新辅助化疗对乳腺癌骨髓微转移的影响

目的探讨乳腺癌骨髓微转移的临床特点及新辅助化疗对骨髓微转移的影响。方法手术治疗的乳腺癌患者100例,采用免疫组化SP法,用EMA,CK19单克隆抗体检测其骨髓微转移情况,分析其临床特点,并以骨髓微转移为指标,评价新辅助化疗对阳性患者的影响。结果100例中,检出骨髓微转移31例,阳性率为31.0%。临床Ⅲ期患者骨髓微转移率明显高于Ⅰ～Ⅱ期患者,阳性患者接受新辅助化疗后,转阴率达67.7%。结论乳腺癌是1种全身性疾病,即使在临床早期也有相当比例微转移,新辅助化疗对抑制骨髓微转移有效,可以指导化疗方案的选择,并可能对预防术后复发和转移起重要作用。     

乳腺癌微转移的研究进展

微转移是乳腺癌早期即发生的行为，与预后密切相关。近年来，随着影像学、病理学、免疫组化技术及分子生物学技术的发展，乳腺癌微转移的诊断水平有了长足的进步。本文综述了乳腺癌微转移方面的最新进展。     

乳腺癌微转移标记物研究进展

骨髓、淋巴结微转移的检出率与乳腺癌患者的预后密切相关,并已成为重要的独立预后因素,可早期诊断肿瘤复发和远处转移。目前乳腺癌微转移标记物的研究主要集中在乳腺小黏蛋白、人乳腺珠蛋白(hMAM)、黏蛋白1、丝氨酸蛋白酶抑制因子(maspin)、细胞角蛋白(CK)19等。     

乳腺癌微转移标记物研究进展

骨髓、淋巴结微转移的检出率与乳腺癌患者的预后密切相关,并已成为重要的独立预后因素,可早期诊断肿瘤复发和远处转移。目前乳腺癌微转移标记物的研究主要集中在乳腺小黏蛋白、人乳腺珠蛋白（hMAM）、黏蛋白1、丝氨酸蛋白酶抑制因子（maspin）、细胞角蛋白（CK）19等。     

曲妥珠单抗对HER-2阳性早期乳腺癌骨髓微转移的影响

目的：检测HER-2阳性的早期乳腺癌患者应用曲妥珠单抗（Trastuzumab）治疗前后骨髓微转移的改变,探讨HER-2基因及Herceptin对骨髓微转移的影响。方法：应用实时定量逆转录-聚合酶链反应（qRT-PCR）方法检测15例HER-2阳性乳腺癌及18例HER-2阴性乳腺癌患者术前及化疗后骨髓CK19的表达水平,其中10例HER-2阳性乳腺癌患者在化疗结束后,继续应用Herceptin治疗,3月后再次抽取骨髓标本,qRT-PCR检测CK19的表达水平。结果：手术前,14例HER-2阳性乳腺癌患者骨髓CK19表达阳性（93.3%）,而HER-2阴性患者8例CK19表达阳性（44.4%）,二者差异显著（P=0.000）。化疗后,12例HER-2阳性乳腺癌患者CK19表达阳性（80.0%）,而HER-2阴性患者3例表达阳性（16.7%）,二者差异显著（P=0.000）。10例HER-2阳性乳腺癌患者化疗后继续应用Herceptin治疗3月后,骨髓CK19的表达明显下降（102.78±98.24 vs 66.92±49.18,P=0.036）。结论：HER-2基因的表达与早期乳腺癌患者骨髓微转移密切相关,而Herceptin可以降低骨髓微转移病灶,提示骨髓微转移情况可以作为Herceptin治疗疗效的早期预测指标。     

检测乳腺癌患者骨髓中CK19的表达及其临床意义

背景与目的:乳腺癌早期即可发生播散和转移,远处转移尤其骨转移是影响患者预后的主要因素之一,而骨髓微转移用常规方法又难以检测出来。本研究旨在探讨检测乳腺癌患者骨髓中CK19mRNA的表达及其临床意义。方法:应用RT鄄PCR技术,同时对照检测65例乳腺癌患者、15例乳腺良性病变患者和8例健康人骨髓中的CK19mRNA表达,并分析CK19mRNA表达与临床病理因素的关系。结果:65例乳腺癌患者中,22例CK19mRNA阳性,阳性率为33.8%;乳腺良性病变患者和健康人骨髓中未检测到CK19mRNA表达。CK19mRNA表达与乳腺癌肿瘤大小和分期有关(P<0.05),与年龄和淋巴结转移状况无显著性相关(P>0.05);与外周血中CEA异常增高呈正相关(r=0.372,P=0.002)。结论:CK19mRNA可作为检测乳腺癌患者骨髓微转移的分子指标之一,可为乳腺癌患者的治疗和预后判断提供帮助。     

hMAM mRNA和CK19 mRNA联合检测乳腺癌骨髓微转移

目的：检测乳腺癌患者骨髓中的human mamglobin（hMAM）mRNA和CK19 mRNA表达,探讨乳腺癌患者早期骨髓微转移与临床病理学因素的关系.方法：采用逆转录-聚合酶链反应（RT-PCR一步法）法检测骨髓组织中hMAM mRNA和CK19 mRNA的表达.结果：102例乳腺癌患者骨髓hMAM mRNA、CK19 mRNA表达阳性者分别为37.3%和56.9%,均高于良性乳腺疾病患者骨髓组织中的表达（P=0.043,P=0.002）.两者的阳性表达率与肿瘤大小、临床分期和组织学分级呈显著相关,P值分别为0.000、0.001、0.020、0.003、0.031和0.001;与淋巴结转移状况、年龄和月经状况无关,P值分别为0.101、0.255、0.111、0.110、0.492和0.187.结论：乳腺癌微转移与肿瘤大小、临床分期和组织学分级有关,hMAM mRNA和CK19 mRNA均可作为检测乳腺癌骨髓微转移标志,且两者间存在一致性.     

乳腺癌前哨淋巴结微转移的研究进展

乳腺癌是在世界范围内严重威胁女性健康的全身性恶性肿瘤之一,早期即可通过淋巴系统转移.肿瘤细胞经淋巴系统转移所必经的第一批淋巴结称为前哨淋巴结(sentinel lymph node,SLN).因此,明确SLN的状态对确定乳腺癌分期、判断预后及指导治疗具有极其重要的意义.目前,由于筛查技术的改进以及人们对乳腺癌认识的增强,多数患者被确诊时都属早期较低级别的肿瘤原发灶或微小的腋窝淋巴结转移灶.腋窝淋巴结的状况对于乳腺癌患者而言是一项重要的预后因素,而前哨淋巴结微转移(sentinel lymph node micrometastases,SLNMM)患者腋窝的处理,以及下一步的辅助治疗方案,仍然是有争议的问题.     

乳腺癌微转移中泌乳素诱导蛋白表达的检测

泌乳素诱导蛋白(PIP)被认为是乳腺癌较特异性的标记物,检测其在乳腺癌组织、转移淋巴结及外周血中的表达对早期发现乳腺癌微转移具有提示意义.免疫组织化学、逆转录聚合酶链反应等技术在检测PIP表达时具有敏感性,现已广泛应用于临床与基础研究.联合检测乳腺珠蛋白、细胞角蛋白(CK)19等标记物可有效提高微转移的检出率.     

乳腺癌患者骨髓微转移与其他预后指标相关性的研究

目的:研究乳腺癌患者骨髓微转移与其他预后指标的相关性.方法:采用RT-PCR法检测了69例乳腺癌患者骨髓中CK19 mRNA的表达,并将骨髓微转移与肿瘤细胞DNA含量、细胞周期分布及增殖细胞核抗原(PCNA)、血管内皮细胞生长因子(VEGF)、HER-2和ER等指标和传统预后指标的相关性进行了研究.结果:RT-PCR技术检测乳腺癌患者骨髓微转移的阳性率为34.8%.骨髓微转移与肿瘤大小、患者年龄、月经状态及激素受体状况等指标无相关性,P0.05.骨髓微转移与腋窝淋巴结状态、HER-2过表达、VEGF水平、S期细胞比值(SPF)以及PCNA有相关性,P<0.05.在淋巴结病理学检查阴性的病例中,有17.6%的病例骨髓微转移检查阳性.结论:乳腺癌患者骨髓微转移与患者的一般临床特点无相关性,但与反映肿瘤细胞增殖、侵袭特性的大部分生物学指标具有相关性.在淋巴结病理学检查阴性的病例中,部分病例骨髓微转移阳性.     

Updates in adjuvant systemic treatment of breast cancer

Breast cancer is a significant public health burden with more than 200,000 new cases diagnosed in the United States each year. Although many incident cases represent localized disease, a significant proportion of women with early stage breast cancer eventually experience a distant relapse and ultimately die of metastatic breast cancer complications. Consequently, investigators strive to improve the adjuvant treatment paradigm and thus, optimize outcomes for women with early stage breast cancer. Within the last year a study describing a decline in incident breast cancer cases in the United States was reported. In addition, the results from a number of notable adjuvant treatment studies were reported or updated. Innovations in taxane-containing strategies and dose dense chemotherapy strategies were prominently featured. In addition, a number of insights pertaining to the treatment of women with HER2-positive breast cancer were reported. An overview of selected recently reported studies will be reviewed here.     

肿瘤相关巨噬细胞的极化方式及其对乳腺癌进展的影响

乳腺癌是严重威胁女性健康的恶性肿瘤之一，在全球范围内，其发病率呈逐年升高以及年轻化的趋势。肿瘤相关巨噬细胞（tumor-associated macrophages,TAMs）是乳腺癌肿瘤微环境中重要的免疫细胞，功能多样，具有高度的可塑性。当前的研究认为，TAMs在乳腺癌形成早期常表现为M1样表型，而在乳腺癌进展的过程中则极化为M2样表型，M2型TAMs能够促进乳腺癌的细胞增殖、血管生成、免疫抑制以及耐药性，与乳腺癌的预后呈负相关。因此，对TAMs极化方向的干预可作为乳腺癌抗癌治疗的一个新的研究方向。本文主要对乳腺癌中TAMs极化的分子机制以及对乳腺癌进展的影响进行综述。     

174例乳腺癌生存因素分析

目的 分析影响乳腺癌生存率的相关因素。方法 收集174例乳腺癌病人的完整临床资料与病理,随访5年以上,观察其生存时间,制作Kaplan-Meier评价生存曲线,并做比较分析。结果 乳腺癌高发年龄在40~49岁;Ⅰ期、Ⅱ期与Ⅲ期乳腺癌患者总体生存曲线不同;乳腺癌的肿块大小与腋窝淋巴结转移成正相关;绝经后患者5年生存率低于未绝经患者;ER(-)病例平均无病存活时间小于ER(+)病例。结论 必须重视乳腺癌的早期检查、早期诊断和早期系统治疗;全社会应普及乳腺癌的筛查工作。     

保乳术治疗早期乳腺癌疗效观察

目的 观察早期乳腺癌保乳术的疗效.方法 入组保乳术治疗的早期乳腺癌30例,其中Ⅰ期21例,Ⅱ期9例,均行象限切除加腋窝淋巴结清扫,术后均进行辅助化疗、放疗和内分泌治疗等综合治疗.结果 30例全部得到随访,随访时间6～96个月,未发现局部复发或远处转移.5年总生存率90.6%,乳房美容优良率93.3%.结论 保乳手术配合...     

保留乳房治疗早期青年乳腺癌

目的 :探讨早期青年乳腺癌保留乳房治疗的可行性与治疗效果。方法 :对 31例早期青年乳腺癌患者行保留乳房手术 ,术后常规放疗 ,腋淋巴结阳性者辅以CMF或CAF方案化疗 ,雌、孕激素受体阳性者给予TAM治疗。结果 :随访 11个月～ 9年 ,中位 4 1个月。术后局部复发率 3.2 % ,3年生存率94 4 % ,5年生存率 85.7% ,美容效果满意率 87.0 %。结论 :对早期青年乳腺癌行保留乳房治疗是安全的 ,术式以乳腺区段切除并全腋淋巴结清除更为合理 ,术后常规放疗可降低复发率 ,该治疗保留了乳房外形 ,满足了患者的精神和生理的需要。     

MRI技术在乳腺癌诊断中的应用进展

乳腺癌作为女性恶性肿瘤的常见病，其发病率和发病人数表现出逐年递增趋势。伴随诊治技术及方案的改进，乳腺癌的诊治方式、疗效监督及预后评估等各方面都有了显著提升，从而也对乳腺癌临床早期诊断的检出率及分期的准确率有了较高的要求。医学影像技术尤其是 MRI检查在乳腺疾病诊治方面不断取得新突破和新应用，乳腺MRI检查技术的角色和作用显得越发重要。MRI基础及功能序列扫描等多种辅助检查，多角度、全方位提供病灶相关解剖、血流动力学、功能及代谢等信息。因而需要全方面熟悉MRI检查技术在乳腺癌诊治中的应用现状，才能使之合理高效的运用于临床诊断、术前分期、治疗方案选取及疗效评估等各方面。     

Early breast cancer detection behaviors among ethnically diverse low-income women

We examined factors associated with early breast cancer detection behaviors among 301 ethnically diverse low-income women participating in a breast cancer educational outreach program. Multivariate analyses showed that women who had a mammogram in the past year were more likely to be more knowledgeable about breast cancer than women who did not have a mammogram in the past year. Women who had received a mammogram at any time in the past and who had a clinical breast examination during the preceding year were more likely to have received encouragement to obtain mammography than those who had never received a mammogram and did not get a CBE during the preceding year. For women between the ages of 20 and 39, recommendation of mammography and breast cancer knowledge were related positively to ever having a mammogram. Recommendation of breast self-examination (BSE) and number of barriers to BSE were related to monthly BSE practice. Results suggests that health care providers play an important role in motivating low-income minority women to comply with breast cancer screening recommendations.     

Reproductive factors and breast cancer risk. Do they differ according to age at diagnosis?

Studies yielding results on risk factors stratified by age at diagnosis or menopausal status were reviewed to better understand the role of hormonal factors and to determine whether reproductive events influence breast cancer risk differently according to age at diagnosis of breast cancer. Through a Medline/Pubmed search, 26 articles providing risk estimates by age at diagnosis of breast cancer or by menopausal status were analysed. A decrease of about 9% of breast cancer risk was found for each additional year at menarche when breast cancer was diagnosed early or before the menopause, and of about 4% when diagnosed late or after. Breast cancer risk increased with increasing age at FFTP by 5% per year for breast cancer diagnosed early or before the menopause and by 3% for cancers diagnosed late or after the menopause. Each full term pregnancy (or child) led to a 3% reduction in the risk of breast cancer diagnosed early or before the menopause, whereas the reduction attained 12% for the breast cancers diagnosed later. No change in the effect of these three factors with time (date of diagnosis of the breast cancer before 1980 or after) was observed. These results support the hypothesis of an age-specific effect of the three breast cancer risk factors considered herein, based on the time of initiation of the carcinogenic process. These observations underline the importance of the time of initiation of the carcinogenic process in determining the effect of promoters such as reproductive factors. This largely unexplored aspect of breast carcinogenesis might open the way for new prevention approaches.     

First degree relatives of breast cancer patients: screening practices and provision of risk information.

Little is known about breast cancer screening knowledge and behaviors among women with a family history of breast cancer. Data gathered from 125 first-degree relatives of breast cancer patients indicated that only 63.3% of women over age 35 "ever" had a mammogram, 53% of women 40 or older reported a mammogram in the last year, and only 36.8% of all participants reported monthly breast self-exam (BSE). Self-reported BSE competence was generally poor. One hundred five (105) (84%) reported a clinical breast exam over the previous year. Only 71 (56.8%) of the women indicated that they had been asked about their family history of breast cancer by their physician, and minimal information about risk related to family history was provided. Worry about developing breast cancer was positively related to mammography use and BSE competence. Confidence in performing BSE and learning BSE from a physician/nurse were both positively related to competence. Women who believed they had control over finding breast cancer in its early stages reported more frequent BSE. Poor compliance of women with a family history of breast cancer in the practice of BSE and utilization of mammography, and lack of risk information provided by physicians mandate a search for effective intervention.     

Knowledge of Risk Factors & Early Detection Methods and Practices towards Breast Cancer among Nurses in Indira Gandhi Medical College,Shimla, Himachal Pradesh,India

Background: Breast cancer is an increasing health problem in India. Screening for early detection should leadto a reduction in mortality from the disease. It is known that motivation by nurses influences uptake of screeningmethods by women. This study aimed to investigate knowledge of breast cancer risk factors & early detectionmethods and the practice of screening among nurses in Indira Gandhi Medical College, Shimla, Himachal Pradesh.Materials and Methods: A cross-sectional study was conducted using a self-administered questionnaire to assessthe knowledge of breast cancer risk factors, early detection methods and practice of screening methods among457 nurses working in a Indira Gandhi Medical College, Shimla-H.P. Chi square test, Data was analysed usingSPSS version 16. Test of significance used was chi square test. Results: The response rate of the study was 94.9%.The average knowledge of risk factors about breast cancer of the entire population is 49%. 10.5% of nurses hadpoor knowledge, 25.2% of the nurses had good knowledge, 45% had very good knowledge and 16.3% of thenurses had excellent knowledge about risk factors of breast cancer and early detection methods. The knowledgelevel was significantly higher among BSC nurses than nurses with Diploma. 54% of participants in this studyreportedly practice BSE at least once every year. Less than one-third reported that they had CBE within thepast one year. 7% ever had mammogram before this study. Conclusions: Results from this study suggest thefrequent continuing medical education programmes on breast cancer at institutional level is desirable.