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1.
目的:比较分析青年和老年乳腺癌患者的病理特征与预后的差异。方法:对我科自2011年6月至2012年12月收治42例青年乳腺癌(≤35岁,青年组)和63例老年乳腺癌(≥60岁,老年组)女性患者的临床资料进行整理,将两个年龄段的一般临床资料、病理特点、治疗方式和随访等情况进行比较分析。采用SPSS 24软件进行数据分析。结果:两组在肿瘤发生位置上、手术方式、辅助化疗、内分泌治疗和基因靶向治疗的比较上两组无统计学差异(P>0.05),而在病程、肿瘤大小、组织病理分级和分期、淋巴结转移情况上比较存在差异性(P<0.05)。青年组中新辅助化疗、乳房重建和辅助放疗多于老年组(P<0.05)。与青年组比较,老年组中PR阳性高表达而HER-2和Ki-67低表达(P<0.05),两组分子分型与ER阳性表达的比较无统计学意义(P>0.05)。随访3年和5年两组的总生率均无统计学意义(P>0.05),但青年组中复发转移多于老年组(P<0.05)。结论:青年乳腺癌患者具有组织病理学分级和分期晚、恶性程度高、侵袭性强、复发转移率高,预后差的特点。  相似文献   

2.
  目的   探讨乳腺癌多原发癌(multiple primary cancers,MPCs)患者的临床病理特征及预后因素。   方法   回顾性分析2005年1月至2015年12月天津医科大学肿瘤医院收治的226例乳腺癌MPCs患者的临床病理资料,应用单因素及多因素分析方法分析其临床病理学特征及影响预后的因素。   结果   226例中74例(32.7%)为同时型MPCs,152例(67.3%)为异时型MPCs。在第二原发恶性肿瘤中甲状腺癌最常见,为90例。患者的中位随访时间为84.75(4.1~384.5)个月,226例患者的3年及5年总生存率分别为91.7%和82.9%。乳腺癌MPCs患者的病理特征以肿瘤负荷大(65.5% vs. 34.5%,P=0.005)和ER受体阳性(76.1% vs. 23.9%,P=0.046)多见,异时型MPCs更倾向于高龄人群(62.4% vs. 37.6%,P < 0.001)。无淋巴结转移(95%CI:0.341~0.932,P=0.025)和异时型MPCs(95%CI:0.033~0.220,P < 0.001)患者预后佳。   结论   甲状腺是最常见的第二原发肿瘤,肿瘤负荷大及ER受体阳性患者易发生乳腺癌MPCs,高龄患者易患异时型MPCs,有无淋巴结转移和MPCs的类型是患者预后的独立影响因素。   相似文献   

3.
Introduction: Trastuzumab is a key drug in the neoadjuvant treatment of breast cancers that overexpress the human epidermal growth factor receptor 2 (HER2). Pathological complete response (pCR) is commonly used as an endpoint in neoadjuvant clinical trials of trastuzumab as evidence suggests it may be a surrogate for long-term survival. Several biosimilar candidates of originator or ‘reference’ trastuzumab are in development and have used pCR as a primary endpoint to assess therapeutic equivalence between treatments. The exact definition of pCR has varied across studies.

Areas covered: Here we look at the clinical relevance of pCR and compare rates of total pCR (defined as ypT0/is ypN0) and breast pCR (defined as ypT0/is) in clinical trials of reference and biosimilar trastuzumab.

Expert commentary: In order to evaluate the efficacy of neoadjuvant systemic therapies in a uniform way, standardization of trial endpoints is necessary. Future studies in HER2-positive breast cancer should include full assessment of the breast and lymph node basin before and after neoadjuvant systemic therapy, and the use of total pCR as the primary outcome.  相似文献   


4.
目的 乳腺癌已是青年女性最常见的恶性肿瘤之一,青年乳腺癌患者也越来越受关注.本研究探讨青年女性乳腺癌(≤35岁)的临床病理学特点,分析影响患者临床预后的因素.方法 回顾性分析广西医科大学附属肿瘤医院2006-01-01-2011-01-01收治的127例≤35岁女性乳腺癌的临床资料,采用Kaplan-Meier法计算无疾病进展生存率和总生存率,Log-rank检验比较生存差异,Cox比例风险回归模型进行预后多因素分析.结果 全组病例TNM病理分期:Tis(原位癌)2例,Ⅰ期38例,Ⅱ期50例,Ⅲ期31例,Ⅳ期6例.5年总生存率、10年累积生存率Ⅰ期分别为97.4%(37/38)和94.7%(36/38),Ⅱ期为92.0%(46/50)和90.0%(45/50),Ⅲ期为71.0%(22/31)和71.0%(22/31),Ⅳ期为33.3%(2/6)和33.3%(2/6).5年无疾病进展生存率、10年累积无疾病进展生存率I期分别为89.5%(34/38)和89.5%(34/38),Ⅱ期为82.0%(41/50)和76.0%(38/50),Ⅲ期为54.8%(17/31)和51.6%(16/31),Ⅳ期为16.7%(1/6)和16.7%(1/6).Cox多因素回归分析显示,TNM分期(P<0.01)和流产史(P[0.04)是影响5年总生存(overall survival,OS)的主要因素,TNM分期(P<0.01)和身体质量指数(P=0.02)是影响10年累积OS的主要因素;TNM分期(P<0.01)和术后放疗(P=0.02)是影响5年无疾病进展生存(progression free survival,PFS)的主要因素,TNM分期(P<0.01)、流产史(P=0.01)和术后放疗(P<0.01)是影响10年累积PFS的主要因素.结论 青年乳腺癌有着独特的临床病理学特点,TNM病理分期、术后放疗、肥胖和流产史是影响其预后的重要因素,早发现、早诊断及早治疗是良好预后的关键.  相似文献   

5.

Background:

We analysed 10-year survival data in 19 411 women aged 50–64 years diagnosed with invasive breast cancer in the West Midlands region of the United Kingdom. The aim was to estimate the survival advantage seen in cases that were screen detected compared with those diagnosed symptomatically and attribute this to shifts in prognostic variables or survival differences specific to prognostic categories.

Methods:

We studied tumour size, histological grade and the Nottingham Prognostic Index in very narrow categories and investigated the distribution of these prognostic factors within screen-detected and symptomatic tumours. We also adjusted for lead time bias.

Results:

The unadjusted 10-year breast cancer survival in screen-detected cases was 85.5% and in symptomatic cases 62.8% after adjustment for lead time bias, survival in the screen-detected cases was 79.3%. Within narrow categories of prognostic variables, survival differences were small, indicating that the majority of the survival advantage of screen detection is due to differences in the distributions of size and node status.

Conclusion:

Our results suggested that a combination of lead time with size and node status in 10 categories explained almost all (97%) of the survival advantage. Only a small proportion remained to be explained by biological differences, manifested as length bias or overdiagnosis.  相似文献   

6.

Background:

Several recent studies have shown that screen detection remains an independent prognostic factor after adjusting for disease stage at presentation. This study compares the molecular characteristics of screen-detected with symptomatic breast cancers to identify if differences in tumour biology may explain some of the survival benefit conferred by screen detection.

Methods:

A total of 1379 women (aged 50–70 years) with invasive breast cancer from a large population-based case–control study were included in the analysis. Individual patient data included tumour size, grade, lymph node status, adjuvant therapy, mammographic screening status and mortality. Immunohistochemistry was performed on tumour samples using 11 primary antibodies to define five molecular subtypes. The effect of screen detection compared with symptomatic diagnosis on survival was estimated after adjustment for grade, nodal status, Nottingham Prognostic Index (NPI) and the molecular markers.

Results:

Fifty-six per cent of the survival benefit associated with screen-detected breast cancer was accounted for by a shift in the NPI, a further 3–10% was explained by the biological variables and more than 30% of the effect remained unexplained.

Conclusion:

Currently known biomarkers remain limited in their ability to explain the heterogeneity of breast cancer fully. A more complete understanding of the biological profile of breast tumours will be necessary to assess the true impact of tumour biology on the improvement in survival seen with screen detection.  相似文献   

7.
Little is known about long-term outcomes following a second breast cancer diagnosis. We describe the epidemiology, characteristics and prognosis of second breast cancers in an Italian cohort. We identified women with two breast cancer diagnoses from 24 278 histology records at a Tuscan breast cancer service between 1980 and 2005, and determined their survival status. Disease-specific survival from second diagnosis was examined using Cox regression analyses. Second cancers were identified in 1044 women with a median age of 60 years. In all 455 were ipsilateral relapses and 589 were contralateral cancers. Median time between first and second diagnosis was 63.4 months. The majority of second cancers was small invasive or in situ tumours. Estimated 10-year survival from a second cancer diagnosis was 78%. Survival was poorest when the second cancer was large (HR=2.26) or node-positive (HR=3.43), when the time between the two diagnoses was <5 years (HR=1.45), or when the diagnosis was in an earlier epoch (HR=2.20). Second tumours were more likely to be large or node-positive if the first breast cancer had these features. Prognosis following a second breast cancer in this cohort was generally good. However, large or node-positive second tumours, and shorter intervals between diagnoses were indicators of poorer survival.  相似文献   

8.
三阴性乳腺癌患者的临床特征与预后分析   总被引:1,自引:0,他引:1  

Objective  

We investigated the clinical characteristics, and the prognostic factors of triple-negative breast cancer.  相似文献   

9.
The aim of the current study is an analysis of tumor parameters, clinical and pathological responses, medical management, and survival on 710 operable breast cancer patients who received neoadjuvant chemotherapy from 1982 to 2004 and were grouped into four successive periods according to diagnosis date: (1) 1982–1989; (2) 1990–1994; (3) 1995–1999; and (4) 2000–2004. Patients were treated by different neoadjuvant chemotherapies combinations : AVCF/M, TNCF, NEM, NET, TAXOTERE, FEC 50, 75, 100, FAC 50, and TAXOTERE-TNCF, mainly in successive prospective phase II trials. They received a median number of six cycles (range, 1–9). After primary chemotherapy, patients underwent a surgery and a radiotherapy. In case of significant residual disease, some patients received additional courses of chemotherapy. In addition, menopausal patients with hormonal receptor-positive tumors received tamoxifen for 5 yr. Clinical factors had some remarkable variations with time. The median age of the patients was 49.5 yr (range, 26–81). The size of the tumor was significantly greater from 1995; conversely, clinical lymph-node involvement was lower in period 4 than in the first period. The percentage of invasive ductal carcinoma and of SBR III tumors increased about 20% from 1982–1989 to 2000–2004. The number of positive hormonal receptors increased from 38.3% in period 1 to 74% in period 4. The clinical response rate improved recently from before 1990. The pathological response rate was greater in periods 2 and 3 than in periods 1 and 4. An adjuvant hormonotherapy became progressively more frequently given (44.7 for period 1 and 73.3% for period 4). Finally, no significant difference was found when we compared overall and disease-free survival through the four periods. It appears that the progressive increase of tumor burden was compensated by more effective treatments.  相似文献   

10.
Summary We examined the influence of hormone replacement therapy (HRT) on breast tumour biology by comparing the prognostic characteristics of breast cancers and survival in 121 women prescribed replacement hormones before diagnosis with those in 1468 women without such treatment. The women receiving HRT had a lowered relative risk of being diagnosed with tumours of more than 20 mm in diameter, OR = 0.7 (CI 0.5–1.0) and axillary lymph node dissemination, OR = 0.7 (CI 0.4–1.1). These risk reductions were most pronounced and statistically significant in the women who had been prescribed a combined estradiol-progestin regimen. The patients in this compound group also had a diminished relative risk of having poorly differentiated tumours. Further, there was an indication that the women prescribed HRT, and especially those with conjugated estrogens/estradiols alone, had a decreased relative risk of developing aneuploid tumours. There was no clear pattern for women receiving the biologically weak oestriol, although risk estimates were generally higher for unfavourable tumours in comparison with those receiving the higher potency compounds. Adjustments for indications of earlier detection (i.e. lead time bias) did not influence the pattern or magnitude of the risk estimates. No association between any type of HRT and survival after breast cancer diagnosis was noted, but analyses were based only on 19 breast cancer deaths among exposed patients. We conclude that breast cancers occurring after treatment with HRT, especially the combined estrogen-progestin regimen, seem to have more favourable tumour features than tumours in non-treated women. Our findings may reflect a less aggressive biological behaviour of breast cancers in women receiving HRT, or in part be explained by the earlier detection of the tumours in these women.  相似文献   

11.
目的:检测乳腺癌组织中Chk1(checkpoint kinase1,Chk1)的表达水平,探索其与患者临床病理特征和预后的关系.方法:选取2012年01月至2017年01月在我院病理科存档的乳腺癌组织蜡块115例,应用免疫组织化学法检测其中Chk1蛋白的表达水平.采用卡方检验分析Chk1蛋白的表达情况与临床病理特征的...  相似文献   

12.
目的:探讨乳腺癌新辅助化疗患者病理完全缓解的影响因素及病理完全缓解对预后的影响。方法:选择河南省肿瘤医院乳腺科2008年1 月至2014年12月女性乳腺癌新辅助化疗患者267 例作为研究对象,收集患者的临床和病理资料,随访患者的生存情况。结果:单因素分析显示新辅助化疗病理完全缓解患者的体质量、哺乳时间、化疗周期、肿瘤直径和未病理完全缓解患者比较,差异均具有统计学意义(P < 0.05);病理完全缓解患者ER、PR、HER-2 和分子分型与未病理完全缓解比较,差异均有统计学意义(P < 0.05)。 多因素分析发现体质量和ER是乳腺癌患者新辅助化疗病理完全缓解的独立预测因素(P < 0.05)。 生存分析病理完全缓解患者和未病理完全缓解患者的无病生存期和总生存期比较,差异无统计学意义(P > 0.05)。 结论:乳腺癌患者体质量和ER是新辅助化疗病理完全缓解的独立预测因素,新辅助化疗病理完全缓解对患者生存无显著影响。  相似文献   

13.

Background:

Approximately 4% of patients diagnosed with early breast cancer have occult metastases at presentation. Current national and international guidelines lack consensus on whom to image and how.

Methods:

We assessed practice in baseline radiological staging against local guidelines for asymptomatic newly diagnosed breast cancer patients presenting to the Cambridge Breast Unit over a 9-year period.

Results:

A total of 2612 patients were eligible for analysis; 91.7% were appropriately investigated. However in the subset of lymph node negative stage II patients, only 269 out of 354 (76.0%) investigations were appropriate. No patients with stage 0 or I disease had metastases; only two patients (0.3%) with stage II and ⩽3 positive lymph nodes had metastases. Conversely, 2.2, 2.6 and 3.8% of these groups had false-positive results. The incidence of occult metastases increased by stage, being present in 6, 13.9 and 57% of patients with stage II (⩾4 positive lymph nodes), III and IV disease, respectively.

Conclusion:

These results prompted us to propose new local guidelines for staging asymptomatic breast cancer patients: only clinical stage III or IV patients require baseline investigation. The high specificity and convenience of computed tomography (chest, abdomen and pelvis) led us to recommend this as the investigation of choice in breast cancer patients requiring radiological staging.  相似文献   

14.
三阴性乳腺癌的临床病理特征及预后因素分析   总被引:2,自引:1,他引:1  
储君 《现代肿瘤医学》2011,19(5):921-924
目的:分析三阴性乳腺癌的临床病理学特征及其影响预后的因素,探索更为有效的治疗方案。方法:收集2000年1月至2005年9月收治的经病理组织学证实、有完整随访资料的510例可手术乳腺癌患者的临床资料,108例(21.2%)患者证实为三阴乳腺癌。比较三阴乳腺癌组与非三阴乳腺癌组的临床特征、复发或远处转移、生存情况。结果:510例患者中108例患者是三阴性乳腺癌,其组织学III级、髓样癌的比例明显高于非三阴性乳腺癌(P<0.05)。三阴性乳腺癌的5年复发或远处转移率(30.8%)明显高于非三阴性(18.7%,P<0.05)。三阴性乳腺癌的5年总生存率(78.4%)明显低于非三阴性(88.1%,P<0.05)。结论:三阴性乳腺癌具有独特的临床病理特征,比非三阴性乳腺癌更易发生局部复发和远处转移,预后较差。  相似文献   

15.
三阴性乳腺癌的临床病理特征及预后因素分析   总被引:1,自引:0,他引:1  
目的:分析三阴性乳腺癌的临床病理学特征及其影响预后的因素,探索更为有效的治疗方案。方法:收集2000年1月至2005年9月收治的经病理组织学证实、有完整随访资料的510例可手术乳腺癌患者的临床资料,108例(21.2%)患者证实为三阴乳腺癌。比较三阴乳腺癌组与非三阴乳腺癌组的临床特征、复发或远处转移、生存情况。结果:510例患者中108例患者是三阴性乳腺癌,其组织学III级、髓样癌的比例明显高于非三阴性乳腺癌(P〈0.05)。三阴性乳腺癌的5年复发或远处转移率(30.8%)明显高于非三阴性(18.7%,P〈0.05)。三阴性乳腺癌的5年总生存率(78.4%)明显低于非三阴性(88.1%,P〈0.05)。结论:三阴性乳腺癌具有独特的临床病理特征,比非三阴性乳腺癌更易发生局部复发和远处转移,预后较差。  相似文献   

16.
Clinical, pathological features and steroid hormone receptors (SR) including receptors of estrogen (ER), progesterone (PR) and androgen (AR) were observed in 58 cases of breast carcinoma, and related to patient 5- year survival rate through stratification and multivariatc analysis. The results showed that histologic tumor type and grading, lymphnode status, ER value and patient age took more important role in patient survival, and SR, especially, conferred survival advantage in advanced cases with tumor size larger than 2 cm, node involved, or TNM Stage Ⅱ-Ⅲ.  相似文献   

17.
Breast cancers from 53 patients were explanted in culture, and 39 with two-year or more follow-up and documentable tissue forms of cancer in culture (histoculture) are the subject of this report. Clinicopathologic findings have been correlated with dynamic aspects of the cancers in short-term histocultures, including cell cohesiveness, yield and survival time of the cancer cells in culture, emigration of macrophages from the explants, and the occurrence of special interactions of lymphocytes with cancer cells. The outstanding finding was the association of special lymphocyte-cancer cell interactions with a more favorable prognosis; six of seven patients (86%) with infiltrating ductal cancer showing lymphocyte congregation, emperiopolesis, or other special activity were tumor-free survivors. Additional findings were: 1) patients having four or fewer lymph nodes positive for cancer had a survival rate of 50%, but this fell to 20% when emigrating macrophages were not present in the cancer cultures; 2) eight of the 12 patients (67%) having discoid histoculture survival time of less than one week were tumor-free, as opposed to three of eight patients (27%) where tumor survival in vitro was greater than one week. The reverse was true for nondiscoid, poorly cohesive colonies of cancer; 3) the combination of tumor-negative lymph nodes and low in vitro cancer yield was associated with the best patient survival rate, 64%. However, the combination of negative nodes and high in vitro yield was linked to the worst patient survival (20%). Although the overall study does not permit definitive conclusions, there is an undeniable potential for the use of histocultures in the evaluation of human cancers. Expanded studies are warranted, including larger numbers of tumors and cultures, and longer patient follow-up periods.  相似文献   

18.
目的 乳腺浸润性微乳头状癌(invasive micropapillary carcinoma,IMPC)是一种特殊类型的乳腺浸润性癌,易发生淋巴管、血管侵犯,但对其预后的认识仍存在分歧.本研究拟探讨IMPC的临床病理特征及预后相关性,为临床治疗提供指导.方法 采用回顾性分析的方法,形态学观察并评估2006-06-19-2015-10-28国家癌症中心中国医学科学院肿瘤医院病理确诊的89例乳腺IMPC中微乳头状结构的比例,应用免疫组化方法检测ER、PR、HER2及Ki-67的表达,并对各临床病理因素进行生存分析.结果 肿瘤内微乳头状癌比例>50%组ER阳性率为85.7%,高于微乳头状癌比例25%~50%组(57.1%)和<25%组(40%),P=0.013;单纯性IMPC组伴脉管瘤栓比率为58.8%,高于混合性IMPC组的32.4%,P=0.018.随访资料显示,微乳头状癌比例>50%组复发/转移率为9.1%,低于微乳头状癌比例25%~50%组(28.6%)和<25%组(40.0%),P=0.047.Kaplan-Meier单因素生存分析显示,微乳头状癌成分>50%组无瘤生存期长于微乳头状癌成分25%~50%组与<25%组,χ2=4.296,P=0.038;ER阳性组无瘤生存期长于ER阴性组,χ2=5.324,P=0.021;原发肿瘤T1组无瘤生存期长于T2组,χ2=7.302,P=0.026.Cox多因素生存分析未发现,影响乳腺IMPC无瘤生存时间的独立预后因素.结论 乳腺IMPC虽然易于发生脉管侵犯,但其侵袭性、转移能力及恶性度并不因而增高;原发肿瘤大小、ER状态、微乳头癌比例可能与其预后相关,但有待扩大样本及更长期随访数据的支持.  相似文献   

19.
目的:探讨影响青年乳腺癌患者新辅助化疗(neoadjuvant chemotherapy,NAC)后病理完全缓解(pathological complete response,pCR)和预后的临床病理因素。方法:回顾性分析2010年01月至2018年12月我院甲乳外科收治年龄≤35岁行NAC的女性乳腺癌患者的临床病理资料。NAC后依据Miller-Payne评分系统,将患者分为pCR组和非pCR组。探讨临床病理因素对青年乳腺癌患者pCR、复发转移和死亡的影响,同时分析pCR与无病生存期(disease free survival,DFS)与总生存期(overall survival,OS)之间的相关性。结果:168例患者中pCR 37例,pCR率为22.0%。体质量指数(body mass index,BMI)、术前淋巴结状态、雌激素受体(estrogen receptor,ER)、孕激素受体(progesterone receptor,PR)、人类表皮生长因子受体2(human epidermal growth factor receptor-2,HER-2)、Ki-67、p53及分子分型与青年乳腺癌患者NAC后的pCR率关系密切(P<0.05)。肿瘤大小、术前淋巴结状态、ER、PR、HER-2、p53及分子分型影响患者的复发转移和死亡(P<0.05),同时肿瘤大小、术前淋巴结状态、组织学分级、ER、PR、HER-2、Ki-67及分子分型均是DFS和OS的独立影响因素(P<0.05)。66例复发转移患者中pCR患者7例,占pCR患者的18.9%(7/37),pCR组和非pCR组DFS比较差异具有统计学意义(P<0.05)。38例死亡患者中pCR患者3例,占pCR患者的8.1%(3/37),pCR组和非pCR组OS比较差异具有统计学意义(P<0.05)。结论:影响青年乳腺癌患者pCR和预后的临床病理因素较多,获得pCR的患者具有更好的远期预后。  相似文献   

20.
Background: The presence in bone marrow of cells which react with monoclonal antibodies against tumor-associated antigens has been proposed over the last few years as a new prognostic factor in breast cancer patients. Patients and methods: Bone marrow aspirates were obtained from 109 stage I and II breast cancer patients during or 2–4 weeks after primary surgery. The samples were processed for leukocyte separation on a Ficoll-Hypaque gradient and then used to prepare cytospin slides for immunocytochemical analysis. The slides were stained with a pool of monoclonal antibodies (MoAbs) which recognize tumor associated antigens, using the alkaline phosphatase anti-alkaline phosphatase method. The median follow-up was 36 months (range 15–62); 22 patients relapsed and 7 died. Results: Thirty-four of the 109 patients (31.1%) had MoAb positive bone marrow cells. The bone marrow was positive in 28/74 (37.9%) patients who had the aspirate taken during surgery and in 6/35 (17.1%) who had it taken after surgery (p = 0.055). No association was found between bone marrow positivity and tumour size, nodal status, menopausal status, estrogen receptor positivity or the proliferative index. No association was found between bone marrow and prognosis: the log-rank test was 0.291 (p > 0.5) for OS and 0.023 for DFS; the hazard ratio (positive vs negative) was 1.51 for OS (95% CI: 0.33–6.86) and 0.93 for DFS (95% CI: 0.35–2.45). Conclusions: In our series, bone marrow positivity did not correlate with prognostic parameters or prognosis. Of interest is the relative excess of positivity when the bone marrow was obtained during surgery.  相似文献   

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