基于SEER数据库的炎性乳腺癌生存预测风险模型的建立与验证

目的:建立可预测炎性乳腺癌(inflammatory breast cancer,IBC)生存情况的风险模型.方法:利用监测、流行病学和结果(Surveillance,Epidemiology and End Results,SEER)数据库,筛选2010年至2015年诊断为IBC的病例,通过单因素和Logistic多...     

基于SEER数据库对HR+/HER2-/T1～2N0M0乳腺癌临床病理特征及预后分析

目的 比较年轻与非年轻HR+/HER2-/T1～2N0M0女性乳腺癌的临床病理特征、治疗及预后因素.方法 提取SEER数据库2010-2012年有完整随访资料的女性HR+/HER2-/T1～2N0M0乳腺癌的数据,将年龄＜40岁患者作为年轻组,≥40岁作为非年轻组,分析两组的临床病理特征及治疗方法差异,通过Kaplan...     

乳腺癌的预后因素分期与受体状态

分期法是评价乳腺癌预后古老而仍然是最广泛使用的方法,虽然分期是一个有用的概念,但它不能在每一期辨别致死性肿瘤,而在这些分期中含有各种生物学潜能的癌肿,限制了准确地预测各种病人病程分期的能力,确切的肿瘤范围的敏感指标和快速的预后将改善判断预后的准确性,随之可给病人选择系统的辅助治疗,肿瘤组织类固醇激素受体已经受到重视.     

辽宁省癌症患者术后分期T0~2N0M0现状抽样调查

[目的]了解辽宁省癌症患者术后分期T0～2N0M0现状,为卫生行政部门制订相关政策提供参考。[方法]采用整群二阶段抽样方法,对辽宁省内抽取的37所不同类型、不同级别医院的癌症手术患者病历进行调查和评估。[结果]共收集有效调查表1947张,其中术后分期T0～2N0M0的癌症患者383例,占19.67%。不同类型、不同等级、不同地区医院,以及不同性别、不同年龄组间T0～2N0M0癌症患者比例均存在统计学差异(P<0.05)。[结论]辽宁省癌症早期诊治率较低,建立一套符合我国国情的科学、合理的癌症早诊早治措施将成为提高癌症早期诊治率的关键。     

T1N0M0乳腺癌的激素受体状况对预后的影响

对４８例Ｔ１Ｎ０Ｍ０乳腺癌患者进行激素受体与预后关系的分析，平均随诊时间为８．５年，全部病例行改良根治术，术后均未进行辅助治疗。雌激素受体或孕酮受体阳性组病例的无复发，生存率明显优于相应之阴性组病例。初步认为Ｔ１Ｎ０Ｍ０浸润性乳腺癌病例的雌激素及／或孕酮受体阴性者应进行术后化疗。     

炎性乳腺癌中肿瘤微环境的研究进展

炎性乳腺癌（IBC）是一种罕见且进展迅速的高侵袭性乳腺癌亚型。因其在起病初期常被误诊,对标准治疗反应较差以及缺少大样本的前瞻性研究,IBC患者的生存率明显低于非炎性乳腺癌患者。国内外一直致力于阐释IBC的各方面生物学机制,而作为肿瘤免疫最直接的表现形式,肿瘤微环境（TME）参与了IBC的各种恶性生物学行为。IBC的TME中包括淋巴管、血管、肿瘤相关成纤维细胞、肿瘤细胞外基质及浸润性免疫细胞等组成成分,但无明确特征,各种调控TME中免疫细胞的分子机制和信号通路在很大程度上仍不清楚。全文就IBC的TME与IBC发病机制及其预后的相关性进行综述。     

炎性标志物在乳腺癌新辅助化疗中的应用研究进展

新辅助化疗（neoadjuvant chemotherapy,NAC）作为乳腺癌治疗方法之一,因具有可使肿瘤降期,增加不可手术患者的手术机会、提高保乳率、评估药效等优势,目前被越来越多地应用于局部晚期乳腺癌患者,但是由于肿瘤的异质性,NAC并不能使所有患者获益,且存在一定的疾病进展率。因此,有必要寻找能够反映NAC疗效的生物标志物以帮助临床医生早期掌握患者对NAC的敏感程度,及早将化疗反应不敏感的患者识别出来,针对这部分患者及时调整或更换治疗方案。但现有的评估手段均有其局限性,外周血炎性标志物的提出可以推动具有更好预测价值的生物标志物的出现。全文就外周血炎性标志物在乳腺癌新辅助化疗中的应用研究进展作一综述,旨在为乳腺癌的综合诊疗提供更全面的参考。     

新辅助化疗对乳腺癌TNM分期及术后治疗方案影响的研究

目的通过研究新辅助化疗对乳腺癌根治术后病理分期及治疗方案的影响,进一步评价新辅助化疗的临床价值。方法对100例经空芯针穿刺取材病理确诊的乳腺癌患者,给予临床证实有效的新辅助化疗方案2周期治疗,继之行根治术,术后病理检查并做免疫组化测ER、PR和c-erbB-2,与化疗前的检查结果比对。结果经新辅助化疗后,乳腺癌原发灶明显缩小,11%达到完全缓解(CR);腋窝淋巴结阳性率下降,21.6%达到完全缓解(CR);ER、PR和c-erbB-2结果与新辅助化疗前不相符,不符合率分别为46%、37%和12%。结论新辅助化疗对降低病期、争取保乳机会、筛选敏感的化疗药物有一定作用,但因其影响了术后病理结果,不利于医生制定放疗、内分泌治疗及基因治疗等方案,有待于进一步研究解决此矛盾。     

pT3N0M0期胸段食管鳞癌根治术后的预后因素

目的 探讨pT3N0M0期胸段食管鳞癌两野根治术后的预后及其影响因素。方法 胸段食管鳞癌行胸腹两野食管癌根治术后、分期为pT3N0M0者249例,中位年龄60岁（33~78岁）;胸上段39例、胸中段166例、胸下段44例,病变中位长度5 cm（2~12 cm）;术中无粘连者35例、轻度粘连者90例、重度粘连者124例;术中清扫淋巴结中位数9枚（1~27枚）;98例单纯手术、151例行术后辅助治疗。结果 249例中1、3、5年总生存率（overall Survival, OS）和无进展生存率（progression-free survival, PFS）分别为90.0%、68.7%、55.2%和82.1%、61.7%、5 3 . 9%。单因素分析结果显示：性别、肿瘤位置、病理分化程度和术前血红蛋白水平与O S 有关（P<0.05）;年龄、肿瘤位置和术中粘连程度与PFS有关（P<0.05）;多因素分析结果显示：肿瘤位置、术前血红蛋白水平、术前CT有纵隔小淋巴结（<1 cm）和清扫淋巴结数目是OS独立影响因素,肿瘤位置是影响PFS独立危险因素。术后辅助治疗对OS和PFS均无明显影响;但术前CT纵隔有小淋巴结（<1 cm）者,术后辅助治疗可以提高OS和PFS（P<0.05）。结论 pT3N0M0期胸段食管鳞癌胸腹两野根治术后,肿瘤位置影响OS和PFS,胸下段癌预后最好,胸上段癌预后最差;术中清扫淋巴结数多、术前CT纵隔无淋巴结者预后较好,反之预后较差;术前血红蛋白高者生存率低;而术后辅助治疗的价值有待证实。     

炎性乳腺癌48例临床分析

目的探讨炎性乳腺癌的临床特点，治疗及预后因素，方法对４８例炎性乳腺癌的临床资料进行回顾性分析，按ＴＮＭ分期，Ⅲｂ期３８例，Ⅳ期１０例，无特定的组织学类型；４８例者均接受综合治疗。结果全组病例平均生存期为３２个月，３年生存率为４５．８％，５年生存率为３３．３％；Ⅲｂ期生存５年者有１６例，Ⅲｂ期１年内死亡者有５例，Ⅳ期１０例中有６例在１年内死亡。结论炎性乳腺癌的治疗主要为诱导化疗、手术、局部放疗及辅助     

Prognostic Model and Nomogram for Estimating Survival of Small Breast Cancer: A SEER-based Analysis

BackgroundDifferent clinicopathologic characteristics could contribute to inconsistent prognoses of small breast neoplasms (T1a/T1b). This study was done to conduct a retrospective analysis and establish a clinical prediction model to predict individual survival outcomes of patients with small carcinomas of the breast.Materials and MethodsBased on the Surveillance, Epidemiology, and End Results (SEER) database, eligible patients with small breast carcinomas were analyzed. Univariate analysis and multivariate analysis were performed to clarify the indicators of overall survival. Pooling risk factors enabled nomograms to be constructed and further predicted 3-year, 5-year, and 10-year survival of patients with small breast cancer. The model was internally validated for discrimination and calibration.ResultsA total of 17,543 patients with small breast neoplasms diagnosed between 2013 and 2016 were enrolled. Histologic grade, lymph node stage, estrogen receptor or progesterone receptor status, and molecular subtypes of breast cancer were regarded as the risk factors of prognosis in a Cox proportional hazards model (P < .05). A nomogram was constructed to give predictive accuracy toward individual survival rate of patients with small breast neoplasms.ConclusionsThis prognostic model provided a robust and effective method to predict the prognosis of patients with small breast cancer.     

Effect of Breast Conservation Therapy vs Mastectomy on Overall Survival and Breast Cancer-Specific Survival Among Men With Stage I-II Breast Cancer: Analysis of SEER, 2000-2018

BackgroundMale breast cancer is a rare malignant tumor, and outcomes of breast conservation therapy (BCT) are currently lacking.MethodThe retrospective, population-based cohort study included 1369 stage I-II (T1–2 N0–1 M0) male breast cancer patients from the SEER database (2000-2018). The patients were grouped in two groups: BCT group and mastectomy group, according to surgical and radiation therapy. Kaplan-Meier method and univariable Cox proportional hazard analysis were used to compare overall survival (OS) and breast cancer-specific survival (BCSS) between two treatment groups. Propensity score matching (PSM) was performed to balance the confounding factors.ResultsOf the 1369 men, 97 (7%) patients received BCT, 1272 (93%) received mastectomy alone. The 5- and 10-year OS rates were 92.3% and 80.7% for BCT group compared with 80.4% and 61.4% for mastectomy group. The 5- and 10-year BCSS rates were 96.5% and 93.9% for patients undergoing BCT, as compared with 93.1% and 84.4% for patients undergoing mastectomy. Compared with mastectomy group, BCT group showed improved OS (hazard ratio [HR], 0.294; 95% CI 0.138-0.623, P = .002) and BCSS (hazard ratio [HR], 0.182; 95% CI 0.040-0.820, P = .027). Of the 791 patients with T1 stage, BCT showed insignificant association with OS (hazard ratio [HR], 0.555; 95% CI 0.207-1.488, P = .242) and BCSS (hazard ratio [HR], 1.217; 95% CI 0.171-8.675, P = .844).ConclusionThe results of this cohort study suggest that BCT is at least equivalent to mastectomy in male breast cancer patients. The underlying mechanism of this association needs further research.     

A Comprehensive Model for Predicting Recurrence and Survival in Cases of Chinese Postoperative Invasive Breast Cancer

We investigated relationships between clinical pathologic data, molecular biomarkers and prognosis of invasive breast cancer based on a Chinese population. Immunohistochemistry (IHC) was used to assess the status of ER, PR, HER-2 and Ki-67, with fluorescence in situ hybridization (FISH) performed to further confirm HER-2 positivity with an equivocal result (IHC 2+). Subsequently, Kaplan-Meier univariate and multivariate COX regression analyses of ER, PR, HER-2, Ki-67, clinical features, therapeutic status and follow-up data were performed according to the establishment principle of the Nottingham prognostic index (NPI). From this study, age, tumor size, lymph node status, ER, HER-2, Ki-67 status were found to be associated with prognosis. Eventually, a prognostic model of (PI= (1.5×age) - size + (0.1×lymph node status) - (0.5×ER) + (2×HER-2) - (0.2×Ki-67)) was established with 288 randomly selected patients and verified with another 100 cases with invasive breast cancer. Pearson correlation analysis demonstrated a significant positive correlation index of 0.376 (P=0.012<0.05) between the prognostic index (PI) and actual prognosis. Remarkably, the consistency with the model predicted recurrence was 93% in the validation set. Therefore, it appears feasible to predict the prognosis of individuals with invasive breast cancer and to determine optimal therapeutic strategy with this model.     

术前化疗结合放疗治疗炎性乳腺癌疗效分析

目的：探讨术前化疗结合放疗治疗炎性乳腺癌的疗效。方法：采用环磷酰胺（CTX），吡柔比星（THP—ADM），氟脲嘧啶（5-FU）或CTX、甲氨喋呤（MTX）、5-FU化疗治疗21例炎性乳腺癌，每21天重复治疗。结果：全部病例随访5年以上．随访率100％。总有效率85．7％，3年、5年生存率为42．9％、23．8％。结论：炎性乳腺癌预后差，经术前化疗、放疗结合局部治疗可取得较好疗效。     

基于第六版AJCC分期的乳腺癌临床分析

目的比较1997年第五版和2002年第六版AJCC的病理分期标准对乳腺癌预后预测的不同点。方法1996年～1999年治疗157例早期女性乳腺癌患者,根据我们医院的存档资料,按照第五版和第六版的AJCC分期系统进行重新病理分期并随访;主要观察目标为不同分期下的无复发生存率和生存期,用Kaplan-Meier和log-rank进行统计学检验。结果第五版Ⅱ期例数有93例,在第六版分期则只有64例(68.8%)仍是Ⅱ期,其中Ⅱa期例数无变化,Ⅱb期71例中有42.3%(30/71)产生了分期的变化。第五版Ⅰ期患者无复发,Ⅱ和Ⅲ期的无复发生存率有差别,平均无复发生存期分别为77.1个月和64.8个月,但无显著性差异(Log-RankP=0.069)。第六版Ⅰ期患者无复发,Ⅱ和Ⅲ期的无复发生存率亦有明显差别,平均无复发生存期分别为81.2个月和65.4个月,有显著性差异(Log-RankP=0.029)。结论由于体现了淋巴结侵犯的数目,AJCC第六版TNM病理分期系统定义了更多的Ⅲ期患者,Ⅱ、Ⅲ期患者间的无复发生存率具有更显著的差别,较第五版分期系统有了进一步改进,新的分期系统一样适用于中国乳腺癌患者。     

男性乳腺癌34例生存分析

目的：探讨男性乳腺癌的生物学特性、治疗及预后情况.方法：对1980年3月～2005年3月吉林大学第一医院收治的34例男性乳腺癌患者的临床资料进行回顾性分析,采用Kaplan-Meier法计算生存率、绘制生存曲线.结果：pTNM分期Ⅰ期6例,Ⅱ期24例,Ⅲ期4例,腋窝淋巴结转移率35.3%（12/34）.均采用改良根治术,术后复发率11.8%（4/34）.5年生存率65.3%.结论：与女性乳腺癌相比,男性乳腺癌有其独特的生物学特性,治疗上采用以手术为主的综合治疗.肿瘤分期和激素受体表达等因素是影响预后的主要因素.     

Impact of Subtype on Survival of Young Patients With Stage IV Breast Cancer

BackgroundAlthough younger age is a negative prognostic factor for patients with early stage breast cancer, data regarding the outcomes of young patients with stage IV disease are limited. We evaluated differences in overall survival (OS) according to age and disease subtype among patients with stage IV breast cancer.Patients and MethodsUsing Surveillance, Epidemiology, and End Results (SEER) data, we identified 6,302 patients aged < 60 years with de novo stage IV breast cancer between 2010 and 2014. We examined age-specific OS among hormone receptor (HR)-positive (HR⁺)/human epidermal growth factor receptor 2 (HER2)-negative (HER2⁻), HR⁺/HER2-positive (HER2⁺), HR-negative (HR⁻)/HER2⁺, and triple-negative cases using log-rank tests and Cox proportional hazards models, adjusting for relevant clinical and demographic variables.ResultsCompared with patients aged 40 to 59 years, patients aged < 40 years (n = 944; 15%) had a higher proportion of HER2⁺ cancers and a lower proportion of HR⁺/HER2⁻ disease (P < .001), but a similar proportion of triple-negative disease. Patients aged < 40 years also experienced significantly longer survival, with a median OS of 45 months (vs. 33 months). Further, after stratification by subtype, patients aged < 40 years experienced significantly longer survival, except in the setting of triple-negative disease. These survival differences persisted in adjusted analyses.ConclusionsCompared with those aged 40 to 59 years, patients with de novo metastatic breast cancer aged < 40 years experienced significantly longer survival, except in the setting of triple-negative disease. Distinct treatment-related or biological factors may exist between earlier stage and metastatic breast cancers; further examination of the potential reasons for our findings are warranted.     

Inflammatory Breast Cancer: a Single Centre Analysis

Background: Inflammatory breast cancer (IBC) is an aggressive form of locally advanced breast cancercharacterized by rapidly progressive breast erythema, pain and tenderness, oedema and paeu d’orangeappearance. It accounts for 1-3% of all newly diagnosed cases of breast cancer in the west. Data on IBC fromIndia are lacking. The aim of our study was to assess the clinical-pathological parameters and outcome of IBCat, All India Institute of Medical Sciences, a large tertiary care centre. Materials and Methods: We screened 3,650breast cancer cases registered from January 2004 to December 2012 and found 41 cases of IBC. Data includeddemographics as well as clinical, radiological and histopathological characteristics, and were collected fromclinical case records using the International Classification of Diseases code (C-50). Patients who presented withIBC as a recurrence, or who had a neglected and advanced breast cancer that simulated an IBC were excludedfrom this study. Results: The median age was 45 years (range 23-66). The median duration of symptoms was5 months. The American Joint Committee on Cancer stage (AJCC) distribution was Stage III - 26 and IV - 15patients. Estrogen receptor (ER), progesterone receptor (PR) positivity and human epidermal growth factorreceptor 2 (HER2/neu) positivity were 50%, 46% and 60%, respectively. Triple negativity was found in 15% of thecases. All the non metastatic IBC patients received anthracycline and/ or taxane based chemotherapy followed bymodified radical mastectomy , radiotherapy and hormonal therapy as indicated. Pathological complete remissionrate was 15%. At a median follow-up of 30 months, the 3 year relapse free survival and overall survival were30% and 40%respectively. Conclusion: IBC constituted 1.1% of all breast cancer patients at our centre. Onethird of these had metastatic disease at presentation. Hormone positivity and Her2 neu positivity were foundin 50% and 60% of the cases, respectively.