青年女性乳癌90例临床分析

我院１９８２年１月至１９９４年１２月共收治３５岁以下女性乳癌９０例，占同期女性乳癌总例数的９．３３％，通过临床分析，我们认为本组病人有易误诊、病期晚，恶性程度高，腋淋巴结转移率高，发展快及预后差等特点，应提高对青年女性发生乳癌的警惕性。     

乳癌患者血清T3值与临床分期关系的初步探讨

我们对56例乳癌患者进行血清T_3、T_4测定,旨在探讨其与乳癌临床分期的关系。资料、方法和结果一、研究对象 1986年6月至1987年11月收住本科的乳癌患者56例,女性,年龄28～76岁,平均50.8岁。病程1个月～5年,平均11.3个月。按TNM国际分期法,属临床Ⅰ期19例,Ⅱ期21例,Ⅲ期16例。56例均经病理证实。手术方式:根治术53例,改良根治术3例。二、测试方法患者在术前及术后一周于清晨静脉采血,以PGE法测定T_3、T_4。同时以20名健康成年女性作对照组,所测数据经统计学处理。三、结果 20名正常人和56例患者术前、术后血清T_3、T_4值见附表。     

全内脏反位并右乳癌1例

全内脏反位并右乳癌１例黎明家主治医师吴勇华，刘永达广东省佛山市第一人民医院（５２８０００）全内脏反位合并右乳癌，临床上甚为少见，我院最近收治１例，报告如下。患者女性，４８岁，因右乳无痛性肿块半年于１９９４年６月１日住我市某医院，临床诊断为右乳癌，一周...     

改良乳癌根治术治疗乳腺癌的体会

手术是治疗乳腺癌的主要方法。但采用何种术式,近些年来争论颇多,特别对Ⅰ.Ⅱ期乳腺癌。国外有些学者提倡对Ⅰ、Ⅱ期乳腺癌采用改良乳癌根治术。为了比较改良乳癌根治术和根治术的疗效及其利弊,我们近些年来对Ⅰ、Ⅱ期乳腺癌107例,其中 56例行改良根治术,51例行根治术,并经随访,现总结分析如下。 临床资料 从1975年1月至1984年12月共收治Ⅰ、Ⅱ期乳腺癌107例,均为女性,年龄在29～68岁。行根治术51例     

保留胸前神经的改良乳癌根治术——附3例报道

目的：探讨根治乳癌更为合理的术式。方法：对３例ⅡⅢ期的乳癌患者在行改良一式乳癌根治术的基础上，沿第２肋软骨上缘作胸大肌开窗清扫腋尖群淋巴结和胸肌间淋巴结。结果：本组术后经１年零３个月至２年零８个月的随访，均无肿瘤复发，术侧胸肌无萎缩，肩关节及上肢活动自如。结论：保留胸前神经的改良乳腺根治术既能彻底根治乳癌，又能使保留的胸肌有功能无萎缩，是一种比较理想的术式，适合于无胸大肌浸润的临床各期乳癌病例。     

紫杉醇联合顺铂治疗难治性或复发性晚期乳癌的临床研究

紫杉醇联合顺铂治疗难治性或复发性晚期乳癌的临床研究钱志英陆禹溶紫杉醇（Ｔａｘｏｌ）是一种新的广谱抗肿瘤药，１９９２年美国ＦＤＡ批准应用于临床［１］。为了研究紫杉醇对难治性乳癌的疗效，我们从１９９４年１１月至１９９６年６月，以紫杉醇加顺铂联合治疗难治性...     

13例双侧原发性乳癌临床分析

１３例双侧原发性乳癌临床分析蒋则达主任医师淄博市第一医院（２５５２００）我科１９７２年６月至１９９２年１１月闯共收治乳癌７６１例，其中原发性双乳癌１３例。本文回顾有关临床病理资料，对其诊断标准，治疗原则进行分析。临床资料本组１３例原发性双乳癌中，男１...     

改良Auchincloss术治疗Ⅲ期乳癌初探

自Ｈａｌｓｔｅｄ 1894年提出的乳癌根治术迄今仍保持着乳癌的标准术式地位。随着生物学、免疫学的深入研究 ,形成了“局部治疗和全身治疗并重的治疗模式” ,外科手术的范围不是扩大而是正在缩小。刘氏早在 1986年就指出仿根治术适应于Ⅰ、Ⅱ、Ⅲ期乳癌。Ａｕｃｈｉｎｃｌｏｓｓ术由于其保留了胸大、小肌而一向被认为不能很好清除腋淋巴结而仅用于临床Ⅰ、Ⅱ期乳癌。我们对此术式进行了改进 ,用于治疗临床Ⅲ期乳癌。体会如下。一般资料　 3 5例临床Ⅲ期乳癌病人术前诊断与术后病理检查结果相符。最大年龄 86岁 ,最小年龄 3 5岁 ,平均年龄 49…     

乳癌保守性切除未经放射治疗病例局部复发采用挽救性乳腺切除术的疗效

乳癌保守性切除未经放射治疗病例局部复发采用挽救性乳腺切除术的疗效背景资料：１９７５一１９８２年间对１２８例临床分期为１一工期的浸润性乳癌病例作保守性切除、未经放射治疗。无病间期８—６４月（中位２０月）后，”其中２５例局部复发，再作挽救性乳腺切除手术。...     

乳癌术后骨转移的探讨

目的 研究乳癌术后骨转移发生的特点。方法 对我院十年间710例乳癌术后病人进行了随访及临床分析。结果乳癌病期越晚,腋窝淋巴结转移越多则术后发生骨转移的可能性越大,乳癌术后发生骨转移的平均时间为36.8个月。结论早期发现早期治疗仍是预防乳癌术后骨转移的关键;骨转移发生的高峰是在术后第3年,此时复查要对全身骨骼给予高度重视,特别是脊柱、骨盆、股骨近端和胸骨。     

Breast carcinoma at the extremes of age: a comparison of patients younger than 35 years and older than 75 years

We assessed the prognosis of patients with breast carcinoma at the extremes of the age distribution of the disease. The groups examined were 166 women 35 years or less and 169 at least 75 years old. Analysis of recurrence and survival showed no significant difference between the groups as a whole or when they were stratified by nodal status. Life expectancy of elderly women with breast carcinoma was significantly reduced when compared with a "normal" age-matched population. Medullary carcinoma was more frequent in young women while a relatively higher proportion of colloid and invasive lobular carcinoma occurred in elderly women. Bilateral carcinoma was found with nearly equal frequency in both age groups. However, elderly women were more likely to have been treated previously for contralateral carcinoma while young women tended to develop asynchronous, subsequent carcinoma.     

Breast carcinoma in women age 25 years or less

BACKGROUND: Although several studies have examined breast carcinoma in young women aged < or = 35 years at diagnosis, there are only occasional cases reported in very young women aged < or = 25 years, and, to the authors' knowledge, no series are available. The presentation, tumor biology, behavior, and outcome of breast carcinoma in very young women are not known, and the rarity of breast malignancy within this age group could lead to diagnostic delays. METHODS: The tumor characteristics and survival of 15 women aged < or = 25 years at the time of diagnosis, have been reviewed and compared with women aged 26-35 years under the care of Guy's Hospital's Breast Unit during the same period of time. Where appropriate, the two groups were individually matched for tumor size (clinical measurement) and histologic grade. RESULTS: Fifteen cases were examined, with a median follow-up of 108 months and a median age of 24 years. The median duration of symptoms was 4 weeks, and the median tumor size was 20 mm. Two patients had ductal carcinoma in situ (DCIS) only, while the other 13 patients had invasive carcinomas, none of which were Grade I. A mastectomy was performed on 8 out of 15 patients (53%). Axillary nodal metastases were present in 4 out of 12 patients (33%). Of the 13 cases of invasive disease, 9 out of 13 patients (69%) experienced recurrence and died of breast carcinoma. Median disease free survival for patients with invasive disease was 86 months. There was no difference in overall survival between the patients aged < or = 25 years and those aged 26-35, but taken together young women < or = 35 had a worse prognosis than women between 36 and 65, due to a higher incidence of high grade and estrogen receptor negative tumors. CONCLUSIONS: The current study suggests that among young women with breast carcinoma there is no difference in prognosis between the very young and the young. Despite two thirds of patients being node negative, the high mortality rate indicates a need for an optimal selection of adjuvant therapy among these cases.     

Effect of breast-conserving therapy versus radical mastectomy on prognosis for young women with breast carcinoma

BACKGROUND: Among middle-aged and older women with early breast carcinoma, breast-conserving therapy (BCT) has been shown to have an effect on survival that is similar to that of modified radical mastectomy (RM). Nonetheless, it remains to be established whether BCT also is the optimal treatment option for early breast carcinoma in young women, because these women generally have more aggressive disease and a higher frequency of local recurrence compared with older women. METHODS: We investigated a cohort of 9285 premenopausal women with primary breast carcinoma who were age < 50 years at diagnosis. These women were identified from a population-based Danish breast carcinoma database containing detailed information on patient and tumor characteristics, predetermined treatment regimens, and survival. RESULTS: In total, 7165 patients (77.2%) were treated with RM, and 2120 patients (22.8%) were treated with BCT. We calculated the relative risk of death within the first 10 years after diagnosis according to surgical treatment and age, both before and after adjustment for known prognostic factors. No increased risk of death was observed among women who received BCT compared with women who underwent RM, regardless of age at diagnosis (< 35 years, 35-39 years, 40-44 years, or 45-49 years), despite the increased risk of local recurrence among young women. Restricting the analysis to women with small tumors (size < 2 cm) yielded similar results. CONCLUSIONS: Despite having a higher rate of local recurrence, young women with breast carcinoma who receive BCT are similar to young women treated with RM in terms of survival.     

Reproductive factors and risk of breast carcinoma in a study of white and African-American women

BACKGROUND: Few studies have investigated the association between reproductive factors and the risk of breast carcinoma among African-American women. The authors assessed whether the number of full-term pregnancies, age at first full-term pregnancy, and total duration of breastfeeding were associated with similar relative risk estimates in white and African-American women in a large multicenter, population-based case-control study of breast carcinoma. METHODS: Case patients were 4567 women (2950 white women and 1617 African-American women) ages 35-64 years with newly diagnosed invasive breast carcinoma between 1994 and 1998. Control patients were 4668 women (3012 white women and 1656 African-American women) who were identified by random-digit dialing and were frequency matched to case patients according to study center, race, and age. Adjusted odds ratios and 95% confidence intervals were estimated using unconditional logistic regression. RESULTS: For white women, the reduction in risk of breast carcinoma per full-term pregnancy was 13% among younger women (ages 35-49 years) and 10% among older women (ages 50-64 years). The corresponding risk reductions for African-American women were 10% and 6%, respectively. Risk decreased significantly with increasing number of full-term pregnancies for both races and both age categories. Duration of lactation was inversely associated with breast carcinoma risk among younger parous white (trend P = 0.0001) and African-American (trend P = 0.01) women. African-American women tended to have more children compared with white women, but parity rates were lower in younger women than in older women in both racial groups. However, breastfeeding was substantially more common in young white women than in young African-American women. CONCLUSIONS: Overall, parity and lactation had similar effects on breast carcinoma risk in white and African-American women. If younger African-American women now are giving birth to fewer children than in the past, without a substantial increase in breastfeeding, breast carcinoma rates may continue to increase at a more rapid rate among these women compared with white women.     

Childbearing and survival after breast carcinoma in young women

BACKGROUND: Many young patients with breast carcinoma have not started, or completed, their desired families. How childbearing after a diagnosis of breast carcinoma affects survival is of importance to these women and their families. The authors measured relative mortality among young patients with breast carcinoma with and without births occurring after diagnosis. METHODS: The authors conducted a cohort study using data from three population-based cancer registries in the U.S. (Seattle, Detroit, and Los Angeles), linked to birth certificate data in each state. Four hundred thirty-eight women younger than 45 years of age with primary invasive breast carcinoma were identified as having births after diagnosis. In addition, 2775 comparison women, matched on the basis of age at the time of diagnosis, race/ethnicity, diagnosis year, disease stage, and presence of previous nonbreast primary tumors, were identified among those with breast carcinoma without births after diagnosis. Relative mortality was assessed using multivariable statistical methods. RESULTS: After adjustment for stage of disease, age at diagnosis, study region, diagnosis year, and race/ethnicity, women with births occurring 10 months or more after diagnosis had a significantly decreased risk of dying (relative Risk [RR] = 0.54, 95% confidence interval [CI], 0.41-0.71) compared to women without subsequent births. Women pregnant at the time of diagnosis had a mortality rate similar to those who did not give birth (RR = 1.10, 95% CI, 0.80-1.60). CONCLUSIONS: The results of the current study, in light of growing evidence from other studies using various methods, may provide some reassurance to young women with breast carcinoma that subsequent childbearing is unlikely to increase their risk of mortality.     

Breast‐conserving therapy in young women with invasive carcinoma of the breast

Higher local recurrence rates have been reported in young women with invasive carcinoma of the breast treated with breast‐conserving therapy (BCT). However, age itself may not be responsible for this increased risk of recurrence. To investigate this further, a computerized literature search of MEDLINE was performed using data from 1996 to May 2003. The research was limited to female patients with localized, invasive adenocarcinoma of the breast but also included patients of young age with ductal carcinoma in situ. Women of young age with breast cancer, treated with BCT are at an increased risk of recurrence ranging from 7.5 to 35%. However, the data would suggest that the increased risk is secondary to the association of young age with more aggressive tumours and a positive family history of breast cancer. Other factors that may explain the adverse prognosis in women of a young age include associated genetic abnormalities and the lack of mammographic screening programmes for women of young age. Young age is a risk factor for breast recurrence after BCT. However, management decisions should be based on tumour stage, grade and other related prognostic features rather than on young age alone.     

E-cadherin和VEGF在青年女性乳腺癌组织中的表达及其临床意义

目的:探讨上皮钙黏蛋白(E-cadherin,E-cad)和血管内皮生长因子(VEGF)在青年女性乳腺癌组织中的表达及其与病理特征的关系。方法:应用免疫组化方法检测80例青年女性,80例绝经后乳腺癌组织中E-cad和VEGF的表达情况,分析它们之间及其与临床病理指标之间的关系。结果:青年组较绝经组患者淋巴转移率高(P<0.01);青年组与绝经组患者组织E-cad和血管内皮生长因子的表达差异皆有显著性意义(P<0.01);各组中腋窝淋巴结转移者和未转移者E-cad和血管内皮生长因子的表达差异均有显著性意义(P<0.01);青年乳腺癌组织中E-cad和血管内皮生长因子基因表达成负相关(P<0.01)。结论:青年乳腺癌侵袭性强,E-cad低表达和血管内皮生长因子基因高表达是预测青年乳腺癌恶性侵袭能力极有价值的生物学指标。     

E-cadherin和VEGF在青年女性乳腺癌组织中的表达及其临床意义

目的：探讨上皮钙黏蛋白（E-cadherin,E-cad）和血管内皮生长因子（VEGF）在青年女性乳腺癌组织中的表达及其与病理特征的关系。方法：应用免疫组化方法检测80例青年女性,80例绝经后乳腺癌组织中E-cad和VEGF的表达情况,分析它们之间及其与临床病理指标之间的关系。结果：青年组较绝经组患者淋巴转移率高（P〈0.01）;青年组与绝经组患者组织E-cad和血管内皮生长因子的表达差异皆有显著性意义（P〈0.01）;各组中腋窝淋巴结转移者和未转移者E-cad和血管内皮生长因子的表达差异均有显著性意义（P〈0.01）;青年乳腺癌组织中E-cad和血管内皮生长因子基因表达成负相关（P〈0.01）。结论：青年乳腺癌侵袭性强,E-cad低表达和血管内皮生长因子基因高表达是预测青年乳腺癌恶性侵袭能力极有价值的生物学指标。     

Relation of body mass index to tumor markers and survival among young women with invasive ductal breast carcinoma

BACKGROUND: Obesity has been shown to affect breast carcinoma prognosis, with the heaviest women having a higher mortality due to breast carcinoma. Few studies have focused on premenopausal women or the correlation of body mass index (BMI) to tumor characteristics related to prognosis. METHODS: The authors conducted a population-based follow-up study for mortality of 1177 women younger than 45 years of age who had invasive ductal breast carcinoma diagnosed from 1983 through 1992. Histologic slides and/or tumor tissue were collected for pathologic review, immunohistochemistry assays, and bivariate flow cytometric analysis. RESULTS: Women with breast carcinoma who were in the highest quartile of BMI were 2.5 times as likely (95% confidence interval [CI], 1.6-3.9) to die of their disease within 5 years of diagnosis compared with women in the lowest quartile of BMI. The tumors of the women in the highest quartile of BMI were more likely to be estrogen receptor negative (odds ratio [OR], 1.5; 95% CI, 1.0-2.2) and to have a high S-phase fraction (OR, 1.9; 95% CI, 1.2-3.1), high histologic grade (OR, 1.7; 95% CI, 1.0-2.9), high mitotic cell count (OR, 2.0; 95% CI, 1.2-3.1), and large tumor size (2 to < 5 cm: OR, 2.3; 95% CI, 1.5-3.1; or > or = 5 cm: OR, 2.7; 95% CI, 1.5-4.8) compared with the tumors of women whose BMI was in the first quartile. Relative to the large tumors (> or = 2 cm) in women in the lowest BMI quartile, the large tumors in women in the highest BMI quartile were more likely to express markers of high proliferation, indicating they may have grown faster than similar size tumors of the thinnest women. In a multivariate analysis including the tumor characteristics, obesity, as measured by being in the highest quartile of BMI, remained an independent prognostic factor for mortality (hazard ratio, 1.7; 95% CI, 1.0-2.9; P < 0.05. CONCLUSIONS: Our study results indicated that being in the highest quartile of BMI was a strong predictor of mortality in women with breast carcinoma diagnosed at a young age. The tumors of the heavy women were larger and more likely to have markers of high cellular proliferation than those of thinner women.     

Factors influencing mortality among young women with second primary breast carcinoma

BACKGROUND: Tumor characteristics are strong predictors of survival among women with breast carcinoma, yet the variability in prognosis among women presenting with similar stages suggests other factors may also play an important role. We examine the prognostic significance of etiologic risk factors for breast carcinoma to determine whether factors that influence the development of breast carcinoma also affect the course of the disease among a prospective cohort of young women with bilateral breast carcinoma. METHODS: The 369 U.S. women included in this study were from the Cancer and Steroid Hormone Study who were diagnosed with an invasive first primary breast carcinoma between 1980 and 1982 and a second primary breast carcinoma before 1999. Cox proportional hazards models were used to evaluate factors known and suspected to be associated with breast carcinoma and with survival, based on reporting at the time of the first primary. RESULTS: One hundred sixty women died during the 16-18-year follow-up period. The adjusted 1, 5, 10, and 15-year survival rates following diagnosis of second primary breast carcinoma were 94%, 70%, 55%, and 49%, respectively. Survival rates werepoorest among the youngest women, those diagnosed with a second primary within 5 years of their first, poor African American women, women with either primary diagnosed at a later stage, those with less than 12 years of school, single women, and those with major weight gain between age 18 and adulthood. CONCLUSIONS: This study provided little evidence that important etiologic factors for breast carcinoma predict mortality following diagnosis of a second primary breast carcinoma.