乳腺癌中survivin表达的预后价值

目的：研究凋亡抑制基因survivin在乳腺癌中表达的预后价值。方法：采用免疫组化SP法检测180例乳腺癌石蜡标本中survivin表达情况,并对survivin表达与乳腺癌的临床分期、雌激素受体表达、月经状况、腋淋巴结转移、病理类型、无病生存时间以及总生存时间的关系进行了分析。结果：Survivin在乳腺癌中的阳性表达率为66.1%,survivin的表达与乳腺癌的临床分期、雌激素受体、月经状况、腋淋巴结是否转移及病理类型无关（P〉0.05）;单因素分析结果表明survivin表达与乳腺癌病人的无病生存时间和总生存时间显著相关,survivin表达阳性病人的无病生存时间和总生存时间均显著低于survivin表达阴性的病人;多因素Cox回归分析结果表明survivin的表达状况是决定乳腺癌病人无病生存时间的独立因素,而与总生存时间无关。结论：Survivin是判断乳腺癌预后的一个独立生物学指标,阳性表达病人的预后较阴性表达病人差。     

凋亡相关基因Fas-1377和Fas-670基因多态对乳腺癌预后的影响

目的 探讨Fas-1377和Fas-670基因的多态性与中国女性乳腺癌患者预后之间的关系.方法 采用聚合酶链反应-限制性片段长度多态性(PCR-RFLP)方法,检测310例中位随访时间达10.5年的原发性乳腺癌患者Fas-1377和Fas-670基因的多态性,分析其与乳腺癌预后的关系.结果 Fas-1377和Fas-670基因的多态性与全组乳腺癌患者的预后无显著的相关性(P>0.05).在腋淋巴结阴性的患者中,Fas-1377基因多态性与乳腺癌患者的预后显著相关,AA纯合突变型患者的5年总生存率(OS)显著低于GA和GG基因型者(66.7%:95.4%,P=0.03);而Fas-670基因多态性与腋淋巴结阴性患者的预后无显著的相关性(P>0.05).在腋淋巴结阳性的患者中,Fas-1377和Fas-670基因的多态性与患者的5年OS均无显著的相关性(均P>0.05).结论 在腋淋巴结阴性的乳腺癌患者中,Fas-1377基因多态具有潜在的预后价值,携带Fas-1377 AA基因型的乳腺癌患者预后不良.     

雌激素受体阳性可手术乳腺癌三苯氧胺辅助治疗的远期疗效

目的：探讨三苯氧胺（TAM）辅助治疗雌激素受体阳性可手术乳腺癌的远期疗效。方法：414例雌激素受体阳性可手术乳腺癌患者按服用TAM与否分成TAM组和非TAM组，并随访观察至少10年，用Kaplan-Meier法计算两组生存率和无瘤生存率，Log-rank统计分析行显著性检验，Cox模型进行多因素分析，结果：TAM组生存率和无瘤生存率均高于非TAM组，服药时间与生存率和无瘤生存率均呈正相关（P＜0．05），进一步分层比较，腋淋巴结阴性患者两指标无差异（P＞0．05），腋淋巴结阳性患者两指标差异有显著性（P＜0．05），结论：TAM用于雌激素受体阳性可手术乳腺癌患者术后辅助治疗可提高远期生存率和无瘤生存率。     

Male breast cancer in the veterans affairs population: a comparative analysis

BACKGROUND: The incidence of male breast cancer (MBC) continues to rise. The Veterans Affairs (VA) Central Cancer Registry (VACCR) provides a unique source for the study of MBC. The objective of this retrospective analysis was to compare the characteristics and outcome of patients with MBC and patients with female breast cancer (FBC) in the VA population. METHODS: VACCR data were used to analyze the database of VA patients who had breast cancer diagnosed between 1995 and 2005. It includes 120 VA medical centers. Primary site codes were identified for breast cancer (500-508). Data were entered and analyzed using biostatistical software. RESULTS: In total, 3025 patients' records were reviewed, and 612 patients who had MBC were compared with 2413 patients who had FBC. The mean age at diagnosis was 67 years for patients with MBC and 57 years for patients with FBC (P < .005). More patients with MBC were black, and patients with MBC presented with higher disease stage and more lymph node-positive disease. The dominant histology in MBC was ductal carcinoma. No difference in grade or laterality was observed. Estrogen and progesterone receptor-positive tumors were more common in MBC compared with FBC. Overall, patients with MBC received less chemotherapy, whereas no statistical difference was observed in the use of hormone treatment. The median overall survival for patients who had MBC was 7 years compared with 9.8 years for patients who had FBC (log-rank test; P < .005). There was no statistically significant difference in median survival for patients with stage III disease and stage IV disease. However, the median survival differed significantly for patients with stage I disease and stage II disease. In lymph node-negative patients, the median survival was 6.1 years for patients with MBC and 14.6 years for patients with FBC (P < .005), whereas the median survival did not differ significantly in lymph node-positive patients. Using Cox regression analysis age, sex, clinical stage, and lymph node status were independent prognostic factors for survival, whereas race, histology, and grade were not. CONCLUSIONS: To the authors' knowledge, this is the largest series of MBC and FBC to date in the veterans population. The results suggested the presence of differences in the biology, pathology, presentation, ethnicity, and survival between patients with MBC and patients with FBC in the VA population. It is noteworthy that the survival of patients with MBC was inferior for those with early-stage disease and lymph node-negative tumors, suggesting that there are differences between the sexes in the pathogenesis and biology of breast cancer. In patients with hormone receptor-positive MBC, survival was inferior despite similar hormone treatment practices between MBC and FBC. This observational study calls for a better understanding of this disease that would allow new opportunities for specific therapeutic intervention.     

Significance of immunohistochemical c-ErbB-2 product localisation pattern for prognosis in human breast cancer

Breast cancer is an increasingly important cause of illness and death among women. In recent years several novel prognostic determinants of breast cancer have been identified, including c-ErbB-2. In this study, expression of c-ErbB-2 in breast carcinoma was correlated with axillary lymph node metastases and disease outcome. The expression of c-ErbB-2 oncoprotein was analysed in 315 tumor specimens of infiltrating ductal carcinoma of breast. They were categorized according to the modified Bloom and Richardson criteria into three histological grades. These patients also had axillary lymph nodes sampling. The expression of c-ErbB-2 oncoprotein was analysed immunohistochemically. Over expression of c-ErbB-2 were observed in 39.36% tumors. Axillary lymph node metastasis had significant correlation with intensified positivity of c-ErbB-2. C-ErbB-2 positive patients did show resistance to chemotherapy when compared for recurrence and distant metastases following surgery (p< 0.05). At a median follow-up of 48 months in c-ErbB-2 positive patients, the overall survival was 3.0 years and disease free survival was 2.5 years. c-ErbB-2 negative tumor patients showed a far better survival. In this group the overall survival was 4.44 years and the disease free survival was 3.78 years. These findings reinforce the view that c-ErbB-2 immunohistochemical detection is of help in detecting a subgroup of breast carcinoma patients who are at high risk. This may also be of particular relevance in decisions regarding adjuvant chemotherapy to these patients.     

CA IX is an independent prognostic marker in premenopausal breast cancer patients with one to three positive lymph nodes and a putative marker of radiation resistance.

PURPOSE: Hypoxia in breast cancer is associated with poor prognosis and down-regulation of the estrogen receptor. Carbonic anhydrase IX (CA IX) is a hypoxia-inducible gene that has been associated with poor outcome in many epithelial cancers. Previous studies of CA IX in breast cancer have been carried out on mixed cohorts of premenopausal and postmenopausal patients with locally advanced disease and varying treatment regimens. We examined the potential prognostic and predictive role of CA IX in premenopausal breast cancer patients. EXPERIMENTAL DESIGN: Using tissue microarrays, we analyzed CA IX expression in 400 stage II breast cancers from premenopausal women. The patients had previously participated in a randomized control trial comparing 2 years of tamoxifen to no systemic adjuvant treatment. Median follow-up was 13.9 years. RESULTS: CA IX expression correlated positively with tumor size, grade, hypoxia-inducible factor 1alpha, Ki-67, cyclin E, and cyclin A2 expression. CA IX expression correlated negatively with cyclin D1, estrogen receptor, and progesterone receptor. CA IX expression was associated with a reduced relapse-free survival (P=0.032), overall survival (P=0.022), and breast cancer-specific survival (P=0.005). Multivariate analysis revealed that CA IX was an independent prognostic marker in untreated patients with one to three positive lymph nodes (hazard ratio, 3.2; 95% confidence interval, 1.15-9.13; P=0.027). CONCLUSION: CA IX is marker of poor prognosis in premenopausal breast cancer patients and it is an independent predictor of survival in patients with one to three positive lymph nodes. As all these patients received locoregional radiation therapy, CA IX may be associated with resistance to radiotherapy.     

35岁以下乳腺癌患者保乳术与改良根治术比较及保乳术预后因素观察

目的:比较年轻乳腺癌患者（年龄≤35岁）保乳手术及改良根治术后疗效,并对保乳手术的患者进行预后相关因素分析。方法:回顾性分析1995年1 月至2006年12月天津医科大学附属肿瘤医院收治并分别实施保乳手术（71例）及改良根治术（70例）的年轻乳腺癌患者临床病理资料,比较两组的局部复发及生存情况,并分析年龄、肿瘤大小、淋巴结情况、组织学分级等因素对保乳患者生存情况的影响。结果:所有患者随访时间12～156 个月,中位时间56个月。保乳组:局部复发5 例,远处转移8 例,死亡7 例;3 年无瘤生存率94.4% ,5 年无瘤生存率78.9% ,总生存率90.1% 。改良组:局部复发3 例,远处转移6 例,死亡5 例;3 年无瘤生存率95.7% ,5 年无瘤生存率82.9% ,总生存率92.9% ;且对两组进行比较后均无显著性差异（P 均>0.05）。 对保乳组患者进行预后相关因素分析,切缘阳性与局部控制率、无瘤生存率、总生存率相关（P 均<0.05）;淋巴结转移与无瘤生存率、总生存率相关（P均<0.05）。结论:年轻乳腺癌患者的保乳手术与改良根治手术在局部复发及远期生存等方面无显著性差异,尤其是对于早期年轻乳腺癌患者,保乳手术是安全的,且局部控制尚满意,切缘阳性、淋巴结转移是影响预后的主要因素。      

Cyclooxygenase-2 expression correlates with diminished survival in invasive breast cancer treated with mastectomy and radiotherapy

PURPOSE: To evaluate the relationship between cyclooxygenase-2 (COX-2) expression and pathologic features and outcome in invasive breast cancer. METHODS AND MATERIALS: Formalin-fixed, paraffin-embedded tumor specimens from 23 women with invasive breast cancer were stained for COX-2 expression. All women underwent mastectomy and locoregional radiotherapy. The distribution (percentage of positive staining cells) and intensity of COX-2 expression within the tumor cells were compared with clinical factors, including stage, grade, lymph node involvement, and outcome. RESULTS: For invasive breast cancer, the distribution and intensity of COX-2 tumor expression correlated significantly with diminished overall survival. The 5-year overall survival rate was 100% for patients with <75% of breast cancer cells expressing COX-2 compared with 49% for patients with > or =75% (p = 0.044). The 5-year overall survival rate was 100% for patients with COX-2 intensity <80 compared with 60% for patients with COX-2 intensity > or =80 (p = 0.018). The percentage and intensity of COX-2 expression also correlated significantly with disease-free survival. The percentage of cells expressing COX-2 was significantly greater in women <40 years old than in women > or =40 years old (81% vs. 59%, respectively, p = 0.04). CONCLUSION: Both the distribution and the intensity of COX-2 expression correlated significantly with disease-free and overall survival in patients with invasive breast cancer. Younger patients with invasive breast cancer may have a greater percentage of COX-2 expression in their tumors.     

Expression of KLF5 is a prognostic factor for disease-free survival and overall survival in patients with breast cancer.

PURPOSE: Kruppel-like factor (KLF5) is a cell growth mediator in various epithelial cells. Higher KLF5 increases cell growth rate and leads to transformed phenotypes. Because tumor cell proliferation is tightly associated with tumor progression, and consequently, with survival of cancer patients, we wanted to examine the prognostic value of KLF5 gene expression for patients with breast cancer. EXPERIMENTAL DESIGN: The gene expression levels of KLF5, ER, PR, HER2, and MKI67 were quantified in the tumor tissues of 90 patients with breast cancer and correlated with disease-free survival and overall survival of the patients. The correlations of gene expression between KLF5 and ER, PR, HER2, and MKI67 were analyzed. In addition, KLF5 expression was also compared with clinical data and age of patients. RESULTS: Statistically significant correlations were found between gene expression of KLF5 and both disease-free survival (univariate analysis) and overall survival (univariate and multivariate analysis). Patients with higher KLF5 expression had shorter disease-free survival and overall survival time, whereas patients with lower KLF5 expression had better survival. Moreover, KLF5 was also found to be positively correlated with HER2 and MKI67, and negatively correlated with age of the patients at diagnosis. CONCLUSION: The gene expression of KLF5 is directly correlated with cell proliferation in vivo and is a prognostic factor for patients with breast cancer. Patients with higher KLF5 expression have shorter disease-free survival and overall survival than patients with lower KLF5 expression. In addition, KLF5 has higher expression in patients ages 50 years old.     

三阴乳腺癌的临床病理特征和预后分析

背景与目的:三阴性乳腺癌(triple negative breast cancer,TNBC)是一类高危乳腺癌,其雌激素受体(estrogen receptor,ER)、孕激素受体(progesterone,PR)和入表皮生长因子受体2(human epidermal growth factor receptor-2.Her-2)表达均为阴性,因而不能从针对激素受体的内分泌治疗和Her-2的靶向治疗中获益.本研究旨在分析TNBC患者的临床病理特征、生存情况和预后影响因素.方法:收集免疫组织化学检测ER、PR和Her-2均为阴性的128例乳腺癌患者的临床病理资料,观察其长期生存情况.结果:所有患者中,浸润性导管癌占89.0%.T1、T2患者占78.1%,有淋巴结转移的患者占48.4%,Ⅰ、Ⅱ期患者占60.9%.5年无病生存率、无局部复发生存率、无远处转移生存率和总生存率分别为71.1%、84.3%、75.8%和83.6%.单因素分析结果显示,淋巴结转移、肿块大小、分期和脉管癌栓与TNBC预后有关.多因素分析显示,淋巴结转移(RR=17.449,P=0.000)、原发肿块大小(RR=31.237,P=0.000)是影响TNBC预后的因素.结论:TNBC有明显不同的临床病理特征,发病时常年轻、有淋巴结转移、肿块较大,有乳腺癌家族史,预后差,淋巴结转移和肿块大小是影响TNBC预后的因素.     

The correlation of extranodal invasion with other prognostic parameters in lymph node positive breast cancer

BACKGROUND: The presence of extranodal invasion (ENI) in the metastatic lymph nodes is reported to increase the risk of locoregional recurrence while shortening disease-free and overall survival in patients with breast cancer. In this study the relationship between ENI and other prognostic parameters and survival is investigated. METHODS: Of 650 patients with breast cancer who were treated in Ankara Oncology Teaching and Research Hospital from 1996 to 2003, 368 (56.6%) had lymph node metastasis. The patients with axillary metastasis were separated into two groups as with and without invasion to lymph node capsule and the surrounding adipose tissue. Clinicopathologic features were analyzed by univariate and multivariate logistic regression. RESULTS: Of 368 patients with axillary metastasis, 135 (36.7%) had ENI. Based on multivariate analysis; the number of metastatic lymph nodes, lymphatic invasion, and tumor necrosis were found to be related with ENI. In the group with ENI, 5-year overall survival rate was 74.8%, compared to 82.3% for patients without ENI which was significantly lower (P = 0.04). CONCLUSIONS: In lymph node positive breast cancer with presence of ENI, adverse prognostic parameters are more frequently encountered and has a worse overall survival compared to group without ENI.     

BTG1 expression correlates with the pathogenesis and progression of breast carcinomas

This study aimed to analyze the expression, clinical significance of B cell translocation gene 1 (BTG1) in breast carcinoma and the biological effect in its cell line by BTG1 overexpression. Immunohistochemistry and western blot were used to analyze BTG1 protein expression in 72 cases of breast cancer and 36 cases of normal tissues to study the relationship between BTG1 expression and clinical factors. Recombinant lentiviral vector was constructed to over-express EMP-1 and then infect breast cancer MCF-7 cell line. Quantitative real-time RT-PCR (qRT-PCR) and western blot were used to detect the mRNA level and protein of BTG1. MTT assay, cell apoptosis, cell cycles, migration and invasion assays were also conducted as to the influence of the upregulated expression of BTG1 that might be found on MCF-7 cells biological effect. The level of BTG1 protein expression was found to be significantly lower in breast cancer tissue than normal tissues (P?<?0.05). Decreased expression of BTG1 was significantly correlated with tumor invasion, lymph node metastasis, clinic stage and histological grade of patients with breast cancer (P?<?0.05). Meanwhile, loss of BTG1 expression correlated significantly with poor overall survival time by Kaplan–Meier analysis (P?<?0.05). The result of biological function shown that MCF-7 cell transfected BTG1 had a lower survival fraction, higher percentage of the G0/G1 phases, higher cell apoptosis, significant decrease in migration and invasion, and lower CyclinD1, Bcl-2, and MMP-9 protein expression compared with MCF-7 cell untransfected BTG1 (P?<?0.05). BTG1 expression decreased in breast cancer and correlated significantly lymph node metastasis, clinic stage, histological grade, poor overall survival, proliferation, and metastasis in breast cancer cell by regulating CyclinD1, Bcl-2, and MMP-9 protein expression, suggesting that BTG1 may play important roles as a negative regulator to breast cancer cell.     

Vimentin DNA methylation predicts survival in breast cancer

The Vimentin gene plays a pivotal role in epithelial-to-mesenchymal transition and is known to be overexpressed in the prognostically poor basal-like breast cancer subtype. Recent studies have reported Vimentin DNA methylation in association with poor clinical outcomes in other solid tumors, but not in breast cancer. We therefore quantified Vimentin DNA methylation using MALDI-TOF mass spectrometry in breast tumors and matched normal pairs in association with gene expression and survival in a hospital-based study of breast cancer patients. Gene expression data via qRT-PCR in cell lines and oligomicroarray data from breast tissues were correlated with percent methylation in the Vimentin promoter. A threshold of 20 percent average methylation compared with matched normal pairs was set for bivariate and multivariate tests of association between methylation and tumor subtype, tumor histopathology, and survival. Vimentin was differentially methylated in luminal breast cancer cell lines, and in luminal A, luminal B, and HER2-enriched breast tumor subtypes, but was rare in basal-like cell lines and tumors. Increased methylation was strongly correlated with decreased mRNA expression in cell lines, and had a moderate inverse correlation in breast tumors. Vimentin methylation predicted poor overall survival independent of race, subtype, stage, nodal status, or metastatic disease and holds promise as a new prognostic biomarker for breast cancer patients.     

三阴性乳腺癌的临床病理特征及预后分析

目的 探讨三阴性乳腺癌(TNBC)患者的临床病理特点、生存情况和预后影响因素.方法 收集免疫组化检测雌激素受体(ER)、孕激素受体(PR)和人表皮生长因子受体2(HER-2)均阴性的108例乳腺癌患者的临床病理资料,观察其长期生存状况.结果 中位发病年龄47岁.108例TNBC患者中,有乳腺癌家族史者8例,卵巢癌家族史者3例,自身曾患卵巢癌者1例.浸润性导管癌占87.0%,组织学分级多为Ⅱ、Ⅲ级.T1、T2期患者占92.6%,有淋巴结转移的患者占49.1%,Ⅰ、Ⅱ期患者占75.0%.5年无病生存率、无远处转移生存率、无局部复发生存率和总生存率分别为68.1%、70.9%、72.1%和76.9%.单因素分析结果显示,淋巴结转移、脉管瘤栓与TNBC预后有关.多因素分析结果显示,淋巴结转移是TNBC预后的独立影响因素(RR=5.944,P=0.001).结论 TNBC在我国的发病情况与白色人种相当,较黑色人种低.散发性乳腺癌可能是我国TNBC发病的主体.淋巴结转移是TNBC的独立预后影响因素.经放疗和以蒽环类药物为主的化疗后,我国TNBC患者的生存率与白色人种患者接近,较黑色人种患者高.     

新疆维吾尔自治区少数民族女性三阴性乳腺癌临床病理特点及生存情况分析

 【摘要】目的：分析新疆少数民族女性三阴乳腺癌的临床病理特点及其生存情况。方法：回顾收集我科自2001年1月——2005年12月诊治的48例术后少数民族女性乳腺癌患者资料,经免疫组化检测雌激素受体（ER）、孕激素受体（PR）和人表皮生长因子受体2（HER-2）均阴性,分析其发病年龄、肿瘤大小、病理类型、淋巴结转移、术后治疗情况及肿瘤复发生存情况。结果：48例三阴性乳腺癌病例中,中位发病年龄47岁,浸润性导管癌占85.4%,组织学分级多为Ⅱ、Ⅲ级。56.2%的患者首诊时有淋巴结转移,Ⅱ期及Ⅲ期患者占83.3%。获随访46例患者中均接受了术后辅助治疗。5年无病生存率及总生存率分别为43.5%及52.2%,淋巴结阳性患者5年总生存率仅为38.5%。结论：新疆主要少数民族女性三阴性乳腺癌首诊时淋巴结转移率高,易发生远处转移,发病情况与国内相当,总生存率较汉族人群偏低,淋巴结阳性患者生存期较短。     

乳腺癌淋巴管生成与淋巴结转移、血管内皮生长因子-C表达的关系

目的 探讨乳腺癌中淋巴管生成的分布特点及与血管内皮生长因子-C(VEGF-C)的表达,淋巴结转移和预后的关系.方法 应用免疫组化方法检测70例乳腺癌组织VEGF-C蛋白的表达,并用淋巴管内皮细胞特异性抗体D2-40标记淋巴管,计数肿瘤淋巴管密度(LVD),结合临床病理特征和随访资料进行分析.结果 VEGF-C蛋白的高表达与淋巴结转移(P=0.010)、淋巴管浸润(P=0.031)呈正相关,与肿瘤组织学分级 (P＜0.001) 呈负相关.乳腺癌LVD与淋巴结转移(P＜0.001)、淋巴管浸润(LVI)(P=0.001)、VEGF-C表达(P=0.012)呈正相关,与无病生存率(P=0.011)及总生存率(P=0.001)呈显著负相关.多因素分析显示LVD是影响无病生存率(P=0.015)和总生存率(P=0.002)的独立因子.结论 乳腺癌组织中新生淋巴管主要分布于肿瘤间质,LVD与VEGF-C表达和癌细胞转移相关,乳腺癌微淋巴管密度测定对评估其淋巴结转移和预后判断可能具有意义.     

Sequencing of chemotherapy and radiation in lymph node-negative breast cancer.

PURPOSE: To conduct a retrospective analysis of chemotherapy and radiation sequencing in lymph node-negative breast cancer patients treated with breast-conserving surgery. PATIENTS AND METHODS: Between February 1982 and January 1996, 124 patients with lymph node-negative breast cancer underwent breast-conserving surgery with axillary dissection followed by chemotherapy and radiation therapy. The outcome of 68 patients who received chemotherapy first was compared with that of 56 patients who received radiation first. The two groups were balanced with respect to patient age, tumor stage, margin status, and estrogen and progesterone receptor status. Sixty-two percent of the patients had T1 primary disease. The median follow-up among surviving patients was 44 months for the chemotherapy-first group and 61 months for the radiation-first group. RESULTS: There were no statistically significant differences in local control, disease-free survival, or overall survival between the two groups. Five-year actuarial rates for local control for the chemotherapy-first and the radiation-first groups were 100% and 94%, respectively. Five-year recurrence-free rates for the chemotherapy-first and radiation-first groups were 92% and 77%, respectively. The 5-year overall survival rate was 89% for both groups. DISCUSSION: Giving chemotherapy before radiation in lymph node-negative breast cancer did not compromise local control. Given the concerns about increased distant metastases if radiation is given first, the chemotherapy-radiation sequence is recommended.     

乳房派杰氏病合并浸润性乳腺癌 患者的生存分析

背景与目的:乳房派杰氏病(Paget's disease)是一种很罕见的疾病.文献报道该病患者的生存情况与其下乳房内的病灶的恶性程度相关.该研究旨在探索合并浸润性乳腺癌的乳房派杰氏病的临床病理特征并分析患者的生存率.方法:2002—2007年,共54例在复旦大学附属肿瘤医院接受治疗的合并浸润性乳腺癌的乳房派杰氏病患者纳入该研究.由于乳腺派杰氏病大多数为人表皮生长因子受体2(human epidermal growth factor receptor 2,HER-2)阳性,研究者随机收集了同期72例HER-2阳性浸润性乳腺癌患者作为对照组,比较两组的生存差异.结果:25例(46.3％)研究组患者没有典型的乳头乳晕派杰氏病皮肤表现,35例(64.8％)研究组患者浸润性癌灶超过2 cm,26例(48.1％)研究组患者腋窝淋巴结有转移.与对照组的患者相比,派杰氏病患者的复发事件更多(5年无复发生存率:76.4％vs 48.5％,P<0.01).对照组复发事件多集中于术后3年内,而派杰氏患者复发风险在术后5年内持续存在.研究组的5年总生存率(61.0％)也低于对照组(80.6％,P=0.01).结论:合并浸润性癌的乳房派杰氏病患者比HER-2阳性乳腺癌患者的预后差.     

Long-term follow-up for locally advanced and inflammatory breast cancer patients treated with multimodality therapy.

PURPOSE: To determine long-term event-free (EFS) and overall survival (OS) for patients with stage III breast cancer treated with combined-modality therapy. PATIENTS AND METHODS: Between 1980 and 1988, 107 patients with stage III breast cancer were prospectively enrolled for study at the National Cancer Institute and stratified by whether or not they had features of inflammatory breast cancer (IBC). Patients were treated to best response with cyclophosphamide, doxorubicin, methotrexate, fluorouracil, leucovorin, and hormonal synchronization with conjugated estrogens and tamoxifen. Patients with pathologic complete response received definitive radiotherapy to the breast and axilla, whereas patients with residual disease underwent mastectomy, lymph node dissection, and radiotherapy. All patients underwent six additional cycles of adjuvant chemotherapy. RESULTS: OS and EFS were obtained with a median live patient follow-up time of 16.8 years. The 46 IBC patients had a median OS of 3.8 years and EFS of 2.3 years, compared with 12.2 and 9.0 years, respectively, in stage IIIA breast cancer patients. Fifteen-year OS survival was 20% for IBC versus 50% for stage IIIA patients and 23% for stage IIIB non-IBC. Pathologic response was not associated with improved survival for stage IIIA or IBC patients. Presence of dermal lymphatic invasion did not change the probability of survival in clinical IBC patients. CONCLUSION: Fifteen-year follow-up of stage IIIA and inflammatory breast cancer is rarely reported; IBC patients have a poor long-term outlook.     

乳腺癌变过程中Pim1和Notch1差异性表达的临床价值

目的 探讨Pim1和Notch1在乳腺组织中差异性表达的临床意义及与预后的关系。方法 qRTPCR、免疫组织化学法和数据库检测评估Pim1、Notch1 mRNA和蛋白在乳腺癌旁正常组织、普通型导管增生、导管原位癌和浸润性导管癌中的表达水平, 分析Pim1和Notch1表达与乳腺癌患者临床病理参数的关系,Kaplan-Meier Plotter数据库发掘Pim1和Notch1在乳腺癌预后中的价值。结果 乳腺癌组织中Pim1 mRNA水平升高,Pim1蛋白表达明显降低;Pim1 mRNA与淋巴结转移和TNM晚期密切相关,Pim1蛋白在淋巴结转移及高分级患者中表达显著减少,其低表达的患者无复发生存期更短（P=0.000）。Notch1 mRNA和蛋白在乳腺癌中显著高表达,Notch1 mRNA与淋巴结转移、高分级和晚分期明显相关,Notch1蛋白在淋巴结转移组中表达显著升高,其高表达患者总生存时间减少（P=0.025）。Pim1和Notch1蛋白表达在乳腺癌中负相关（r=-0.385,P=0.001）。结论 Pim1低表达和Notch1高表达可能是促进乳腺癌发生发展及预后不良的危险因素,可能成为评估乳腺癌潜在生物标志物。