晚期三阴性乳腺癌的临床特征及生存分析

Objective To characterize the sites of distant recurrence and clinical outcomes in a cohort of Chinese patients with metastatic triple-negative breast cancer (TNBC ). Methods One hundred and thirty-four patients with metastatic TNBC treated at Cancer Hospital of CAMS from January 1999 to December 2007 were included in this study. Hie clinicopathological features and long-term survival of the patients were retrospectively analyzed. Results The median age of the patients was 45 years. Most patients (72.7% ) had a higher predilection for visceral metastasis and early recurrence within the first two years of follow-up. Six patients (4.5%) presented with stage Ⅳ disease, 14 patients were diagnosed with locoregional recurrence after mastectomy, 75 patients with distant metastases, and 45 patients with both locoregional recurrence and distant metastasis. The most common site of first recurrence was the lung, and 62(51.7% )of the patients had more than two sites of metastasis. By July 30, 2009, 75 patients died of breast cancer (56.0%). The median overall survival (OS) was 26. 5 months [95% confidence interval (CI), 20. 5-32. 6 months]. The l-,3- and 5-year overall survivals ( OS) were 80. 9% ,37. 1% and 30.1% , respectively. The median overall survival time of 58 patients with single site of metastasis was 28.5 months, longer than that of patients with more than two sites of metastases. Patients whose initial distant recurrence was bone metastasis only (7 patients) had better prognosis, with a median OS of 84.2 months. The median OS (28.5 vs. 12.6 months, P =0.0001) differed significantly between patients who received first-line chemotherapy and those who did not. Forty-five of the 96 patients with measurable disease achieved complete/partial response (CR/PR), 39 patients had stable disease (SD), and 12 patients had disease progression (PD). The median OS was 36.1 months in patients with CR/PR, 20. 8 months with SD, and 14 months with PD, respectively. The median OS of patients with CR/PR was significantly longer than that of patients with SD/PD (P =0. 0106). Distant metastasis, first-line chemotherapy and clinical response were significantly related with OS by univariate analysis. Furthermore, first-line chemotherapy and the clinical response were demonstrated to be an independent prognostic factor by multivariate analysis. Conclusions Recurrence risk and mortality are considerably higher in TNBC patients within the early years of follow-up. TNBC patients have a higher risk of multiple and visceral metastases, and poorer survival, which might attribute to its aggressive clinical behavior and lack of effective regimens. Our findings also suggest that chemotherapy can effectively improve the clinical outcome of those patients.     

长春瑞滨单药周疗方案治疗既往应用过蒽环类和紫杉类药物的晚期乳腺癌临床观察

目的 观察长春瑞滨(NVB)单药治疗对既往应用过蒽环类和/或紫杉类药物的转移性乳腺癌的疗效和安全性.方法 我院从2008年1月至2011年7月共有31例既往应用过蒽环类和/或紫杉类药物的转移性乳腺癌患接受了NVB单药周疗方案治疗.结果 全组化疗共113个周期,中位化疗周期数为4个(2～6个周期).完全缓解(CR)1例(3%),部分缓解(PR)7例(22%),稳定(SD)4例(13%),进展(PD)19例(61%),总有效率(RR＝CR+PR)为26%,临床获益率(CR+PR+SD＞6个月)为32%,中位疾病进展时间(TTP)4.0个月,中位生存期为13个月.主要不良反应为骨髓抑制及胃肠道反应,无化疗相关死亡病例.结论 长春瑞滨单药治疗既往应用过蒽环类和/或紫杉类药物的转移性乳腺癌有一定疗效,且耐受性好.     

乳腺癌检测新方法的前景看好

现已研制出一种非侵入性检测方法,并被证明可减少患良性乳腺疾病妇女不必要的活检。这种检测手段的依据是测量乳腺皮肤的电势位。这是一种非侵入性检查,病人不必暴露在电离辐射中,可重复使用,无风险。检测结果立等可取,且客观。欧洲的一个多中心研究小组在研究了661例行乳腺开放活检病人的资料后,发现电位变化与活检组织的增生特性有非常显著的相关(Ｌａｎｃｅｔ1998;352:35963)。研究发现这种检测方法最适用于绝经期前且乳腺有可触及包块的妇女。研究者声称在不具阳性体征的患者中分辨率低的原因是由于传感器缺乏确切的定位点。英国皇家癌…     

中心体异常与抗肿瘤药物敏感性的关系

近年来研究发现，几乎在人类所有的恶性肿瘤中均可以见到中心体的异常，中心体蛋白的异常表达与肿瘤对化疗药物敏感性的关系目前也受到了极大的关注。对各种刺激（stress）所致凋亡的抗拒不仅促进了肿瘤发生发展，也是其对化疗药物抗拒的机制之一，对相关机制的了解可以指导临床对化疗药物的选择，提高治疗效果，避免化疗药物的毒性以及医疗资源的浪费，对耐药机制相关通路的理解可以开发相应的靶向治疗药物，是目前的发展方向。     

可手术乳腺癌CMF辅助化疗随机研究的30年随访：队列研究

目的根据1973年6月至1980年12月期间的3项连续随机试验和1项观察研究，评价有复发风险的可手术乳腺癌患者使用环磷酰胺、甲氨蝶呤和氟尿嘧啶(CMF)辅助治疗的长期有效性。设计队列研究。地点意大利米兰国家肿瘤研究所。主要结局指标无复发生存和总生存，采用单变量和多变量分析。结果在首项研究随访平均28．5年后，发现辅助CMF能显著降低复发的相对危险度(危险比为0．71，95％可信区间0．56～0．91，P=0．005)并减少死亡(0．79，0．63～0．98，P=0．04)。12个周期的CMF似乎并不优于6个周期的相对短期治疗。在淋巴结和雌激素受体阴性的研究中，平均随访20年后，静脉使用CMF能显著降低疾病复发的相对危险度(0．65，0．47～0．90，P=0．009)以及死亡的相对危险度(0．65，0．47-0．92，P=0．01)。结论如应用适当，CMF方案能使具有远处复发风险的患者获益，没有证据显示它对任何研究亚组有不良影响。     

切尔诺贝利核反应堆爆炸后10年受污染区域乳腺癌的发生率升高

一项研究发现，乌克兰切尔诺贝利核电厂爆炸后放射污染最严重的区域妇女发生乳腺癌的可能性是污染较少区域的2到3倍。     

乳腺癌死亡率下降归功于筛查和辅助治疗的增加，尤其是辅助治疗

2005年在英国和欧洲诊断为乳腺癌的妇女预后明显优于20世纪70和80年代的妇女，但是其5年生存率仍低于美国(79％比89％)。是什么原因造成这些差异，怎样做才能进一步提高存活率呢?     

为什么要进行新辅助化疗?

新辅助化疗或称初始化疗,指手术前进行的化疗。因其不同于术后的辅助化疗,故一般称为新辅助化疗。进行新辅助化疗是因为有的肿瘤虽然是局限性的,但肿块较大或局部浸润明显,立即进行手术治疗存在困难或效果不好。而且实验研究发现如果肿瘤≥2cm,则淋巴结     

人体膀胱癌细胞对丝裂霉素耐药机制的研究

作者以对丝裂霉素分别敏感和耐药的人体膀胱癌细胞Ｊ８２和ＳＣａＢＥＲ进行对照，研究ＳＣａＢＥＲ对ＭＭＣ的耐药机制。药物作用１小时，对ＳＣａＢＥＲ细胞的ＩＣ＿（５０）是对Ｊ＿（８２）细胞的２．７倍。ＳＣａＢＥＲ细胞中，两种生物激活酶，即ＮＡＤＰＨ细胞色素Ｐ＿（４５０）还原酶和ＤＴ－黄递酶较Ｊ＿（８２）细胞显著降低，提示该细胞对ＭＭＣ相对低敏感性是由于药物活化过程障碍。ＢＭＹ２５２８２苯醌还原能力弱，易于活化，其对两种细胞的ＩＣ＿（５０）值相似，进一步支持上述观点。ＳＣａＢＥＲ细胞的氧自由基形成较Ｊ＿（８２）细胞稍高，抗氧化酶活性无明显变化，提示ＳＣａＢＥＲ细胞对ＭＭＣ耐药不是由于氧自由基形成减少。此外，ＭＭＣ所致ＳＣａＢＥＲ细胞的ＤＮＡ链间交联（ＩＳＣ）较Ｊ＿（８２）细胞明显减少。研究结果表明，ＳＣａＢＥＲ细胞对ＭＭＣ耐药是由药物活化障碍和ＩＳＣ减少所致。