40岁以上亚洲男性HBV携带者肝癌发病高

香港中文大学威尔士亲王医院全科医学教授Dickinson指出，虽已开展了大量的流行病学调查，但仍难以计算出乙肝病毒（HBV）携带者的肝细胞癌发病危险，然而有一点较为明确，即亚洲男性的肝细胞癌发病危险最高。在大部分以在专科门诊就诊的少数人作为研究对象的研究中，与女性相比，男性发病危险增加1倍以上，而且肝细胞癌发病率随年龄增加而显著上升，但按年龄分段研究发病危险的论文还没有。Dickinson教授从MEDLINE、Health-Sstar和EMBASE上检索了有关的论文。先查找普通人群为研究对象的队列研究，并除外纳入人数少和并发慢性肝炎…     

胰腺癌发生的危险及保护因素

研究发现吸烟、慢性胰腺炎、糖尿病、遗传、乙肝病毒等多种因素都是胰腺癌发生的危险因素,适量运动、白藜芦醇以及维生素等物质的摄入可使胰腺癌发病风险降低.研究胰腺癌的危险及保护因素对于预防胰腺肿瘤发生有重要意义.     

中国林州市食管癌高发区人群病因学预防效果观察

[目的]探讨降低食管癌发病率的有效预防对策和措施。[方法]根据食管癌流行病学和病因学研究发现的主要可疑致癌因素、促癌因素和保护因素．组织实施五项综合性病因学预防措施。应用自身前后对照的类实验研究方法，以林州市居民食管癌标化发病率为终点指标，以食管癌的主要致癌、促癌因素和保护因素的暴露水平为中间指标，评价其预防效果。[结果]林州市居民20年来食管癌标化发病率呈显著下降趋势，2003年与1980年相比男性下降了56、33％，女性下降45．07％；林州市居民体内致癌性亚硝胺和霉菌毒素的暴露水平明显下降；体内维生素A、B：水平明显增高，个人行为与社会环境危险因素明显减少、保护因素明显增加。[结论]林州食管癌高发区居民食管癌发病率的显著降低可能与实施针对病因的五项综合性预防措施有关。     

新疆维哈汉三民族喉癌发病危险因素的病例对照研究

目的探讨新疆维哈汉三民族喉癌发病的危险因素。方法选取2009年6月至2014年12月间新疆医科大学第一附属医院收治的90例新疆维哈汉三民族喉癌患者为研究组,采用配对病例对照法对90例喉癌患者的发病危险因素进行研究,并按性别、年龄和居住区域进行1:1配对,选取同期健康体检人群90例为对照组。对新疆三民族喉癌发病的单因素及多因素进行Logistic回归分析。结果单因素分析显示,经常食用熏烤食物、加工性肉制品、吸烟、饮酒、性格暴躁和体育锻炼较少等因素,可增加喉癌患病风险;而经常食用新鲜蔬菜、牛奶、蛋类和粗粮,及经常参加体育锻炼,则可有效降低喉癌患病风险。多因素分析结果显示,经常食用熏烤食物、吸烟和饮酒者,喉癌患病风险较大,体育锻炼是喉癌发病的保护性因素。结论熏烤食品摄入、吸烟及饮酒是新疆维哈汉三民族喉癌发病的主要潜在危险因素,增加体育锻炼时间则有可能降低三民族喉癌发病风险。     

预防对侧乳腺癌发生的治疗方式的研究进展

对侧乳腺癌(CBC)的发生概率因首发乳腺癌患者的生存时间延长而呈上升趋势，与一般女性群体中罹患乳腺癌的风险相比，首发乳腺癌患者CBC发生的终生风险增加2～4倍，且预后更差。分析导致CBC发生的危险因素，积极进行首发乳腺癌的治疗，通过内分泌治疗、放化疗、其他药物和预防性切除手术等个性化预防治疗，进而降低CBC发生率。本文将简述CBC发病的危险因素、风险控制措施和预防性治疗的临床管理方案。     

甲状腺微小乳头状癌淋巴结转移危险因素的研究进展

甲状腺乳头状癌是最常见的甲状腺癌,近年来其发病率在逐年上升,其中主要为甲状腺微小乳头状癌。大部分微小癌处于低风险状态,但仍有一部分微小癌处于高风险状态、预后差,这可能与微小癌的淋巴结转移状态有关。因此,明确甲状腺微小乳头状癌淋巴结转移的相关危险因素,对临床制定针对性的治疗方案具有重要意义。     

基因丢失与侵袭性癌有关

在英国进行的一项流行病学调查表明，基因组内缺少CSTM1者，发生致死的膀胱侵袭性癌的危险大大增加。人们熟知膀肤癌与工业致癌物有关。英国Bristol市的膀肤癌发病率较高；该地区适于调查基因因素与环境致癌物对诱发膀肤癌的相应作用。研究小组以非癌患者为对照组，进行了膀脱癌患者GSTMI酶的标记物和它的基因测定；结果发现患侵袭性膀优癌的病人中，70％丢失了GSTMI基因，而非侵袭性膀优癌患者中仅为58％。报告人指出GSTMI基因的丢失，只是发病原因的一部分，其它辅助因素的作用也很重要，如大量饮含添加剂的啤酒就是一项突出的致…     

膳食因素与前列腺癌关系的研究进展

前列腺癌居全球男性常见恶性肿瘤第2位, 中国前列腺癌发病率呈上升趋势。膳食因素与前列腺癌的关系研究结果争议较多。红肉、加工肉类和乳制品的摄入可能是前列腺癌的危险因素, 番茄、大豆和绿茶可能是前列腺癌的保护因素, 但均缺乏高质量证据。维生素和矿物质补充剂的摄入可能影响前列腺癌的发病风险, 但相关结论并不统一。高膳食炎症指数饮食可能会增加前列腺癌发病风险。膳食暴露至前列腺癌发病有较长时间, 这对暴露因素的收集与队列研究的随访提出了较高的要求。暴露测量偏倚和检出偏倚是影响前列腺癌膳食因素研究真实性的主要因素, 研究者应注意采用多种方法测量研究对象的膳食摄入水平, 同时收集前列腺癌死亡等重要结局变量。文章总结了膳食因素和前列腺癌关系的现有流行病学证据, 旨在为后续的前列腺癌相关营养流行病学研究提供参考。     

乳腺相关生理及病理因素对妇女患乳腺癌的影响

目的研究乳腺相关生理及病理因素对妇女患乳腺癌的影响，为乳腺癌的防治提供依据。方法采用病例对照研究方法，问卷调查1997年1月至2007年4月入院并经病理组织学确诊的女性乳腺癌生存病例200例及同时段年龄相近的非乳腺癌人群200例。利用SPSS10．0的logistic回归模型进行数据录入和分析。结果单因素和多因素分析筛选出有意义的生理及病理危险因素为体重指数（BMI）较大、绝经年龄大、乳腺增生、乳腺癌家族史；保护因子为月经持续天数长。结论BMI较大、绝经年龄大、乳腺增生、乳腺癌家族史可增加乳腺癌的患病风险；月经持续天数长可降低乳腺癌的发病风险。     

维生素D与恶性肿瘤发病的关系

维生素D为脂溶性维生素，具有刺激肠道钙和磷酸盐的吸收，肾钙和磷酸盐的再吸收和调节骨矿物质的代谢作用。维 生素D缺乏易引起佝偻病、骨软化症、骨质疏松症及手足抽搐症；过量摄入维生素D可引起维生素D中毒。维生素D主要来源于 皮肤合成和食物。经常晒太阳是获得充足有效的维生素D的最好来源。维生素D与多种恶性肿瘤的发生、发展有关，主要集中 在两点：①观察不同人群机体维生素D水平与恶性肿瘤发病的关系；②补充维生素D对改变恶性肿瘤的发生率的影响。本文就 维生素D和多种恶性肿瘤如结直肠癌、皮肤癌等之间的相关研究展开综述发现，目前缺乏充分的证据支持，机体较高维生素D水 平，可降低恶性肿瘤的发病风险。由于目前关于维生素D与肿瘤发生、发展研究较少, 并且研究结果容易受到气候、地理环境、饮 食等因素的影响，需要进一步大样本的前瞻性研究，明确维生素D与肿瘤的关系。     

Family history of cancer and risk of sporadic differentiated thyroid carcinoma

BACKGROUND:

Thyroid cancer incidence in the United States, particularly in women, has increased dramatically since the 1980s. Although the causes of thyroid cancer in most patients remain largely unknown, evidence suggests the existence of an inherited predisposition to development of differentiated thyroid carcinoma (DTC). Therefore, the authors explored the association between sporadic DTC and family history of cancer.

METHODS:

In a retrospective hospital‐based case‐control study of prospectively recruited subjects who completed the study questionnaire upon enrollment, unconditional logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) as estimates of the DTC risk associated with first‐degree family history of cancer.

RESULTS:

The study included 288 patients with sporadic DTC and 591 cancer‐free controls. Family history of thyroid cancer in first‐degree relatives was associated with increased DTC risk (adjusted OR, 4.1; 95% CI, 1.7‐9.9). All DTC cases in patients with a first‐degree family history of thyroid cancer were cases of papillary thyroid carcinoma (PTC) (adjusted OR, 4.6; 95% CI, 1.9‐11.1). Notably, the risk of PTC was highest in subjects with a family history of thyroid cancer in siblings (OR, 7.4; 95% CI, 1.8‐30.4). In addition, multifocal primary tumor was more common among PTC patients with first‐degree family history of thyroid cancer than among PTC patients with no first‐degree family history of thyroid cancer (68.8% vs 35.5%, P = .01).

CONCLUSIONS:

The study suggests that family history of thyroid cancer in first‐degree relatives, particularly in siblings, is associated with an increased risk of sporadic PTC. Cancer 2012;. © 2011 American Cancer Society.     

Management of thyroid carcinoma-an experience in Bangladesh

All patients (n=154) of thyroid malignancy admitted in the Otoluryngology Department of Bangabandhu Sheikh Mujib Medical University (former IPGMR) between 1986 and 2000 were retrospectively analyzed to find out the extent and result of surgery used for thyroid carcinoma. The other objectives were to find out the incidence of differentiated thyroid carcinoma among the thyroid malignancy and also to find out the age, sex and clinical presentation of papillary and follicular carcinoma. Among all the thyroid malignancy (n-154), Differentiated Thyroid Carcinoma (DTC) was seen in 130 (84.41%) cases, where as papillary carcinoma occurred in 98(63.64%), and follicular carcinoma in 32(20.77%)cases. On the basis of risk factors, the DTC were designated as low and high risk. The year-wise incidence of DTC revealed increasing trend from 1986 (3 cases) to 2000 (23 cases). Among the 98 papillary thyroid carcinoma highest number of cases (35.71%) were seen in 31-40 year age group. The male to female ratio was 1: 1.64. In follicular carcinoma, highest number (35.25%) of cases were also seen in 31-40 year age group. The male to female ratio was 1:1.66. The commonest presentation in papillary carcinoma was thyroid swelling (96.93%). The other presentations were occult thyroid (3.06%), Cervical lymph node metastasis (38.77%) and distant metastasis (2.04%). In Follicular carcinoma, the presentations were thyroid swelling (100%), Cervical lymph node metastasis (6.25%) and Distant metastasis (21.87%). In this series, low risk DTC were treated by Lobectomy & Isthmusectomy plus Thyroxin. In low risk group the rate of recurrence was 6.89% and the mortality was nil in five years follow-up. Except two inoperable cases, all high risk patients were managed by Total thyroidectomy (with or without neck dissection, plus removal of metastatic lesion when required) with Radioiodine ablation plus Thyroxin. . The rate of recurrence was 7.81% and mortality was 1.56% in high risk group in similar period of time. Vocal cord palsy were noted in 5 (3.84%) unilateral, and inane (0.76%) bilateral cases. Hypoparathyroidism was found in 4.61%.     

Management of the central compartment in differentiated thyroid carcinoma

Management of differentiated thyroid carcinoma (DTC) is gradually evolving with considerations of de-escalation of treatment and/or active surveillance in a significant proportion of patients on the basis of an improved understanding of the long-term disease and functional outcomes from both surgical and non-surgical approaches. This is fueled by improved risk stratification using clinicopathologic prognostic factors as determined through high resolution ultrasound and fine needle aspiration cytology. This paper discusses general recommendations for preoperative decision-making in the management of the central compartment in DTC with particular reference to micropapillary thyroid carcinoma and encapsulated follicular variant papillary thyroid carcinoma. Given the multitude of specific factors that must be considered for each patient, therapeutic decisions should occur in a multidisciplinary setting weighing the risks of treatment morbidity against the risks of disease progression or recurrence. Recurrent/persistent disease merits special attention with regard to pre-operative planning and surgical risk, and should be managed by high-volume thyroid surgeons.     

Functional polymorphisms in the insulin-like binding protein-3 gene may modulate susceptibility to differentiated thyroid carcinoma in Caucasian Americans

The insulin-like growth factor (IGF) pathway is believed to play a pivotal role in thyroid carcinogenesis. Polymorphisms of IGF-1 and IGF binding protein-3 (IGFBP-3) have been associated with modulation of risk for the emergence of assorted common malignancies, but studies of the influence of such polymorphisms on risk of differentiated thyroid carcinoma (DTC) are lacking. In a case-control study of 173 DTC patients, 101 patients with benign thyroid disease, and 401 controls, an unconditional logistical regression model adjusted for age and sex was applied to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between polymorphisms of IGF-1 and IGFBP-3 and DTC risk. IGFBP-3 rs2132572 GA/AA genotypes were associated with a decreased risk of DTC (adjusted OR = 0.6, 95% CI: 0.4-0.9), particularly multifocal DTC (adjusted OR = 0.3, 95% CI: 0.1-0.7). The association with DTC was more evident in subjects with a first-degree family history of cancer (adjusted OR = 0.4, 95% CI: 0.2-0.7, P(interaction) = 0.013) and non-drinkers (adjusted OR = 0.4, 95% CI: 0.2-0.7, P(interaction) = 0.028). A four single nucleotide polymorphism haplotype of IGFBP-3 was associated with a decreased risk of DTC (adjusted OR = 0.7, 95% CI: 0.5-1.0, P = 0.030). Our study suggests that polymorphic IGFBP-3 may be involved in susceptibility to DTC.     

雌激素受体和细胞增殖周期调控蛋白D1在分化型甲状腺癌中的表达及意义

目的:探讨雌激素受体(ER)和细胞增殖周期调控蛋白(cyclinD1)在分化型甲状腺癌(DTC)中的表达及意义。方法:用免疫组织化学SP法研究不同甲状腺组织中ER和cyclinD1的表达。DTC43例(乳头状癌39例,滤泡状癌4例),甲状腺良性腺瘤30例,腺瘤旁正常组织16例。结果:DTC组织中ER和cyclinD1蛋白阳性率分别为53.5%(23/43)、65.1%(28/43);甲状腺良性瘤中ER和cyclinD1蛋白阳性率分别为26.7%(8/30)、36.7%(11/30);正常甲状腺组织中ER阳性率为12.5%(2/16),而cyclinD1则不表达。DTC中ER的表达明显高于甲状腺良性腺瘤和正常甲状腺组织(P<0.05);DTC中cyclinD1的表达明显高于甲状腺良性腺瘤(P<0.05);且DTC中cyclinD1和ER表达存在正相关关系(P<0.05)。结论:雌激素在DTC的发生、发展中有促进细胞增殖的作用;DTC可能为雌激素依赖性肿瘤。     

女性分化型甲状腺癌临床及病理特点分析

  目的   分析女性分化型甲状腺癌的临床及病理特点。   方法   回顾性分析云南省第一人民医院2003年1月至2012年12月云南地区1 034例女性分化型甲状腺癌（differentiated thyroid carcinoma,DTC）及良性结节患者病历资料,进行单因素和多因素条件Logistic回归分析。   结果   女性DTC患者的平均年龄低于良性结节组。经单因素分析,女性DTC患者的术前血清TSH浓度高于良性结节组;DTC组TGAb、TRAb和TPOAb阳性率显著高于良性结节组;DTC组合并桥本氏甲状腺炎及淋巴细胞性甲状腺炎显著高于良性结节组;DTC组初潮年龄≤13岁、孕育子女数≤2个及未绝经的比率明显高于良性结节组。经多因素分析,年龄 < 45岁（OR=0.060,P < 0.001）、结节直径 < 1 cm（OR=0.377,P=0.006）和TG升高（OR=0.431,P=0.009）是女性DTC的保护性因素;TGAb（OR=4.949,P < 0.001）和TRAb（OR=23.001,P < 0.001）的异常升高是其独立危险因素。   结论   女性DTC发病年龄早于良性组;甲状腺术前血清TSH的异常升高、合并HT、月经初潮早、绝经晚及孕育子女数少与女性DTC的发生有一定关联;TGAb和TRAb的异常升高是女性DTC的独立危险因素;年龄 < 45岁、结节直径 < 1cm和TG升高是其保护性因素。       

甲状腺自身抗体水平与分化型甲状腺癌中央区淋巴结转移的相关性

目的:探讨甲状腺自身抗体［甲状腺球蛋白抗体（TGAb）、甲状腺过氧化物酶抗体（TPOAb）和促甲状腺激素受体抗体（TRAb）］增高是否会影响分化型甲状腺癌（DTC）的中央区（VI区）淋巴结转移率。方法:回顾性分析200例单中心收治的行甲状腺全切术+中央区淋巴结清扫术且病理证实为DTC患者的临床及病理资料,比较不同的自身抗体组合状态患者的临床病理特征的差异以及分析不同自身抗体组合状态是否是影响DTC患者中央区淋巴结阳性的独立危险因素。结果:共纳入200例DTC患者,年龄≤45岁80例,>45岁120例;男性67例,女性133例;TGAb阳性、TPOAb阳性、TRAb阴性者24例;TGAb阳性、TPOAb阳性、TRAb阳性者29例;TGAb阳性、TPOAb阴性、TRAb阴性者27例;TGAb阳性、TPOAb阴性、TRAb阳性者23例;TGAb阴性、TPOAb阳性、TRAb阴性者14例;TGAb阴性、TPOAb阳性、TRAb阳性者17例;TGAb阴性、TPOAb阴性、TRAb阴性者48例;TGAb阴性、TPOAb阴性、TRAb阳性者18例。发现自身抗体阳性状态更倾向于双侧肿瘤（P＜0.05）以及中央区淋巴结阳性（P＜0.001）DTC患者,但未发现这8种不同组合在年龄、性别、肿瘤大小、是否侵犯神经、血管、是否多灶性及术前TSH水平方面比较差异有统计学意义（P＞0.05）。本研究中央区淋巴结阳性者112例,阴性者88例,多因素分析结果发现肿瘤多灶性、双侧性、自身抗体均阳性组合状态（TGAb阳性、TPOAb阳性、TRAb阳性）以及术前TSH降低是影响中央区淋巴结转移的独立危险因素（P均＜0.05）,未发现自身抗体其他组合状态及其他因素与中央区淋巴结转移有关（P＞0.05）。结论:DTC患者甲状腺自身抗体（TGAb、TPOAb、TRAb）均增高是影响中央区淋巴结阳性的高危因素,增加中央区淋巴结转移率,建议行预防性中央区淋巴结清扫。     

Chemotherapie beim Schilddrüsenkarzinom

Anaplastic and undifferentiated thyroid carcinoma as well as differentiated thyroid carcinoma (DTC) not cured by combination surgery and radioiodine ablation are candidates for palliative chemotherapy. Although general improvement of survival has not been proven, impressive temporary remission has been found in individual cases. Depending on the protocol, chemotherapy of progressive DTC has resulted in complete and partial remission in up to 20% and up to 40%, respectively. Initially, monotherapy with doxorubicin 10 mg/m² weekly up to a cumulative dose of 400 mg/m² or until progress is noted is recommended for progressive thyroid cancer. Anaplastic thyroid carcinoma should primarily be treated multimodally with surgery, hyperfractionated accelerated radiation therapy (57 Gy), and chemotherapy with anthracyclines (mitoxantrone or doxorubicin) to avoid obstructive growth at the neck. Medullary thyroid carcinomas (MTC) with unresectable tumors or diffuse metastases associated with rapid increases of calcitonin levels (doubling in less than a year) have a poor prognosis. However, up to half of these affected MTC patients benefit at least from partial remission with chemotherapy. Preferred regimes include either doxorubicin or the combination of cyclophosphamide, vincristine, and dacarbazine described by Wu and Averbuch. Taxol and gemcitabine are promising new agents for the treatment of metastatic undifferentiated thyroid carcinoma resistant to other chemotherapeutic regimes. Inhibition of angiogenesis with VEGF receptor antagonists and gene therapy are new concepts that need further studies for evaluation of their potential.     

Associations Between XRCC1 Arg399Gln,Arg194Trp,and Arg280His Polymorphisms and Risk of Differentiated Thyroid Carcinoma: A Meta-analysis

Background: Associations between Arg399Gln, Arg194Trp and Arg280His polymorphisms of the XRCC1 geneand risk of differentiated thyroid carcinoma (DTC) have been widely studied but the findings are contradictory.Methods: We performed a meta-analysis in the present study using STATA 11.0 software to clarify any associations.Electronic literature databases and reference lists of relevant articles revealed a total of 10, 6 and 6 publishedstudies for the Arg399Gln, Arg194Trp and Arg280His polymorphisms, respectively. Results: No significantassociations were observed between Arg399Gln and DTC risk in all genetic models within the overall andsubgroup meta-analyses, while the Trp/Trp vs Arg/Arg and recessive model of the Arg194Trp polymorphismwas associated with DTC susceptibility, and the dominant model of Arg280His polymorphism contributed toDTC susceptibility in Caucasians. Conclusions: Our meta-analysis suggests that XRCC1 Arg194Trp may be arisk factor for DTC development.     

Initial management and follow-up of differentiated thyroid cancer in children

Children with differentiated thyroid cancer (DTC) often present with metastatic disease and have a high risk for recurrence, but rarely die of the disease. This article reviews DTC in children and discusses current approaches to their initial care and follow-up. These recommendations take into account the greater risk for recurrence and lower disease-specific mortality in these patients. Total thyroidectomy and central compartment lymph node dissection are appropriate for most children, but should be performed by a high-volume thyroid surgeon. Radioactive iodine (RAI) should generally be prescribed for those at very high risk for recurrence or known to have microscopic residual disease, and those with iodine-avid distant metastases. RAI should be considered in other patients only after carefully weighing the relative risks and benefits and the aggressiveness of the clinical presentation, because RAI may be associated with an increased risk for second malignancies and an increase in overall morbidity and mortality. All patients should be treated with thyroid hormone suppression, and follow-up should be lifelong. However, the degree of thyroid hormone suppression and frequency of disease surveillance usually decrease over time as patients are determined to be disease-free.