复发性乳腺癌预后分析

根据４０２例乳腺癌术后复发患者的临床回顾性分析的资料，探讨影响乳腺癌术后复发转移的预后因素及其改善疗效的途径。分析结果表明，６０％的乳腺癌复发患者在复发后２年内死亡。乳腺癌复发患者复发后的２年生存率与患者的年龄、月经状况、雌激素受体与孕酮受体状况、手术方式、预防或治疗性去势无关，与首发部位、原发肿瘤分期、肿瘤大小、手术时淋巴结转移数、复发后治疗情况及无复发间期长短有关。文章指出重视手术操作，合理安排术后治疗及加强术后患者的随诊，力求改善疗效。     

Mammography Surveillance Following Breast Cancer

Background. To describe when women diagnosed with breast cancer return for their first mammography, and to identify factors predictive of women returning for mammographic surveillance. Methods. Women who underwent mammography at facilities participating in the National Cancer Institute's Breast Cancer Surveillance Consortium (BCSC) during 1996 and who were subsequently diagnosed with ductal carcinoma in situ or invasive breast cancer were included in this study. Data from seven mammography registries were linked to population-based cancer and pathology registries. Kaplan–Meier curves were used to depict the number of months from the breast cancer diagnosis to the first mammogram within the defined follow-up period. Demographic, disease and treatment variables were included in univariate and multivariate analyses to identify factors predictive of women returning for mammography. Results. Of the 2503 women diagnosed with breast cancer, 78.1% returned for mammography examination between 7 and 30 months following the diagnosis. Mammography facilities indicated that 66.8% of mammography examinations were classified as screening. Multivariate analyses found that women were most likely to undergo surveillance mammography if they were diagnosed at ages 60–69 with Stage 0, I or II breast cancer and had received radiation therapy in addition to surgery. Conclusions. While the majority of women return for mammographic surveillance following breast cancer, some important subgroups of women at higher risk for recurrence are less likely to return. Research is needed to determine why some women are not undergoing mammography surveillance after a breast cancer diagnosis and whether surveillance increases the chance of detecting tumors with a good prognosis.     

乳腺癌胸壁复发的后装敷贴近距离放射治疗

目的 探讨乳腺癌胸壁敷贴近距离放射治疗的临床价值.方法 采用胸壁敷贴近距离放射治疗乳腺癌胸壁大面积复发且经化疗及内分泌治疗后效果欠佳的患者30例.外照射总剂量为DT 50Gy/25次,5周,然后再用胸壁后装敷贴近距离放射治疗DT 20～30 Gy,每次250 cGy,2次/d.部分单纯后装敷贴近距离放射治疗,每次250 cGy,2次/d,DT 30～40 Gy.结果 CR 20例,PR 5例,NC 3例,PD 2例,有效率83.33%(25/30).1年生存率52%、2和3年生存率26%.局部达全部消退的生存优于残留和进展(x2=4.35,P＜0.05).复发距第1次放疗间隔时间、首次原病灶分期、照射总量与敷贴后生存无明显关系.未发现严重毒副反应.结论 敷贴近距离放射治疗乳腺癌胸壁大面积复发是一种局控率高,无严重毒副反应的有效方法.     

56例乳腺癌术后胸壁复发放射治疗价值

１９８０年至１９９０年间，我院对５６例有病理证实的乳腺癌术后胸壁复发患者进行了放疗，放疗后病灶完全消失３０例，残存２０例，６例无变化或恶化。１、３、５年生存率分别为８７．５％、５８、９％、２６．８％。手术组与术后放疗组５年生存率无明显差异（２９．０％与２４．０％），作者统计，术后腋淋巴结转移数目与胸壁复发有直接关系，乳腺癌术后腋淋巴结阳性数目递增，胸壁复发率随之增高。而乳癌术后放疗有可能延迟复发时间，故绝经前妇女、雌激素受体阳性及腋下淋巴结阳性患者，不仅要进行内分泌治疗而且要进行胸壁和区域淋巴引流区放疗，对术后胸壁复发患者，应积极行放射治疗，复发灶放疗剂量以５０Ｇｙ～７０Ｇｙ为宜。     

乳腺癌术后胸壁及区域淋巴结复发的治疗

本文对我科1985年6月至1988年6月收治的52例乳腺癌术后复发病例进行了分析。全部病例均完成了放射治疗，其中39例与化疗联合。全组病例局部控制率为59．6％，1年及2年生存率分别为80．8％和51.9%，本文结果提示，单纯胸壁复发的病例，预后明显好于胸壁及区域淋巴结同时复发的病例（P＜0．05)，与化疗联合对局部控制率无影响，但能显著提高长期生存率（P＜O．01）。     

Analysis of 6 Cases of Stromal Sarcoma of the Breast

OBJECTIVE To investigate the clinical and pathological characteristics,diagnosis and treatment of stromal sarcoma of the breast(SSB).Methods:The clinical and pathological data of 6 patients with SSB treated between 1954 and 2007 were retrospectively analyzed.METHODS The clinical and pathological data of 6 patients with SSB treated between 1954 and 2007 were retrospectively analyzed.RESULtS Atl patients were female and one was menopausal.The median age of the patients was 39 years old(range,20-55).All cases had a history of a palpable mass.The tumor rapidly augmented in a short time period in 3 patients.One patient had discontinuous pain and 3 patients had masses located in the upper outer quadrant of the breast.The median tumor radius was 6.0 cm(range,3-15 cm).According to the AJCC breast cancer staging standard(6th edition),1 case was of stage ⅡA,2 cases were of stage ⅡB,2 cases were of stage ⅢB and one case couldn't be staged.Four patients were initially treated by excising the tumor and then undergoing mastectomy or modified radical mastectomy after recurrence.Radical mastectomy was suitable for those with pectoralis major muscle involvement.Two patients received simple mastectomy, 2 patients underwent radical mastectomy and another 2 patients received modified radical mastectomy,After surgery,all patients were identified as SSB through pathology,with focal ossification in one case and mucinous degeneration in another one case.Four patients who underwent axillary Iymph node dissection did not have lymph node metastases.Three patients received chemotherapy after surgery. After a median follow-up time of 36.5 months(8-204 months),4 patients had recurrence after local excision and 3 patients had recurrence more than 2 times with a median time to recurrence of 2.5 months(1to 4 months) after surgery.One patient had lung metastases at 7months after the initial surgery and the other 5 patients were alive without disease at the end of the follow-up period.CONCLUSION SSB is difficult to diagnose preoperatively and is characterized by its tendency to recur locally.To obtain negative margins,wide local excision or mastectomy must be performed.Axillary lymph node dissection is not mandatory.The roles of adjuvant chemotherapy and radiotherapy have still been controversial.     

Prognostic and Predictive Factors of Early Breast Cancer

OBJECTIVE To identify risk factors for relapse and death in patients with T1 to T2 breast cancer with 0-3 positive axillary lymph nodes.METHODS The case files of 540 breast cancer patients with T1-T2 tumors with 0-3 positive nodes were reviewed retrospectively. Ten-year locoregional recurrence (LRR), distant recurrence (DR), disease-free survival (DFS) and overall survival (OS) of the patients were analyzed. Univariate statistical analysis and Cox proportional hazards models were carried out with SPSS so ware v.16.0.RESULTS The median follow-up of all the patients was 7.2 years. On multivariate analysis, > 20% positive axillary nodes was the only variable that influenced LRR adversely (hazard ratio[HR], 12.816; 95% confidence interval, 4.657-35.266, P < 0.001); > 20% positive axillary nodes and ductal carcinoma were variables that influenced DR adversely (HR, 11.088, 95% confidence interval, 3.807-32.297, P < 0.001; HR, 0.390, 95% confidence interval, 0.179-0.851, P = 0.018); 1-3 positive axillary nodes and > 20% positive axillary nodes were the only variables that had negative e. ect on 10-year OS (HR, 2.110, 95% confi dence interval, 1.364-3.264, P = 0.001; HR, 10.244, 95% confidence interval, 3.497-30.011, P < 0.001) and they were also adverse prognostic variables on 10-year DFS (HR, 1.634, 95% confidence interval, 1.171-2.279, P = 0.004; HR, 7.339, 95% confi dence interval,2.906-18.530, P < 0.001).CONCLUSION Axillary lymph nodal status is the only risk factor with a signifi cant impact on 10-year LRR, DR, OS and DFS.Patients with T1-T2 breast cancer with 0-3 positive lymph nodes have the LRR and DR of over 10 years, and the OS and DFS of less than 10 years, compared to patients with negative lymph nodes.Histology in primary tumors is a signifi cant prognostic factor for the 10-year DR.     

生长抑素受体在复发和转移性乳腺癌组织中的表达及意义

目的 探讨生长抑素受体(SSTR)在复发和转移性乳腺癌组织中的表达及意义.方法 采用免疫组化法检测86例复发和转移性乳腺癌切除转移病灶、转移灶旁组织和正常组织中的SSTR,比较分析3组表达情况;同时将检测结果与这86例患者第1次术后的SSTR表达情况进行比较.结果 局部复发癌组织、转移淋巴结组织中SSTR的阳性表达率分...     

乳腺癌术后放疗对局部复发的影响

目的 :评价乳腺癌术后放疗的作用。方法 :选择 117例根治术后乳腺癌患者 ,用 χ2 检验比较 3年局部复发率。结果 :全组 3年局部复发率 12 8% ,无内乳、腋窝复发患者。胸壁复发占局部复发的80 % (12 15 )。无腋窝淋巴结转移 ,但乳腺肿块位于内象限、中央区或腋窝淋巴结转移 1～ 3个的 80例中 ,3年局部复发率为 8 75 % ,对于接受或未接受术后放疗患者分别为 10 3%、7 3% ,差异无显著性 (P>0 0 5 )。对于乳腺肿块 <5cm或≥ 5cm患者分别为 3 17%、2 9 4 1% ,差异有显著性 (P =0 0 0 4 )。结论 :无腋窝淋巴结转移但乳腺肿块位于内象限、中央区或腋窝淋巴结转移 1～ 3个可不作为术后常规术后放疗指征 ,但此种情况下若乳腺肿块≥ 5cm ,或腋窝淋巴结转移≥ 4个 ,尤其当腋窝淋巴结转移 >10个时 ,应该进行包括胸壁照射在内的术后放疗。     

Breast cancer subtype approximations and loco-regional recurrence after immediate breast reconstruction

Background

A small but significant proportion of patients with breast cancer (BC) will develop loco-regional recurrence (LRR) after immediate breast reconstruction (IBR). The LRR also varies according to breast cancer subtypes and clinicopathological features.

Methods

We studied 1742 consecutive BC patients with IBR between 1997 and 2006. According to St Gallen conference consensus 2011, its BC approximations were applied to classify BC into five subtypes: estrogen receptor (ER) and/or progesterone receptor (PgR) positive, HER2 negative, and low Ki67 (<14%) [luminal A]; ER and/or PgR positive, HER2 negative and high Ki67(≥14%) [luminal B/HER2 negative]; ER and/or PgR positive, any Ki67 and HER2 positive [luminal B/HER2 positive]; ER negative, PgR negative and HER2 positive [HER2 positive/nonluminal]; and ER negative, PgR negative and HER2 negative [triple negative]. Cumulative incidences of LRR were compared across different subgroups by means of the Gray test. Multivariable Cox regression models were applied.

Results

Median follow up time was 74 months (range 3–165). The cumulative incidence of LRR was 5.5% (121 events). The 5-year cumulative incidence of LRR was 2.5% for luminal A; 5.0% for luminal B/HER2 negative; 9.8% for luminal B/HER2 positive; 3.8% for HER2 non luminal; and 10.9% for triple negative. On multivariable analysis, tumor size (pT) >2 cm, body mass index (BMI) ≥25, triple negative and luminal B/HER2 positive subtypes were associated with increased risk of LRR.

Conclusion

Luminal B/HER2 positive, triple negative subtypes and BMI ≥25 are independent prognostic factors for risk of LRR after IBR.     

乳腺叶状肿瘤17例诊治分析

[目的]总结乳腺叶状肿瘤的诊治情况。[方法]回顾分析17例经病理证实乳腺叶状肿瘤的临床资料。[结果]17例中良性11例,交界性3例,恶性3例。行乳腺肿瘤局部切除3例,乳腺肿瘤扩大切除7例,乳房切除术4例,乳房改良根治术3例,3例乳腺肿瘤术后出现复发。[结论]乳腺叶状肿瘤术前诊断较困难,主要依靠组织学检查,其局部复发与是否手术彻底切除密切相关。     

可手术乳腺癌内分泌受体状态对预测近期复发的意义

目的为了调查可手术乳腺癌病人术后近期复发与内分泌受体状态的相关性。材料和方法对1985-1988年间76例Ⅰ、Ⅱ期乳腺癌改良根治手术病人进行专人调查，注重询问术后36个月内的近期复发病人，探讨复发和未复发病例的雌激素受体（ER）和孕酮受体（PR）的状态。结果确认16例术后36个月内出现复发，近期复发率为21％（16／76）。16例复发的ER、PR同时呈（＋）和（-）的比率分别为29％和57％；而60例未复发的ER、PR同时呈（＋）和（-）的比率分别为50％和40％；两组之间具有显著差异（P＜0.01）。在复发组中单独PR呈（＋）和（-）的比率分别为36％和64％；而未复发组单独PR呈（＋）和（-）的比率分别为51．9％和48．1％，两组之间也具有显著差异（P＜0．05）。结论表明可手术乳腺癌内分泌状态ER、PR同时呈（-）病人较其同时呈（ ）者抑或单独PR呈（-）者具有近期易复发倾向，其预后更劣。因而作者认为PR状态是另一个主要的预后因素。提议：应把PR（-）肿瘤病人列入高危人群，并作为术后3年内定期复诊主要对象之一。     

Breast conserving surgery for invasive breast cancer: Risk factors for ipsilateral breast tumor recurrences

To identify risk factors associated with an increasedrisk for ipsilateral breast tumor recurrence following breast-conservingsurgery, a cohort of 759 women with T₁–T₂tumors were studied. The majority of the patients(88%) had received postoperative radiation therapy to thebreast. Median follow-up time was 10 (range: 6–17)years. There was a 1–1.5% yearly increase inipsilateral breast tumor recurrences. For women < 50ys the cumulative recurrence rate at 10 yearswas 18% and for women 50 ys,9%. Node positive women had a cumulative breastrecurrence rate of 25% versus 10% for nodenegative women. Ten years postoperatively, irradiated patients hada cumulative recurrence rate of 11% versus 26%when no irradiation was given. The beneficial effectof radiotherapy was substantial during the first fourpostoperative years. The relative risk for an ipsilateralbreast tumor recurrence during this period was 4.5times higher than for non irradiated patients. However,the protective effect of radiotherapy decreased with time.After ten years the relative risk of ipsilateralbreast tumor recurrence was the same among irradiatedand non-irradiated patients although the number of eventsduring this period was low.Univariate analysis showed that seven factors were significantlyassociated with an increased risk of ipsilateral breasttumor recurrence, namely age < 50 ys, increasingtumor size, uncertain microscopic margins, axillary lymph nodemetastases, no postoperative tamoxifen treatment, premenopausal status, andno postoperative radiotherapy. Three factors remained independently significantafter multivariate analysis: age < 50 ys,no postoperative radiation therapy, and positive lymph nodes.In conclusion, radiotherapy reduced the breast recurrence rate,but the effect decreased with time. Node-negative women 50 were a low risk-group for ipsilateralbreast tumor recurrence, with a cumulative risk at10 years of 9% without radiation therapy and5% with breast irradiation.     

Breast cancer: molecular mechanisms of underlying resistance and therapeutic approaches

Breast cancer (BC) affects over 250,000 women in the US each year. Drug-resistant cancer cells are responsible for most breast cancer fatalities. Scientists are developing novel chemotherapeutic drugs and targeted therapy combinations to overcome cancer cell resistance. Combining drugs can reduce the chances of a tumor developing resistance to treatment. Clinical research has shown that combination chemotherapy enhances or improves survival, depending on the patient’s response to treatment. Combination therapy is a highly successful supplemental cancer treatment. This review sheds light on intrinsic resistance to BC drugs and the importance of combination therapy for BC treatment. In addition to recurrence and metastasis of BC, the article discussed biomarkers for BC.     

乳腺癌Oncotype DX检测研究进展

Oncotype DX可以进行21基因检测,计算复发分数(recurrence score,RS),预测雌激素受体(ER)阳性的早期乳腺癌患者的10年复发率,进一步为患者制定治疗方案,规避过度治疗与复发的风险.全文将Oncotype DX的临床试验结果,与其他基因检测方式进行比较,在淋巴结阳性患者、BRCA1和BRCA2突变患者、中危组患者以及亚洲患者中的应用等方面进行综述分析-讨论其实践成果、研究热点及前景展望,为乳腺癌个体化治疗提供参考.     

年龄与乳腺癌患者保乳术后局部复发风险的Meta分析

[目的]使用Meta分析方法分析年龄与乳腺癌患者保乳术后局部复发的关系。[方法]检索关于年龄与乳腺癌保乳术后具有复发关系的文献,采用Meta分析。[结果]共有5篇文献符合纳入标准,乳腺癌保乳术后患者5188例,其中＂年轻＂患者380例,＂年老＂患者4808例。Meta分析显示相对于＂年老＂患者,＂年轻＂患者术后局部复发风险增加（OR=3.73,95%CI：1.64～8.49）。以40岁为界限,≤40岁组术后局部复发风险增加（OR=4.10,95%CI：1.55～10.85）。[结论]＂年轻＂乳腺癌患者保乳术后局部复发风险增高,≤40岁患者局部复发明显高于〉40岁患者。     

A Comparison of the Biological and Clinical Features of Invasive Lobular and Ductal Carcinomas of the Breast

Altogether 295 consecutive pure lobular invasive breast cancers diagnosed between 1990 and 1999 in the area of Tampere University Hospital were compared to 295 ductal invasive breast cancers. Biological factors, DFS, OS, recurrence types, survival after recurrence and other primary cancers were analyzed. ILC tumors were more often hormone receptor-positive, slowly proliferative and Erbb-2-negative. During the mean follow-up time of 5.1 years 76 recurrences in both groups were discovered. During the whole follow-up time there was more metastation to gynecological organs and GI tract in the ILC group. Bilateral breast cancers did not differ between the groups. DFS and OS were the same between the groups despite the fact that ILC patients received statistically significantly less adjuvant treatment. In conclusion, since ILC cancers are more often hormone receptor-positive, there is a good option to adjuvant endocrine therapy with present and future preparations, this possibly leading to improvement in OS.     

乳腺癌患者术后长期随访服务利用情况及 效果分析

 目的了解乳腺癌患者术后长期随访服务利用情况及效果,为制订中国女性乳腺癌随访策略提供依据 。方法应用系统抽样方法从1996年—2000年住院的5987例患者抽取1197名患者,分析资料齐全的1 086名 乳腺癌患者术后5年内参加随访检查情况和效果。结果追踪满5年的847名乳腺癌患者中,只有34名（4.0% ）患者接受了14次及以上的术后随访复查,131名（15.5%）患者在术后5年内无任何随访服务利用记录。 38.3%（18/47）的局部复发或对侧转移和22.0%（18/82）的远端转移是在定期随访中发现的。结论乳腺癌 患者术后随访服务的利用率相对低,而随访检查的效果亦有待深入研究。