nm23和MTSL基因在乳腺癌中的表达与淋巴结转移的关系

应用LSAB免疫组织化学杂色方法，研究转移抑制基因nm23表达产物二磷酸核苷激酶（NDPK）和转移基因MISL在乳腺癌的表达及其意义。结果NDPK／nm23在乳腺癌中有较高的表达，阳性率为62％。伴淋巴结转移春阳性事为50％,无淋巴结转移者阳性年为75％。两者差异有显著性意义（P＜0.05）。MTSL在乳腺癌中有较高表达，阳性率为50％。伴淋巴结转移者其阳性率为923％，无淋巴结转移者其阳性年为45.8％，两者差异有显著性（P＜0.01）。提示nm23和MTSL两个调控肿瘤转移的因于在乳腺癌研究中起重要作用。     

胃癌淋巴结大小与转移的关系

[目的]评估胃癌淋巴结大小与转移的相关性。[方法]分析115例胃癌患者手术摘取的淋巴结数目、最大径、病理结果,探讨转移频数与淋巴结大小的相关性。[结果]115例标本共2252个淋巴结,556个淋巴结(24.7%)有转移,转移淋巴结平均直径(10.1±4.2)mm,而无转移淋巴结是(5.9±3.5)mm(P<0.01)。1～5mm和6～9mm淋巴结转移率分别为12.3%(112/908)和26.2%(238/910);10～14mm和≥15mm淋巴结转移率分别为40.5%(130/321)和67.3%(76/113),后3组间存在显著差异(P<0.05)。40例无淋巴结转移患者中,33例患者(82.5%)至少有一个淋巴结≥10mm,12例患者(30%)至少有一个淋巴结≥15mm。[结论]淋巴结大小不能作为评估胃癌淋巴结转移的可靠参数。     

nm23基因在人乳腺癌中的表达及与淋巴结转移的关系

应用免疫组织化学抗生蛋白链菌素－生物素标记法，对１２２例乳腺部ｎｍ２３基因的表达及其与淋巴结转移的关系进行了研究。结果显示：１２２例乳腺癌ｎｍ２３基因性阳性率为５１．６％，而有腋窝淋巴结转移的５３例乳腺癌，其阳性率为２８．３％，无腋窝淋巴结转移的６９例，阳性主６９．６％，两者有非常显著差异。     

Tumor Characteristics Influencing Non-Sentinel Lymph Node Involvement in Clinically Node Negative Patients with Breast Cancer

Purpose

The negative sentinel lymph node (SLN) biopsy avoids conventional axillary dissection in patients with breast cancer with clinically negative axilla. Despite negative SLN, there is a risk of leaving involved non-SLN behind in the axilla. We investigated the predictive power of tumor characteristics for non-SLN metastasis.

Methods

Lymphatic mapping with blue dye method for SLN biopsy and level 1-2 axillary dissections were performed to establish axillary status in 59 patients with T1 and T2 breast cancer and clinically negative axilla. Tumor''s characteristics were histopathologically established to assess their association with non-SLN metastasis.

Results

The axilla was malignant in 23 (39%) patients. The SLN alone was metastatic in 10, both SLN and non-SLN in 9, and non-SLN alone in 4 (7%) patients. The false negative rate for SLN biopsy was 10% in our series. The rate of positive non-SLN was found as 0% in T1a-b, 19% in T1c, and 40% in T2 tumors (p=0.035). Lymphovascular invasion was positive in 14 (61%) patients with axillary metastasis (p<0.001), and in 10 (77%) patients with non-SLN involvement (p<0.001).

Conclusion

We concluded that there was a small risk of involved non-SLN despite negative SLN. Tumor size (near or greater than 2 cm) was significantly associated with non-SLN metastasis. Peritumoral lymphovascular invasion was a positive predictor of the metastatic involvement in non-SLNs.     

乳腺癌前哨淋巴结活检的临床研究

目的　探讨乳腺癌前哨淋巴结活检 (SLNB)的临床应用价值 ,分析影响检出率的相关因素。方法　在乳腺肿瘤表面或活检部位周围皮下组织注射99mTc标记的硫胶体 ,采用核素淋巴显像和γ计数器探测仪检测识别前哨淋巴结 (SLN ) ,先行SLNB ,随后行乳腺癌改良根治术。结果　 5 0例患者中SLN检出率为 96.0 % ;敏感度为 88.2 % ;准确性为 95 .8% ;假阴性为11.8% ;假阳性为 0。患者年龄 <5 0岁、原发肿瘤位于乳腺外上象限、术前穿刺活检确诊与SLN检出有关 (P <0 .0 5 ) ;是否绝经、肿瘤大小、病理类型、雌激素受体 (ER)、孕激素受体 (PR)与SLN检出无关 (P >0 .0 5 )。结论　SLNB具有安全可靠、敏感度和准确性较高等特点 ,可以正确反映大多数乳腺癌患者腋窝淋巴结 (ALN )有无转移     

乳腺癌前哨淋巴结的临床研究

目的：探讨前哨淋巴结活检（sentinel lymph node biopsy，SLNB）在乳腺癌临床应用中的可行性、准确性。方法：术前肿瘤表面或活检腔周围皮内注射99mTc-DX，进行前哨淋巴结（sentinel lymph node，SLN）显像、体表定位；术中r-探测仪识别SLN，先行SLNB，再行乳腺癌根治术或改良根治术，术后对SLN和腋窝淋巴结清扫（axillary Lymph Node Dissectio，ALND）的病理结果进行综合分析。结果：淋巴闪烁显像和r-探测器联合应用检测SLN准确率为96.9％，敏感度为90.9％，假阴性率为9.1％，假阳性率为0。结论：SLNB是乳腺癌治疗中的一项新技术，能高灵敏度反应腋淋巴结状态。     

The Prognostic Significance of the Lymph Node Ratio in Axillary Lymph Node Positive Breast Cancer

Purpose

This study evaluated the prognostic impact of the lymph node ratio (LNR; i.e., the ratio of positive to dissected lymph nodes) on recurrence and survival in breast cancer patients with positive axillary lymph nodes (LNs).

Methods

The study cohort was comprised of 330 breast cancer patients with positive axillary nodes who received postoperative radiotherapy between 1987 and 2004. Ten-year Kaplan-Meier locoregional failure, distant metastasis, disease-free survival (DFS) and disease-specific survival (DSS) rates were compared using Kaplan-Meier curves. The prognostic significance of the LNR was evaluated by multivariate analysis.

Results

Median follow-up was 7.5 years. By minimum p-value approach, 0.25 and 0.55 were the cutoff values of LNR at which most significant difference in DFS and DSS was observed. The DFS and DSS rates correlated significantly with tumor size, pN classification, LNR, histologic grade, lymphovascular invasion, the status of estrogen receptor and progesterone receptor. The LNR based classification yielded a statistically larger separation of the DFS curves than pN classification. In multivariate analysis, histologic grade and pN classification were significant prognostic factors for DFS and DSS. However, when the LNR was included as a covariate in the model, the LNR was highly significant (p<0.0001), and pN classification was not statistically significant (p>0.05).

Conclusion

The LNR predicts recurrence and survival more accurately than pN classification in our study. The pN classification and LNR should be considered together in risk estimates for axillary LNs positive breast cancer patients.     

食管鳞状细胞癌淋巴结转移对预后影响的分析

目的：探讨胸段食管鳞状细胞癌淋巴结转移数对预后的影响。方法：对1146例胸段食管鳞状细胞癌单纯手术切除的临床病理资料,应用Kaplan-Meier生存曲线和Spearmam相关进行研究,结果：1）0、1、≥个转移淋巴结间的生存率差异显著（P＜0．001）。2）Ⅱb期和Ⅲ期间的生存率无差异（P＞0．05）;1和≥2个转移淋巴结的T3N1M0期间的生存率差异显著（P＞0．001）;3基于0、1和≥2个转移淋巴结的分期,该分期中的Ⅱa期、Ⅱb期、Ⅲa期和Ⅲb期之间的生存率差异显著（P＜0．001）。结论：淋巴结转移数和基于淋巴结转移数的分期能够反映食管癌切除术预后的变化,但还需更大样本量和多中心的进一步研究。     

新疆维吾尔族女性乳腺癌腋窝淋巴结转移的危险因素分析

目的 探讨影响新疆维吾尔族女性乳腺癌患者腋窝淋巴结转移的危险因素.方法 对256例临床诊断为Ⅰ～Ⅲ期维吾尔族女性乳腺癌患者的临床资料进行回顾性分析,并对影响腋窝淋巴结转移的危险因素进行单因素及多因素Logistic回归分析.结果 对12项临床和病理指标进行单因素分析显示,妊娠次数、肿瘤大小、部位、病理类型、脉管浸润、H...     

VEGF-C,VEGF-D在乳腺癌中的表达及其与淋巴结转移及预后的关系

目的探讨VEGF-C和VEGF-D在乳腺癌组织中的表达以及与淋巴结转移、预后的相关性。方法采用SP免疫组化法检测78例乳腺癌癌组织和30例癌旁组织中VEGF-C,VEGF-D的表达水平,并完成所有患者的5年的随访资料。结果 78例乳腺癌癌组织中VEGF-C/D表达与癌旁组织相比差异有统计学意义(P<0.05);乳腺癌中VEGF-C表达与VEGF-D表达无相关性。VEGF-C,VEGF-D的表达水平与乳腺癌脉管内侵犯、淋巴结转移密切相关(P<0.05),但与年龄、肿瘤大小、TNM临床分期、ER、PR及Her-2的表达无关(P>0.05)。VEGF-C和VEGF-D的表达水平与乳腺癌的总生存期及无病生存期密切相关(P<0.05)。结论 VEGF-C,VEGF-D在乳腺癌组织中呈高表达;VEGF-C/D的表达水平与乳腺癌淋巴结转移能力和预后密切相关。     

乳腺原发癌与淋巴结转移癌基因表达谱的比较研究

目的：通过乳腺原发癌与琳巴结转移癌基因表达谱的比较研究,筛选乳腺癌转移相关基因,探讨淋巴强转移阳性乳腺癌患者分子分型的临床意义.方法：采用eRNA扩增方法分别将乳腺原发癌与配对的淋巴结转移癌标记Cy3和Cy5的荧光探针,与点有21 329个人功能基因的Oligo芯片进行配对杂交.筛选30例病中至少16对样本（50%以上）有2.0倍以上相同差异表达趋势的基因：采用Cluster3.0对样本及病例进行非监督聚类分析.结果：共筛选得到95个差异表达基因,其中41个在转移癌中表达上调,54个下调,分别与细胞格附和运动能力,细胞外基质,蛋白水解酶,信号传导与转录调节.细胞生长与凋亡相关.基于全基因表达谱对样本聚类将83.3%（25/30）病例的原发癌与其配对的淋巴结转移癌聚类在一起,基于差异表达基因对病例的聚类分析将30便患者分为2组,其中A组与B组比较,A组多为肿瘤体积T3-4（P〈0.05）,ER阴性（P〈0.05）,组织学Ⅲ组（P=0.073）和3年内发生远处转移（P=0.085）的预后较差的病例.结论：以同一病例乳腺原发癌与其淋巴结转移癌进行基因表达谱的比较分析,筛选得到的在多病例中有共同差异表达趋势的基因,涉及了与转移相关的重要生物学过程;同一病例的原发癌与转移癌聚类在一起,证实淋巴结转移癌是其原发癌高转移能力细胞的亚克隆,因而具有相近的基因表达谱,其中的差异基因即包含了涉及转移表型的基因改变.基于原发癌差异基因的表达谱可以将淋巴结转移阳性乳腺癌病例进行分子分组并能预测预后.     

nm23基因在乳腺癌中的表达及与远处转移相关性的研究

应用免疫组化方法，对１０１例有８年随访结果的乳腺癌病例，进行了ｎｍ２３基因蛋白表达的检测。结果显示，ｎｍ２３基因蛋白表达与血行转移、淋巴结转移的发生呈负相关，与其它临床指标无关。生存率分析表明：ｎｍ２３基因高表达组患者的生存率明显高于低表达组（Ｐ＜０．０５）；腋淋巴结阴性组中，ｎｍ２３基因高、低表达的患者生存率差别显著，提示若将腋淋巴结阴性组中具有潜在转移危险性的ｎｍ２３低表达患者筛选出来，加强治疗，将会有助于提高生存率。应用Ｃｏｘ比例风险模型进行的多因素分析显示，ｎｍ２３基因表达与腋淋巴结转移、肿瘤大小均为乳腺癌的预后因素，其中ｎｍ２３基因高表达患者死亡的相对危险度较低表达患者低５４％。本研究结果提示，ｎｍ２３基因表达可以作为一项独立的预后指标，用以指导乳腺癌的临床治疗。     

Breast Cancer Subtype as a Predictor of Lymph Node Metastasis according to the SEER Registry

Purpose

Breast cancer subtype correlates with response to systemic therapy and overall survival (OS), but its impact on lymphatic spread is incompletely understood. In this study, we used the Surveillance, Epidemiology, and End Results registry to assess whether the subtype can predict the presence of nodal metastasis or advanced nodal stage in breast cancer.

Methods

A total of 7,274 eligible patients diagnosed with T1-3 infiltrating ductal carcinoma with known estrogen or progesterone hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2) status, who underwent surgical excision of the primary tumor and pathologic lymph node evaluation, were included in this analysis. Patients were categorized into four breast cancer subtypes: HR+/HER2-; HR+/HER2+; HR-/HER2+; and HR-/HER2-. Binary logistic regression analysis was used to determine whether breast cancer subtype, tumor size, tumor grade, patient race, and patient age at diagnosis are independently predictive of lymph node positivity or advanced nodal stage. The Pearson chi-square test was used to determine whether progesterone receptor (PR) status had an impact on the incidence of lymph node positivity in estrogen receptor (ER) positive patients.

Results

Independent predictors of nodal positivity included breast cancer subtype (p=0.040), tumor size (p<0.001), tumor grade (p<0.001), and patient age (p<0.001), whereas only tumor size (p<0.001), grade (p=0.001), and patient age (p=0.005) predicted advanced nodal stage. Triple-negative cancers had a significantly lower risk of nodal positivity than the HR+/HER2- subtype (odds ratio, 0.686; p=0.004), but no other significant differences between subtypes were observed. There was also no difference in lymph node positivity between PR+ and PR- tumors amongst ER+/HER2- (p=0.228) or ER+/HER2+ tumors (p=0.713).

Conclusion

The HR+/HER2-breast cancer subtype has a higher rate of lymph node involvement at diagnosis than the triple-negative subtype. These findings may play a role in guiding regional management considerations if confirmed in further studies.     

Occult Breast Cancers Manifesting as Axillary Lymph Node Metastasis in Men: A Two-Case Report

Occult breast cancer is a type of breast cancer without any symptoms on the breasts or any abnormalities upon radiologic examination such as mammography. In males, there are few cases of breast cancer, the rate of diagnosis of occult breast cancer is very low, and little is known about this disease. We experienced two cases of occult breast cancers manifesting as axillary lymph node metastasis in men. They had a palpable lesion on axillary area several years ago and had not seen a doctor about it. As such there was no abnormality on evaluations for cancer except for axillary lymph node showing signs of carcinoma (primary or metastatic) on biopsy and estrogen receptor-positive and progesterone receptor-positive on immunohistochemistry. The patients were diagnosed with occult breast cancer, and treatments were performed. Herein, we report the rare cases of occult breast cancers in men.     

Ectopic Male Breast Cancer in Suprapubic Area That Relapsed with Hematogenous Metastasis

Tough ectopic male breast cancer is extremely rare, non-axillary ectopic male breast cancer is even rare. To date, the natural course and prognosis of this disease are not fully understood. Consequently, the appropriate treatment for this disease has not been established. We report on a patient with ectopic male breast cancer in the suprapubic area that relapsed with hematogenous metastasis 3 years after complete surgical resection and adjuvant treatment despite an early diagnosis. This unusual case highlights the need for new prognostic factors such as genomic profiling to predict whether ectopic male breast cancer is aggressive and to guide on the duration between follow-ups and the appropriate method for conducting them.     

Feasibility of Sentinel Lymph Node Biopsy in Breast Cancer Patients with Initial Axillary Lymph Node Metastasis after Primary Systemic Therapy

Purpose

Primary systemic therapy (PST) downstages up to 40% of initial documented axillary lymph node (ALN) metastases in breast cancer. The current surgical treatment after PST consists of breast tumor resection and axillary lymph node dissection (ALND). This strategy, however, does not eliminate unnecessary ALND in patients with complete remission of axillary metastases. The aim of this study was to examine the accuracy of sentinel lymph node biopsy (SLNB) after PST among patients with documented ALN metastasis at presentation and to identify the rate of pathologic complete-remission (CR) with ALN after PST.

Methods

We analyzed 66 patients with ALN metastasis that was pathologically proven preoperatively who underwent SLNB and concomitant ALND after PST. Axillary ultrasound (AUS) was used to evaluate the clinical response of initially documented ALN metastasis after PST. Intraoperative lymphatic mapping was performed using blue dye with or without radioisotope.

Results

After PST, 34.8% of patients had clinical CR of ALN on AUS and 28.8% patients had pathologic CR of ALN. The overall success rate of SLNB after PST was 87.9%, and the sentinel lymph node identification rate in patients with clinical CR was 95.7%. In patients with successful lymphatic mapping, 70.7% of patients had residual axillary metastases. The overall accuracy and false-negative rate were 87.9% and 17.1% in all patients: 95.5% and 10.0% in patients with clinical CR of ALN, and 83.3% and 19.4% in patients with residual axillary disease after PST.

Conclusion

Our findings suggest that SLNB may be feasible in patients with initial documented ALN metastasis who have clinical CR for metastatic ALN after PST. Further investigation in a prospective setting should be performed to confirm our results.     

女性原发浸润性乳腺癌淋巴结转移水平与预后观察

目的:探讨女性原发性乳腺癌腋淋巴结转移水平与预后的关系。方法:对1989年1月至1994年6月收治的781例淋巴结转移患者的资料进行回顾性分析。结果:经单因素、多因素COX分析结果显示淋巴结转移数和腋尖淋巴结转移作为独立的预后危险因素被筛出,提示,淋巴结转移数分级与淋巴结分组对预后的影响有一定的重叠,但腋尖淋巴结出现转移是独立于淋巴结转移数分级之外另一个对预后有着独立影响的预后危险因素且与10年生存期相关(RR=1.570)。结论:腋尖淋巴结转移为独立预后危险因素。     

人附睾蛋白4表达水平与子宫内膜癌淋巴结转移相关性的Meta分析

目的 系统评价子宫内膜癌（EC）中人附睾蛋白4（HE4）表达水平与淋巴结转移的相关性。方法 计算机搜索PubMed、Cochrane、Web of Science、CBM、CNKI和WanFang Data数据库中公开发表的有关HE4表达水平与子宫内膜癌淋巴结转移相关性的文献资料,检索时间自数据库建立截止2021年5月。按文献纳入和排除标准筛选文章,NOS病例对照研究质量评分量表进行文献质量评价,Stata12.0进行Meta分析,TSA进行样本量评价。结果 最终纳入25项符合标准的研究,共2 736例子宫内膜癌患者。Meta分析结果显示,HE4在EC淋巴结转移组的表达水平明显高于非转移组（SMD=1.58, 95%CI: 1.13~2.03）,且Meta回归分析显示HE4与EC淋巴结转移的相关性与年龄有关（P=0.009）。TSA分析表明纳入研究的总样本量满足要求。结论 HE4的表达水平与子宫内膜癌淋巴结转移存在相关性,此相关性可能受年龄影响,随着年龄的增加,此相关性减弱。     

Treatment Outcome of Breast Cancer with Pathologically Proven Synchronous Ipsilateral Supraclavicular Lymph Node Metastases

Purpose

The aim of this study was to investigate the prognosis, patterns of failure, and prognostic factors for breast cancer patients with pathologically proven synchronous ipsilateral supraclavicular lymph node (ISCLN) metastases.

Methods

We reviewed the records of breast cancer patients with pathologically proven ISCLN metastases. Local aggressive treatment was defined as treatment including surgery, axillary lymph node dissection (ALND), ISCLN excision, radiotherapy (RT), and chemotherapy.

Results

A total of 111 patients were included. The 5-year overall survival (OS) and disease-free survival (DFS) rates were 64.2% and 56.2%, respectively. On univariate analysis, RT, ALND, trastuzumab treatment, hormone receptor (HR) status, and local aggressive treatment were identified as significant factors for OS. The 5-year OS for 73 patients who received local aggressive treatment was superior to that of 38 patients who received nonaggressive treatment (70.9% vs. 49.3%, p=0.036). Multivariate analysis showed that RT, HR status, and trastuzumab were significant variables for the 5-year OS and DFS.

Conclusion

Multimodality treatment with surgery, taxane-based chemotherapy, hormone therapy, and RT is strongly recommended for breast cancer patients with synchronous ISCLN metastases.     

Ki-67和DNA倍体分析与乳腺癌淋巴转移倾向

[目的]探讨乳腺癌组织的Ki鄄67基因表达和DNA倍体与其淋巴转移倾向的关系。[方法]采用流式细胞技术对72例乳腺癌组织新鲜标本进行Ki鄄67表达及肿瘤细胞DNA倍体含量检测的研究。[结果]Ki鄄67表达与乳腺癌病变大小、病理类型和ER无关。乳腺癌腋淋巴转移阳性组DNA异倍体高于无淋巴转移组(P<0.05)。Ki鄄67在腋淋巴转移阳性组高表达,其阳性表达百分比分别是:腋淋巴结转移组为12.61±6.23;无转移组为7.61±3.85(P<0.05)。[结论]Ki鄄67表达及DNA倍体可作为判断乳腺癌具有淋巴转移倾向的临床参考指标。