202例乳腺癌患者营养状况调查

目的调查乳腺肿瘤患者营养现状,为规范肿瘤患者的营养治疗提供依据。方法采用定点连续取样方法,调查2011年4月至6月间入院的202例乳腺癌患者,采用NRS-2002进行营养风险筛查;采用体质指数、化验指标、消化道症状等进行全面的营养状况评估,分析营养状况和常见化疗不良反应发生率的关系。结果乳腺癌患者营养不足2例(1.0%),营养风险12例(5.9%),超重101例(50.0%),向心性肥胖80例(39.6%),体重增加26例(12.8%);三酰甘油>1.7mmol/L64例(31.7%),白细胞<4.0×109/L 42例(20.8%),胆固醇>5.68 mmol/L 40例(19.8%),血红蛋白<110g/L 33例(16.3%),空腹葡萄糖>6.1mmol/L 19例(9.4%),淋巴细胞百分率<20%19例(9.4%);便秘29例(14.3%)。有营养风险与无营养风险的乳腺癌患者,白细胞低的发生率比较,差异无统计学意义(P=0.14)。结论乳腺癌患者营养风险发生率较低,而肥胖及营养过剩的比例较高,高脂血症及便秘发生率较高,提示乳腺癌患者应注意平衡膳食,合理控制体重。     

癌症放疗患者营养状况分析及评价

目的分析接受放疗的肿瘤患者营养状况、营养素摄入及膳食结构。方法采用膳食回顾法和称量法相结合的方法,对120例患者进行了营养素摄入量及膳食结构调查;通过体格测量及血液中血红蛋白(HB)、血清白蛋白(Alb)和总淋巴细胞(totallymphocytecount,TLC)等生化指标分析了解患者营养状况。结果放疗患者热能摄入不足,平均为5862kJ(1400kcal),占参考摄入量(dietaryrecommendedintakes,DRIs)的76%;蛋白质和碳水化合物来源不足,脂肪摄入过高,占DRIs的123%;Ca、Fe、Zn、维生素A和维生素B1摄入不足。膳食结构中存在谷类、水产品和豆制品摄入较少的问题。贫血患病率为40%左右,消瘦[体质指数(bodymassindex,BMI)<18.5]比例为23%。结论癌症放疗患者肥胖与消瘦并存,蛋白质储备及碳水化合物摄入不足,脂肪摄入过高,膳食结构需要调整。     

中晚期肿瘤患者的营养状况研究

目的：运用营养评估的方法,探究中晚期肿瘤患者的营养状况及评定的意义,并对不同的指标进行比较。方法：对９９例初诊的中晚期肿瘤患者进行身高、体重、血清白蛋白、转铁蛋白、前白蛋白、淋巴细胞总数的测定,对患者营养状况作客观的综合评价。结果：９９例肿瘤患者中营养不良有６９例,发生率为６９．７％。其中２４例为消瘦型营养不良,１５例为蛋白质营养不良,３０例为混合型营养不良。结论：肿瘤患者合并不同程度的营养不良的     

血清瘦素与肺癌患者营养状况相关性分析

[目的]探讨肺癌患者营养状况与肥胖基因表达产物瘦素的相关性。[方法]采用放射免疫分析法测定165例肺癌患者血清瘦素含量,同时测定身高、体重、疾病分期、体力状况(ECOG),根据体重指数(BMI)将肺癌患者分为营养正常、不良和肥胖,并比较血清瘦素与营养状况的相关性。[结果]肺癌患者营养不良组的血清瘦素平均含量明显低于营养正常组或肥胖组。男性肺癌患者营养不良、营养正常及肥胖组血清瘦素水平分别为(2.01±1.14)μg/L、(5.06±5.97)μg/L、(8.26±3.86)μg/L;女性则分别为(8.76±11.11)μg/L、(9.64±5.85)μg/L、(16.65±6.34)μg/L。全组男性、女性肺癌患者的血清瘦素水平分别为(4.73±3.19)μg/L、(11.98±7.47)μg/L;女性均值高于男性近3倍。肺癌患者的血清瘦素水平与BMI显著相关(男性r=0.663,P<0.05;女性r=0.716,P<0.05)。BMI正常的肺癌患者的血清瘦素与健康人无差异。[结论]血清瘦素含量可以反映肺癌患者的BMI变化和营养状况,且可作为判断肺癌患者营养状况的指标。     

恶性肿瘤患者营养状况及相关影响因素分析

目的:探讨恶性肿瘤患者营养状况及其相关影响因素。方法:选择在院恶性肿瘤患者210例,运用患者自评营养状况主观评估表（PG-SGA）作为病人营养状况筛查工具判断其营养状况,并探讨其相关影响因素。对纳入患者逐一进行面对面问卷调查,采用SPSS 18.0软件进行数据分析。结果:营养不良情况在恶性肿瘤患者中发生率高达73.8%;单因素分析显示性别、年龄、体重丢失、合并症、肿瘤类型、肿瘤分期、消化道毒副反应、疼痛分级、睡眠对营养评分有影响,差异均有统计学意义(P<0.05)。治疗方案、陪护、医保类型、经济状况4个因素对营养评分无影响,差异无统计学意义(P>0.05)。将单因素分析对营养评分有影响的因素进行二元logistics回归分析,男性、年龄＞65岁、消化道肿瘤、体重丢失多、疼痛评分高和睡眠时间＜6 h的患者更容易发生营养不良,差异有统计学意义(P<0.05)。结论:营养不良在恶性肿瘤患者中普遍存在;男性、年龄＞65岁、消化道肿瘤、体重丢失多、疼痛评分高和睡眠时间＜6 h的患者更容易发生营养不良。     

新疆乌鲁木齐市某三甲医院1701例乳腺癌患者流行病学分析

目的 回顾性分析2010-2019年新疆乌鲁木齐市某三甲医院1701例乳腺癌病例的流行病学变化趋势,为新疆省乳腺癌的防治及研究工作提供一定的参考依据。方法 收集新疆省乌鲁木齐市某三甲医院10年间收治的经病理证实的1701例乳腺癌患者的临床病理资料,进行整理分析。结果 1701例患者中,女性1686例(99.12%),男性15例(0.88%),中位年龄(48.95±6.31)岁,45～55岁患者占比最高。乳腺癌患者中汉族1140例(67.02%),维吾尔族371例(21.8%);哈萨克族58例(3.41%),回族70例(4.12%),蒙古族22例(1.3%),其他民族40例(2.35%);浸润性导管癌1256例(78.84%)为主要的病理类型,Ⅰ期患者656例(38.57%),Ⅱ期患者540例(31.74%),大部分患者为中早期乳腺癌。结论 近10年,乳腺癌发病率呈上升趋势;45～55岁年龄段的妇女罹患乳腺癌的风险较大,需加大健康宣教及体检筛查力度;早期癌构成比上升,说明全民体检工作初见成效。     

中晚期肿瘤患者的营养状况研究

目的 :运用营养评估的方法 ,探究中晚期肿瘤患者的营养状况及评定的意义 ,并对不同的指标进行比较。方法 :对 99例初诊的中晚期肿瘤患者进行身高、体重、血清白蛋白、转铁蛋白、前白蛋白、淋巴细胞总数的测定 ,对患者营养状况作客观的综合评价。结果 :99例肿瘤患者中营养不良有 69例 ,发生率为 69 7%。其中 2 4例为消瘦型营养不良 ,15例为蛋白质营养不良 ,30例为混合型营养不良。结论 :肿瘤患者合并不同程度的营养不良的发生率高 ,营养不良与疾病预后有关。在各项血清学指标中 ,前白蛋白最为敏感     

恶性肿瘤患者营养状况评估的研究进展

恶性肿瘤患者营养风险及营养不足是因机体营养需求同代谢失衡所致,其机制为微观生物、患者临床特征及治疗的影响三个方面。目前已有许多公认的营养风险筛查与营养状况评估方法,如PG-SGA、NRS2002等,这些方法的应用更证实了恶性肿瘤患者的营养问题发生率高,而营养支持率普遍偏低。营养不良及营养风险的发生对预后及临床结局产生负面影响已被肯定,及时评估并了解患者的营养状况也就显得格外重要。     

乳腺癌骨转移患者生存分析

目的 提高对乳腺癌骨转移患者预后影-向因素的进一步认识，指导临床个体化治疗。方法 回顾分析有完整病例资料的乳腺癌骨转移患者68例。结果 68例患者的中位生存期20个月，乳腺癌骨转移合并肝脏和/或肺转移同时存在时，患者的中位生存期13．5个月；乳腺癌骨转移不合并肝脏和/或肺转移患者的中位生存期为26个月；仅有骨转移而不合并其他脏器转移的患者的平均生存时间为44.2个月。结论 乳腺癌转移患者中肝脏和/或肺转移是预后不良指标。骨转移而不合并其他转移的患者生存期较长，其次是骨转移合并肺转移者、合并淋巴结转移、骨转移合并多个脏器转移者及合并肝脏转移者。     

Menopause: a problem for breast cancer patients

Many women who are treated for breast cancer will subsequently undergo the menopause, either as a result of cancer treatment or as a natural process. For this group of women hormone replacement therapy is currently not recommended and so women lose a major option to help control menopausal symptoms. The extent of this problem has not been widely researched and alternative methods of coping with menopause in this group have not been explored. This paper reviews the menopause in relation to these women and suggests avenues for future research.     

Cathepsin-D in primary breast cancer: prognostic evaluation involving 2810 patients

There is controversy regarding the prognostic value of cathepsin-D in primary breast cancer. An increased level of cathepsin-D in tumour extracts has been found to be associated with a poor relapse-free and overall survival. Studies performed with immunohistochemistry or Western blotting have produced diverse results. We have analysed 2810 cytosolic extracts obtained from human primary breast tumours for cathepsin-D expression, and have correlated their levels with prognosis. The median follow-up of the patients still alive was 88 months. Patients with high cathepsin-D levels had a significantly worse relapse-free and overall survival, also in multivariate analysis (P < 0.0001). Adjuvant therapy which was associated with an improved prognosis in node-positive patients in univariate analysis, also significantly added to the multivariate models for relapse-free and overall survival. There were no statistically significant interactions between the levels of cathepsin-D and any of the classical prognostic factors in analysis for relapse-free survival, suggesting that the prognostic value of cathepsin-D is not different in the various subgroups of patients. Indeed, multivariate analyses in subgroups of node-negative and -positive patients, pre- and post-menopausal patients, and their combinations, showed that tumours with high cathepsin-D values had a significantly poor relapse-free survival, with relative hazard rates ranging from 1.3 to 1.5, compared with tumours with low cathepsin-D levels. The results presented here on 2810 patients confirm that high cytosolic cathepsin-D values are associated with poor prognosis in human primary breast cancer. © 1999 Cancer Research Campaign     

Chemotherapy and pattern of metastases in breast cancer patients

A retrospective analysis of all breast cancer patients who died of their disease at Harper Grace Hospital during 1962 to 1976, was conducted to determine the pattern of metastases and its relation to chemotherapy. The autopsy incidence of distant metastases, to all organ sites, was noted to be higher among patients who previously received cytotoxic therapy, compared with those who did not. Such incidence was unrelated to differences in patients' age, menopausal status, and disease-free interval. It is postulated that chemotherapy contributes to the wider metastases, especially to the central nervous system and meninges, in a breast cancer patient. This is possibly due to a longer survival of patients treated.     

Partial breast irradiation versus whole breast radiotherapy for early-stage breast cancer: a decision analysis

PURPOSE: To compare the quality-adjusted life expectancy between women treated with partial breast irradiation (PBI) vs. whole breast radiotherapy (WBRT) for estrogen receptor-positive early-stage breast cancer. METHODS AND MATERIALS: We developed a Markov model to describe health states in the 15 years after radiotherapy for estrogen receptor-positive early-stage breast cancer. Breast cancer recurrences were separated into local recurrences and elsewhere failures. Ipsilateral breast tumor recurrence (IBTR) risk was extracted from the Oxford overview, and rates and utilities were adapted from the literature. We studied two cohorts of women (aged 40 and 55 years), both of whom received adjuvant tamoxifen. RESULTS: Assuming a no evidence of disease (NED)-PBI utility of 0.93, quality-adjusted life expectancy after PBI (and WBRT) was 12.61 (12.57) and 12.10 (12.06) years for 40-year-old and 55-year-old women, respectively. The NED-PBI utility thresholds for preferring PBI over WBRT were 0.923 and 0.921 for 40-year-old and 55-year-old women, respectively, both slightly greater than the NED-WBRT utility. Outcomes were sensitive to the utility of NED-PBI, the PBI hazard ratio for local recurrence, the baseline IBTR risk, and the percentage of IBTRs that were local. Overall the degree of superiority of PBI over WBRT was greater for 55-year-old women than for 40-year-old women. CONCLUSIONS: For most utility values of the NED-PBI health state, PBI was the preferred treatment modality. This result was highly sensitive to patient preferences and was also dependent on patient age, PBI efficacy, IBTR risk, and the fraction of IBTRs that were local.     

湿疹样乳腺癌85例临床分析

目的探讨湿疹样乳腺癌的临床特点、诊治方法及预后因素,提高对湿疹样乳腺癌的认识。方法回顾性分析作者在韩国首尔峨山医院进修进时收集的85例湿疹样乳腺癌患者的临床资料。结果共入组85例患者,女性83例,男性2例。乳腺有湿疹样表现79例（92．9％）,伴乳腺肿块52例（61．2％）,同侧腋窝淋巴结转移27例（占本组85例的31．8％及伴乳腺肿块病例的51．9％）,均为伴有乳腺肿块的病例。52例行乳癌改良根治术,30例行乳腺单纯切除术,3例行局部切除术。单纯乳头及乳晕湿疹样乳腺癌11例（12．9％）,均为无乳腺肿块的病例,其余74例（87．1％）均合并其他类型的乳腺癌。本组5年生存率为82．1％,其中无乳腺肿块者5年生存率为93．9％,合并肿块者5年生存率为75．0％（P〈0．05）,无同侧腋窝淋巴结转移者5年率为96．6％,有转移者5年生存率为51．9％（P〈0．01）。结论湿疹样乳腺癌有特殊的临床表现,但易误诊,病灶细胞学和病理学检查可以确诊,伴乳腺肿块者应选择乳癌改良根治术,无乳腺肿块者可选择乳腺单纯切除术,预后与乳腺肿块及同侧腋窝淋巴结转移密切相关。     

Evaluation of lymphocyte immunity in breast cancer patients

Summary One hundred forty-two breast cancer patients were evaluated for three functional immunologic parameters: the ability of their lymphocytes to proliferate in response to general T-(phytohemagglutinin) and B-lymphocyte (pokeweed mitogen) stimulators and their ability to proliferate in response to specific autologous tumor antigens. Tests were performed on patient blood specimens collected approximately 2 hours prior to surgery or 2–4 weeks following chemotherapy. T-lymphocyte functional competence was impaired in 83/142 (58%) of the patients, while B-lymphocyte competence was impaired in 34/142 (24%) of these patients. A total of 21/52 (40%) of the patients had lymphocyte immunity against autologous tumor antigen. There were weak associations between the ability of patients' T- and B-lymphocytes to function normally, and their ability to respond to autologous tumor-antigen. There was no relationship of age, tumor burden (clinical or pathological tumor size), extension to skin and/or muscle, or metastasis to any of the three immunological parameters. A relationship (p = 0.0463) between T-lymphocyte competence and pathological nodal status was observed; individuals that were node positive for disease, tended to have impaired T-lymphocyte function. When evaluating T- and B-lymphocyte competence and lymphocytic immunity against tumor antigen in pre- and post-chemotherapy patients, an immunologic rebound (increase in immune parameters shortly after completion of chemotherapy) was observed in some patients. These results demonstrate the utility of measuring these immune parameters in breast cancer patients, their relevance to the natural biology of the disease, and the influence that chemotherapy may have on host immune function.     

The impact of bilateral breast cancer on the prognosis of breast cancer: a comparative study with unilateral breast cancer

BACKGROUND: The clinical significance of bilateral breast cancer is unclear and its influence on prognosis is controversial. We assessed the impact of synchronous and metachronous bilateral breast cancer on the prognosis compared with unilateral breast cancer. METHODS: Between January 1, 1960 and December 31, 2001, 1,214 women were treated for primary operable breast cancers. Thirteen (1.1%) had synchronous bilateral breast cancer; 33 (2.7%) had a metachronous contralateral breast cancer. We compared age at operation, menopausal status, clinical stage, tumor size and histology, lymph node status, hormone receptor status, and use of adjuvant chemotherapy or hormone therapy, and we analyzed the impact of these factors on recurrence and survival in the 46 patients with bilateral breast cancer and the 1,168 patients with unilateral breast cancer. RESULTS: The 5-and 10-year disease-free survival rates, respectively, were 65% and 65% in metachronous cases, 85.7% and 64.3% in synchronous cases, and 77.9% and 72.1% in unilateral cases. There was no significant difference in overall survival among the three groups. On multivariate analysis, metachronous bilaterality, tumor size, lymph node status and adjuvant hormone therapy were each independent risk factors for recurrence, whereas bilaterality of breast cancer did not influence overall survival. CONCLUSIONS: Our data suggest that metachronous bilateral breast cancer is associated with shorter disease-free survival than synchronous bilateral or unilateral breast cancer, although overall survival does not differ among the 3 groups. Patients with metachronous bilateral breast cancer should be followed particularly closely in order to detect recurrence early and maximize quality of life.     

Plasma sialyltransferase in patients with breast cancer

Sialyltransferase enzyme levels (Sialtx), CEA, and 10 standard laboratory tests were studied in 50 patients with treated, recurrent, or disseminated breast carcinoma. All groups of patients had elevated mean Sialtx activity (CPM/mg protein) as compared with normal controls. Sialtx levels (expressed as % of normal controls) of patients with disseminated lesions were significantly elevated as compared to patients without evidence of disease or with only soft tissue recurrences, whereas CEA and alkaline phosphatase levels were significantly elevated (peripheral blood lymphocyte count, total protein and albumin levels significantly decreased) in patients with recurrent disease of all sites. Among patients with disseminated breast cancer and normal CEA levels, about 50% had markedly elevated Sialtx activities. From our limited experience, it appears that Sialtx study is of value when CEA failed to indicate the presence of breast malignancy. Further testing including serial studies should be done to better define its clinical usefulness.     

Biochemical evaluation of patients with breast cancer

Peripheral blood specimens were obtained from 50 patients with various stages of breast cancer (I-II = 7, III = 6, IV = 24, treated and NED = 13), and 20 biochemical tests were performed. There are significant differences of hemoglobin, LDH, SGPT, serum protein, albumin, and alpha globulin values between patients with early (I, II, NED) and late (III, IV) lesions. Among patients with stage IV diseases, those patients with bony metastases had significantly higher values of alkaline phosphatase, alpha-1 globulin, IgA, and C-reactive protein than those with nonosseous lesions. Neither CEA nor pregnancy-associated alpha-2 glycoprotein showed any correlation with different stages or sites of breast cancer in these small series of patients.