的治疗新策略.现对晚期三阴乳腺癌的挽救治疗做一综述.     

Objective and self-reported cognitive dysfunction in breast cancer women treated with chemotherapy: a prospective study

The objective of this study is to investigate if changes in cognitive functions can be recognised in patients undergoing chemotherapy for breast cancer. Forty women with breast cancer and without depression underwent cognitive evaluation before and after 6 months of chemotherapy; emotional evaluation was performed before and after 1, 3 and 6 months of chemotherapy. Self-reported cognitive deficit evaluation was included. Global cognitive functioning before starting chemotherapy was good. After 6 months of treatment there was a significant decline in some cognitive functions, particularly involving the attention subdomain. Objective cognitive deficit resulted independent from the emotional status. On the contrary, self-perceived mental dysfunction was unrelated to the objective cognitive decline, but it was associated with depression and anxiety. Breast cancer chemotherapy can induce domain-specific cognitive dysfunction. Patients' self-perception of mental decline is unrelated to objective cognitive deficit. Breast cancer patients negatively judge their cognitive performances if they have a negative emotional functioning.     

三阴乳腺癌的研究进展(英文)

Triple-negative breast cancer (TNBC) is a unique subgroup defined by a lack expression of ER (estrogen receptor), PR(progesterone receptor) and HER2 (human epidermal growth factor receptor 2), which has distinctly biological, clinical and pathological characteristics. This subgroup has close relationship with basal-like and BRCA1 (breast cancer susceptibility gene-1) breast cancers. Since endocrine and HER2-targered therapy can not be applied, chemotherapy is the major mean of therapy. Some studies show tha...