炎性乳腺癌八例诊治体会

炎性乳腺癌是一种较少见的恶性肿瘤,我院30年间(1965～1995)经手术治疗及病理证实乳腺恶性肿瘤847例,其中炎性乳腺癌8例,占0.9%,误诊4例,现报告如下.     

炎性乳腺癌12例的综合治疗

我院自 1 993年至 1 998年 1 1月以多种方法综合治疗炎性乳腺 (ｉｎｆａｍｍａｔｏｒｙｂｒｅａｓｔｃａｎｃｅｒ) 1 2例 ,报告如下。临床资料1 .一般资料 :本组为炎性乳腺癌患者 1 2例 ,占同期收治的全部乳腺癌患者 32 8例的 3 6 %。年龄 35～ 52岁 ,绝经后2例。患乳为左侧者 5例 ,右侧者 7例。孕2 产1 者 4例 ,孕3产1者 5例 ,孕3产2 者 2例 ,孕3产3者 1例 ,全部母乳喂养。病程1～ 3个月 ,平均 2 5个月 ,均曾采用过抗生素治疗 ,疗程 5～2 0ｄ。2 .局部体征及诊断 :1 2例患者患侧乳房局部红、肿、痛 ,皮肤呈红色或紫红色 ,范围占乳房表面积…     

乳腺癌的药物治疗进展

乳腺癌是一个全身性疾病。随着对乳腺癌生物学特性的更深入认识，导致了乳腺癌的治疗模式发生了明显的改变。近10年来，Ⅰ、Ⅱ期乳腺癌外科治疗的手术范围在缩小。国外有价值的前瞻性随机临床试验对保留乳房与根治性乳房切除手术的临床疗效进行了比较，其结果都一致认为两组的生存差异无统计学意义。同时，多种抗癌新药的问世，新辅助化疗或早期化疗能缩小原发灶，增加保乳机会，并减少或杀灭亚临床转移。与此对应的是，全身性药物治疗的作用日益突出，化疗、内分泌治疗和基因治疗等已成为当前确有成效的全身治疗方法。     

炎性乳腺癌的治疗新进展

炎性乳腺癌是一种特殊的局部晚期乳腺癌,肿瘤侵袭性和转移性强,病死率非常高.由于炎性乳腺癌恶性程度极高,病情发展迅速,早期即有全身广泛转移而危及生命,预后很差.目前临床上主要采取以手术、放疗、化疗等综合治疗措施来治疗这类疾病,但是治疗效果极其有限.而现代分子生物学和肿瘤免疫学领域的突破进展为这类疾病的治疗带来了希望.本文...     

三阴性乳腺癌的临床病理特征及治疗进展

三阴性乳腺癌是乳腺癌的一种特殊类型,具有独特的临床病理特征,缺乏内分泌治疗及靶向治疗相应的靶点,对放疗和化疗敏感,但复发率高,治疗效果较差。本研究对近几年来三阴性乳腺癌的临床病理特征及治疗方面的研究进展进行综述。     

曲妥珠单抗在乳腺癌治疗中的进展

靶向治疗是通过特异性干扰参与肿瘤发生、发展的分子功能,进而阻断肿瘤生长和播散的治疗手段;因此,相比于其他传统治疗手段如化疗、放疗等,其对正常细胞基本没有损伤,治疗过程中病人耐受性较好。     

分子靶向药物在乳腺癌新辅助治疗中的应用

乳腺癌位居女性恶性肿瘤发病首位,近年来其罹患率逐年上升且渐呈年轻化趋势。虽然各种综合治疗手段已经提高了乳腺癌的疗效,但是有文献报道,超过20％的患者会出现复发转移以及对常规治疗耐药的现象。对此,人们一直致力于寻求新的治疗方法以改善乳腺癌的不良预后和转归。     

炎性乳腺癌26例诊治分析

目的探讨炎性乳腺癌的综合治疗方法,以期延长炎性乳腺癌患者的生存期。方法回顾性分析26例炎性乳腺癌患者的治疗方法。结果目前炎性乳腺癌的推荐治疗策略为诱导化疗→乳腺切除和（或）放疗→辅助化疗,该治疗策略对炎性乳腺癌的治疗可使3年或者5年生产率提高到35%～55%。结论炎性乳腺癌比较罕见,是局部进展期乳腺癌中预后最差的一类,侵袭性强,恶性程度高,病情进展迅速,有效治疗方法少,疗效差,生存期短,单纯手术治疗或手术加放疗,平均生存期短,合理的综合治疗可明显提高患者的生存期。     

乳腺癌的新辅助化疗

随着临床和基础研究的不断深入,乳腺癌新辅助化疗逐渐成为乳腺癌临床研究中十分活跃的领域.理论上,新辅助化疗较辅助化疗有诸多优势,但多个大型临床试验结果表明,新辅助化疗并不能显著改善患者生存.许多因素可能与之有关,例如,以往的研究在最初设计时多仅根据患者临床分期来决定患者是否需要新辅助化疗,而忽视了重要生物学指标雌激素受体(ER)、Her-2等对疗效的影响,且不同研究中生物学指标的检测方法及使用的化疗方案也不一致.本文结合最近的文献资料,就生物学指标对乳腺癌新辅助化疗的影响及其他几个临床上十分关注的问题谈一些个人的体会和看法,与同行探讨.     

乳腺癌的新辅助化疗

本文回顾了有关乳腺癌新辅助化疗的临床研究，认为可使大部分原发性乳腺癌体积明显缩小，进而使80％的可手术治疗的患者能选择保留乳房术式。虽然理论上可更大程度地杀灭亚临床的微小转移灶，减少耐药细胞株的产生，但在提高这部分患者的无复发生存率及总体生存率方面尚无临床定论。     

Sentinel lymphadenectomy after neoadjuvant chemotherapy for breast cancer may reliably represent the axilla except for inflammatory breast cancer

Background After neoadjuvant chemotherapy, women with locally advanced breast cancer (LABC) undergo a modified radical mastectomy or lumpectomy with axillary lymph node dissection (ALND) and radiotherapy. Sentinel lymphadenectomy (SL) is accepted for axillary evaluation in early breast cancer. We assessed the feasibility and predictive value of SL after neoadjuvant chemotherapy. Methods Eligible women received neoadjuvant therapy for LABC and were scheduled to undergo a definitive surgical procedure. Vital blue dye SL was attempted followed by level I and II axillary dissection. Results SL was successful in 29 of 34 patients (detection rate, 85%). Thirteen patients (45%) had positive nodes, and eight (28%) had negative nodes on both SL and ALND. In five patients (17%), the sentinel node was the only positive node identified. Overall, there was a 90% concordance between SL and ALND. The false-negative rate and negative predictive value were 14% and 73%, respectively. Among the subgroup without inflammatory cancer, the detection and concordance rates were 89% and 96%, respectively. The false-negative rate was 6%, and the negative predictive value was 88%. Conclusions SL after neoadjuvant chemotherapy may reliably predict axillary staging except in inflammatory breast cancer. Further studies are required to assess the utility of SL as the only mode of axillary evaluation in these women.     

Selection of local therapy after neoadjuvant chemotherapy in patients with stage IIIA,B breast cancer

Background: Stage IIIA,B breast cancer is commonly treated with neoadjuvant chemotherapy because of high objective response rates and improved operability. Criteria for subsequent selection of local therapy—mastectomy, radiotherapy, or both—are not well defined. We adopted a policy of selective local therapy based on rebiopsy of the breast and clinical axillary lymph node status at the time of best response to chemotherapy. Methods: Between 1980 and 1993, 126 patients with stage IIIA,B breast cancer were treated with neoadjuvant chemotherapy and definitive local therapy. The long-term incidence of locoregional failure (in-breast, chest wall, axilla, supraclavicular, neck), relapse-free survival, and overall survival was determined. Results: The overall clinical objective response rate to chemotherapy was 95.2%. Eighty-three patients underwent mastectomy, with negative margins achieved in 91.6%. Forty-two patients had breast preservation; the overall in-breast recurrence rate was 19.0% (8 of 42 patients). The overall locoregional recurrence rate by site was: chest wall—8.7% (11 of 126 patients), axilla—8.7% (11 of 126 patients), supraclavicular—5.6% (7 of 126 patients), and neck—4.0% (5 of 126 patients). The axillary recurrence rate was 6.6% (5 of 76 patients) for clinically negative axilla treated with radiotherapy only, and 12.0% (6 of 50 patients) for clinically positive axilla treated with surgery only. The overall long-term survival probabilities (6 years) according to stage were: stage IIIA—58.0%, stage IIIB_noninflam—58.0%, stage IIIB_inflam—36.0%. Conclusions: These findings support a selective approach to local therapy in patients with stage IIIA,B breast cancer. This approach provides local control in most patients, and allows for breast preservation and elimination of axillary dissection in selected patients. Presented at the 49th Annual Cancer Symposium of the Society of Surgical Oncology, Atlanta, Georgia, March 21–24, 1996.     

Genomic profiling of inflammatory breast cancer: A review

Inflammatory breast cancer (IBC) is a rare but aggressive form of breast cancer. Despite efforts in the past decade to delineate the molecular biology of IBC by applying high-throughput molecular profiling technologies to clinical samples, IBC remains insufficiently characterized. The reasons for that include limited sizes of the study population, heterogeneity with respect to the composition of the IBC and non-IBC control groups and technological differences across studies. In 2008, the World IBC Consortium was founded to foster collaboration between research groups focusing on IBC. One of the initial projects was to redefine the molecular profile of IBC using an unprecedented number of samples and search for gene signatures associated with survival and response to neo-adjuvant chemotherapy. Here, we provide an overview of all the molecular profiling studies that have been performed on IBC clinical samples to date.     

TAC新辅助化疗方案治疗三阴性乳腺癌的疗效及预后

【摘要】目的 探讨TAC新辅助化疗方案治疗三阴性乳腺癌（triple-negative breast cancer,TNBC）的临床疗效。方法 对接受4～6个周期TAC新辅助化疗方案治疗的63例TNBC进行回顾性研究,分析近远期化疗疗效。结果 63例患者总有效率(RR)96.83%,其中完全缓解(CR)57.14%（36/63),部分缓解(PR)39.68%(25/63）。主要不良反应中性粒细胞减少36例（57.14%）,中性粒细胞减少性发热25例（39.68%）,恶心呕吐33例（52.38%）,腹泻14例（22.22%）,口腔黏膜炎13例（20.63%）,乏力虚弱10例（15.87%）。术后死亡7例,局部复发8例,远处转移21例,3年生存率88.89%。结论 应用TAC新辅助化疗方案能提高TNBC治疗效果,改善患者生活质量,提高3年生存率。     

“三阴”乳腺癌新辅助化疗前后BCSG1基因状况研究

目的 探讨乳腺癌特异基因（BCSG1）在“三阴”性乳腺癌新辅助化疗疗效评估中的价值。方法采用免疫组化S．P法和荧光定量PCR方法检测32例“三阴”性乳腺癌患者新辅助化疗（CEF方案）前后乳腺癌组织BCSG1的表达,比较化疗前后肿瘤体积的变化情况,分析新辅助化疗前后BCSG1蛋白表达与肿瘤形态学变化的关系。结果23例乳腺癌患者新辅助化疗后肿瘤体积均有明显缩小,病灶缓解率（CR＋PR）为84．4％;新辅助化疗后BCSG1mRNA表达水平亦明显低于化疗前（P〈O．05）,BCSG1蛋白高表达率低于新辅助化疗前（P〈0．01）。结论BCSG1分子和蛋白水平在“三阴”性乳腺癌新辅助化疗后均明显降低,与新辅助化疗后疗效呈负相关（r=-0．584,P〈0．01）,提示BCSG1可作为“三阴”乳腺癌新辅助化疗疗效的预测因子。     

新辅助化疗对ⅡB期乳腺癌的疗效对比研究

目的 研究新辅助化疗治疗ⅡB期乳腺癌的临床作用.方法 选取2002年1月至2004年11月ⅡB期女性乳腺癌330例,全部单侧患病,随机分成2组.新辅助化疗组152例(年龄32～73岁,平均42.6岁;左侧78例,右侧74例),给予紫杉类、蒽环类为主的联合化疗,每2个周期后评价疗效,4个周期后实施手术.非新辅助化疗组17...     

表阿霉素联合多西紫杉醇新辅助化疗治疗三阴乳腺癌的疗效及预后评价

目的探讨三阴乳腺癌(TNBC)与非三阴乳腺癌(non-TNBC)接受表阿霉素联合多西紫杉醇方案(ET方案)的化疗敏感性及预后方面的差别。方法对接受ET新辅助化疗方案治疗的249例乳腺癌患者进行回顾性分析。依据免疫组化雌激素受体(ER)、孕激素受体(PR)、表皮生长因子受体2(HER2)表达水平将乳腺癌分为三阴乳腺癌及非三阴乳腺癌两类,分析三阴与非三阴乳腺患者接受ET新辅助化疗方案后,二者病理疗效及远期生存的差别。结果 249例患者中,54(21.7%)例为三阴乳腺癌,195(78.3%)例为非三阴乳腺癌。三阴乳腺癌的病理完全缓解(pCR)率为25.9%,明显高于非三阴乳腺癌的12.3%(P=0.019)。三阴乳腺癌患者,特别是新辅助化疗后仍有癌残留的患者,其5年无病生存率(DFS)及5年的总生存率(OS)均明显低于非三阴乳腺癌(P值均<0.05)。获得pCR的乳腺癌患者5年的DFS和OS均明显高于化疗后仍有癌残留的患者(P值均<0.05)。获得pCR的三阴乳腺癌与非三阴乳腺癌患者的DFS(P=0.837)及OS(P=0.398)均无统计学差异。结论本研究结果表明,相比于非三阴乳腺癌患者,三阴乳腺癌患者具有更高的病理完全缓解率,但预后却较差。     

Male inflammatory breast cancer

We report herein the case of a 68-year-old man diagnosed with inflammatory breast cancer. The patient presented following the rapid onset of redness and swelling over the left anterior chest wall. On examination, the left chest wall and left axilla were extensively hard, and the left upper limb was swollen. Ultrasonography and computed tomography (CT) scanning disclosed a mass in the left breast, about 2 cm in diameter with an unclear margin, and swelling of the major and minor pectoral muscles. Needle biopsy of the breast mass confirmed invasive lobular carcinoma. As a radical operation was considered contraindicated, systemic and intraarterial chemotherapy using 5-fluorouracil (5-FU) and Adriamycin (ADR) were performed. Nevertheless, the patient died of carcinomatous pleurisy 6 months after the initial onset of the disease.     

长春瑞滨和表阿霉素联合新辅助化疗方案治疗局部晚期乳腺癌的临床研究

目的评估长春瑞滨和表阿霉素的联合新辅助化疗方案在局部晚期乳腺癌治疗中的临床疗效和毒性反应.方法2001年9月至2004年12月,158例经空芯针活检组织学诊断证实的局部晚期乳腺癌患者在术前接受新辅助化疗,方案为长春瑞滨25 mg/m^2（第1、8天）,表阿霉素60mg/m^2（第1天）,每3周为1个疗程共3个疗程.结果原发病灶临床有效率为81.6%,其中23.4%（37/158）达到临床完全缓解（cCR）,58.2%（92/158）达到临床部分缓解;疾病稳定（SD）16.5%（26/158）,疾病进展（PD）1.9%（3/158）.病理完全缓解29例（18.3%）,其中15例术后标本未见肿瘤残留,14例仅残留原位癌组织.68例新辅助化疗前区域淋巴结细针穿刺活检阳性的病例,化疗后18例（26.5%）手术标本中未见区域淋巴结转移.最常见的毒性反应包括中性粒细胞减少症、脱发和恶心呕吐,共有111例患者（70.3%）发生3～4度中性粒细胞减少症.无因新辅助化疗引起的败血症和死亡病例.结论长春瑞滨和表阿霉素的联合新辅助化疗方案在局部晚期乳腺癌治疗中疗效显著且耐受性良好.     

5-FU植入剂联合静脉化疗在乳腺癌新辅助化疗的临床观察

目的 对比CAF方案与植入型5-氟尿嘧啶（5-FU）替代CAF方案治疗II-III晚期乳腺癌的近期疗效与毒性反应。方法 将63名II-III期乳腺癌患者随机分组,植入型5-FU替代CAF方案为试验组,CAF（静脉给药）方案为对照组。结果 1）标准组有效率为56.3％,试验组为83.9％,差异有统计学意义;3）试验组消化道反应及III-IV度白细胞下降发生率较对照组低。结论 植入型5-FU可以提高II-III期乳腺癌新辅助化疗有效率,且毒性反应较低。肿瘤药物局部植入是一种有效安全的给药途径。