目的 研究乳腺癌根治术中保留乳头乳晕对术后疗效、上肢功能及外观满意度的影响。方法 选取我院2013年3月—2018年5月40例早期乳腺癌的患者为研究对象,按照数字表随机分组的方案分为观察组和对照组各20例。观察组患者采用保留乳头乳晕的乳腺癌根治术治疗;对照组患者采用传统的根治性手术。比较两组手术时间、术中出血量、术后引流量、术后下床时间、住院时间。比较两组患者术后上肢功能情况,采用上肢功能评定量表(disabilities of arm,shoulder and hand scale,DASH)评估。比较两组术后乳房外观满意度及两组患者术后并发症发生率。结果 观察组手术时间、术中出血量、术后引流量及平均住院时间均低于对照组,差异有统计学意义(P＜0.05)。观察组与对照组患者术后患侧上肢水肿及活动受限发生率相当,差异无统计学意义(P＞0.05)。观察组皮瓣缺血发生率为10.0%低于对照组40.0%,差异有统计学意义(P＜0.05)。观察组术后乳房外观优良率为90.0%,高于对照组优良率60.0%,差异有统计学意义(P＜0.05)。观察组患者术后并发症发生率15.0%低于对照组35.0%,差异有统计学意义(P＜0.05)。结论 保留乳头、乳晕的乳腺癌根治术具有手术效果好、与传统根治术相比,对上肢功能损伤较小、美容效果更好,患者满意度较高等优点,值得临床应用和推广。

目的 探讨分析30岁及以下青年乳腺癌患者术后首次复发转移特点,以期指导术后随访,早期发现转移病灶。方法 回顾性分析2003年1月—2018年8月在梅州市人民医院收治的年龄≤30岁乳腺癌患者73例,所有患者均行根治性手术治疗,分析临床病理特点及术后首次复发转移特点。结果 共纳入23例三阴性(31.5%)、20例luminal B(HER2-)型(27.4%)、12例HER-2阳性型(16.4%)、10例 Luminal B(HER2+)型(13.7%)、4例Luminal A型(5.5%)和4例分型不明(5.5%)。中位随访28.4个月,7例三阴性(7/23, 30.4%)、 6例HER-2阳性型(6/12, 50.0%)、 4例Luminal B(HER2-)型(4/20, 20.0%) 和3例 Luminal B(HER2+)型(3/10, 30.0%)出现复发转移。复发转移患者中,90.0%合并远处转移,75.0%合并内脏转移,其中HER-2阳性型均合并内脏转移;92.3%(12/13)激素受体阴性患者复发转移发生在术后2年内。三阴性患者最常见远处转移部位是远处淋巴结,HER-2阳性型患者最常见远处转移部位是肝,luminal B(HER2+)型患者最常见远处转移部位是肺和骨,luminal B(HER2-)型患者最常见远处转移部位是肺和远处淋巴结。结论 ≤30岁青年乳腺癌患者术后首次复发转移多合并远处转移,激素受体阴性患者容易早期复发,不同分子分型患者具有不同的好发远处转移部位。

Objective We retrospectively investigated the first recurrent pattern after radical surgery in breast cancer patients aged ≤30 years, so as to guide postoperative follow-up and early detection of recurrent lesions. Methods A total of 73 consecutive early breast cancer patients aged ≤30years admitted to Meizhou People's Hospital from January 2003 to August 2018 were included. Retrospective analysis was conducted to analyze the clinicpathologic characteristics and characteristics of first recurrent pattern. Results 23 triple negative(31.5%), 20 Luminal B(27.4%), 12 HER2 enriched (16.4%), 10 Luminal/HER2+(13.7%), 4 Luminal A(5.5%) and 4 undifined subtypes(5.5%) were included. After a median follow-up of 28.4 months, 20 patients relapsed, which included 7 triple-negative(7/23, 30.4%), 6 HER2-enriched (6/12, 50.0%), 4 luminal B(4/20, 20.0%) and 3 luminal/HER2+(3/10, 30.0%) subtypes. 90.0% of patients combined with distant metastasis. 75.0% of patients had visceral metastasis, which included all the recurrent HER-2 enriched patients. 92.3% of hormone receptor negative(HR-) patients had a RFS less than 2 years. The most common metastatic sites in triple-negative, HER-2-enriched, luminal/HER2+ and luminal B subtypes were distant nodes, liver, lung and bone, distant nodes and lung, respectively. Conclusion The first recurrent pattern mainly presented as distant metastasis in breast cancer patients aged≤30 years, with early relapse in patients with HR- diseases. Different molecular subtypes of breast cancer favor different distant metastatic sites.

目的 探讨6野切线射野方式调强放疗(6F-IMRT)用于左侧乳腺癌根治术后放疗的临床价值。方法 纳入我院70例左侧乳腺癌根治术患者为研究对象,进行模拟CT增强扫描,三维重建后勾画大体靶区,分别对每个患者靶区设计4F-IMRT、5F-IMRT、6F-IMRT三种治疗计划,规定计划靶区(PTV)达到95%的处方剂量前提下,分析三种治疗计划PTV所受照射的平均剂量、最大剂量、最小剂量,95%、100%等剂量线包绕的靶区体积(V₉₅、V₁₀₀),适形度指数(CI)及剂量不均匀指数(HI),并比较三种计划下心脏、双肺、右乳受照射剂量。结果 各治疗计划靶区最大剂量、最小剂量、平均剂量比较无统计学意义(P＞0.05)。6F-IMRT的V₉₅、V₁₀₀均高于4F-IMRT、5F-IMRT,差异有统计意义(P＜0.05)。4F-IMRT、5F-IMRT、6F-IMRT的CI呈递增趋势,HI呈递减趋势,各组间比较差异有统计学意义(P＜0.05)。三种放疗计划中心脏的平均剂量、V₃₀,双肺的平均剂量、V₂₀、右乳平均剂量比较无显著差异(P＞0.05)。三种放疗计划中,4F-IMRT右乳V₁₀显著低于5F-IMRT、6F-IMRT,差异有统计学意义(P＜0.05),但均在最大耐受剂量范围内。结论 与4F-IMRT、5F-IMRT相比,6F-IMRT用于左侧乳腺癌根治术后放疗有明显剂量学优势,可提高靶区照射剂量,靶区适形程度及剂量均匀性均较好,而且并不会增加周围正常器官照射剂量。

目的 探讨乳腺癌原发病灶超声声像图特点及病理分子分型与腋窝淋巴结转移的相关性。方法 回顾性分析106例接受乳腺超声检查及腋窝淋巴结活检,病理确诊为乳腺癌的患者资料。超声观察乳腺癌原发病灶的位置、大小、有无钙化、纵横比、内部血流、腋窝淋巴结声像图特点,结合临床病理学特点,分析与腋窝淋巴结转移相关的因素。结果 超声诊断未见明显异常的腋窝淋巴结75例,可疑的腋窝淋巴结31例;病理证实腋窝淋巴结未转移70例,转移36例。灵敏度66.7%、特异度90%、阳性预测值77.4%、阴性预测值84%。单因素分析显示原发肿块的位置、最大径、腋窝淋巴结淋巴门消失、ER表达与腋窝淋巴结转移有关(P<0.05 )。多因素分析显示原发肿块的位置、腋窝淋巴结淋巴门消失与腋窝淋巴结转移有关(P<0.05)。结论 腋窝淋巴结常规超声检查结合乳腺癌原发病灶超声声像图及病理分子分型有助于评估腋窝淋巴结状态。

Objective To analyse the ultrasonographic features and pathological molecular typing of the primary lesions and axillary lymph node (ALN) of breast cancer related to axillary lymph node metasta-sis(ALNM). Methods The Grey-scale and color Doppler ultrasound and axillary lymph node biopsy were performed in 106 patients with breastcarcinomas. The observed features included the position,the most dimen-sion,inner calcification,aspect ratio,the type of blood supply of the primary tumor and axillary lymph node image. Combining with the clinicopathological features, we analyzed the factors associated with axillary lymph node metastasis. Results Ultrasound found normal axillary lymphnodes in 70 patients and abnormal in 31 patients. Pathology confirmed axillary lymph node metastasis in 36 patients, and no metastasis in 70 patients.The sensitivity, specificity, positive predictive value, negative predictive value were 66.7%, 90%, 77.4% and 84% r-espectively.Univariate analysis showed that the location, maximum diameter, lymphnode with disappearance hilus and ER expression were related to axillary lymph node metastasis (P< 0.05). Multivariate analysis showed that the location of primary mass and lymph node with disappearance hilus were related to axillary lymph node metastasis (P< 0.05). Conclusion Axillary lymph node routine ultrasound examination combined with ultrasonographic and pathological molecular typing of primary breast cancer is helpful to evaluate axillary lymph node status.

目的 比较阿那曲唑与他莫昔芬治疗激素受体阳性绝经后转移性乳腺癌[HR（+）MBC]的疗效和安全性。方法 本次研究对象为在我院诊治的80例HR（+）MBC患者,选取时间段为2016年1月—2018年1月,随机分为各40例的阿那曲唑组与他莫昔芬组,比较两组临床疗效及安全性差异。结果 治疗3个月后,阿那曲唑组的临床缓解率（92.50%）优于他莫昔芬组（72.50%）,性激素E2、LH、P水平低于他莫昔芬组,T水平高于他莫昔芬组（P<0.05）;治疗期间,两组患者的不良反应发生率（30.00%、25.00%）比较无统计学意义（P>0.05）。结论 阿那曲唑治疗HR（+）MBC效果确切,有利于调节机体性激素水平,减慢癌症进展,对于提高患者的生存质量有重要意义。

目的 研究BAG-1基因与乳腺癌他莫昔芬(TAM)治疗敏感性的相关性。方法 以58例乳腺癌患者为观察组,50例乳腺良性肿瘤患者为对照组。予以观察组患者TAM治疗,检测并统计2组患者肿瘤组织BAG-1基因的阳性率;并根据检测结果将观察组患者分为BAG-1阳性组与阴性组,对比分析观察组BAG-1阳性者与阴性者的临床预后及血清肿瘤标志物水平,包括癌胚抗原(CEA)、糖类抗原153(CA153)。结果 观察组BAG-1基因阳性率为74.14%,对照组为12%,2组比较, P＜0.05。观察组BAG-1阳性组患者临床缓解率为46.51%,阴性组为66.67%,2组比较,P＜0.05;BAG-1阳性组患者临床控制率为67.44%,阴性组为86.67%,2组比较,P＜0.05。观察组BAG-1阳性组患者平均OS为(1.55±0.86)a,PFS为(1.02±0.31)a,阴性组依次为(2.76±0.95)a、(2.06±0.82)a,2组比较,差异均有统计学意义(P＜0.05)。治疗后,观察组BAG-1阴性组患者血清CEA、CA153指标值均低于对照组(P＜0.05)。结论 BAG-1基因与乳腺癌TAM治疗敏感性密切相关,BAG-1阳性者行TAM治疗的临床效果及预后均较阴性者差。

Objective To study the correlation between BAG-1 gene and the sensitivity of tamoxifen (TAM) in breast cancer. Methods 58 cases of breast cancer patients as the observation group, 50 cases of benign breast cancer patients as the control group.The positive rate of BAG-1 gene in two groups of patients was detected and statistically analyzed by TAM. The patients in the observation group were divided into BAG-1 positive group and negative group according to the test results, and the positive rate of BAG- (CEA), carbohydrate antigens 153 (CA153) and carcinoembryonic antigen (CEA). Results The positive rate of BAG-1 gene was 74.14% in the observation group and 12% in the control group, P<0.05. The clinical response rate of BAG-1 positive group was 46.51% and negative group was 66.67%, P<0.05; The clinical control rate of BAG-1 positive group was 67.44%, negative group was 86.67%. Compared 2 groups , it was P<0.05. The mean OS was (1.55±0.86) years, PFS was(1.02±0.31) years in the BAG-1 positive group and (2.76±0.95) years in the negative group and (2.06±0.82) years in the negative group, (P<0.05). After treatment, the serum CEA and CA153 values in the negative group of BAG-1 were lower than those in the control group (P<0.05). Conclusion BAG-1 gene and breast cancer TAM treatment sensitivity is closely related to BAG-1 positive TAM treatment of clinical efficacy and prognosis were worse than negative.

目的 通过本研究观察卡培他滨单药维持治疗晚期乳腺癌患者的临床疗效。方法 纳入本院2014年4月1日—2016年9月31日收治的晚期乳腺癌(复发、转移性乳腺癌)患者64例,均经过解救化疗达到缓解并稳定,按随机数字表法将所有入选对象分为治疗组与对照组(各32例),治疗组给予口服卡培他滨维持治疗,对照组给予定期(每12周)复查评价,比较2组患者的临床疗效、PFS、OS及生活质量。结果 治疗组的临床有效率(18.75%)、临床控制率(78.13%)均显著优于仅给予定期复查的对照组(3.12%)、(56.25%)(P＜0.05);治疗组维持治疗后生活质量改善者21例(65.63%),优于对照组9例(28.13%)(P＜0.05);治疗组用药期间出现Ⅰ～Ⅱ度为主的手足综合征、腹泻、恶心呕吐等毒副反应,均可耐受, Ⅲ-Ⅳ度毒副反应少发生。综合评估显示治疗组中位PFS为(9.6±1.4)个月、中位OS为(20.5±2.8)个月显著长于对照组(6.1±1.5)个月、(15.8±3.1)个月,两组中位PFS、中位OS比较差异有统计学意意义(P＜0.05)。结论 在晚期乳腺癌治疗中使用卡培他滨单药维持治疗具有显著的疗效,可延长患者的生存期,并提高患者的生活质量,毒副反应较轻,可作为晚期乳腺癌维持治疗的首选药物之一,值得临床推广应用。

目的 研究雷公藤红素对人阿霉素耐药MCF-7/ADR乳腺癌细胞生长的作用。方法 采用MTT试验检测MCF-7/ADR细胞对阿霉素的耐药情况以及雷公藤红素对MCF-7/ADR细胞生长的影响;采用Annexin V-FITC/PI双染试验分析雷公藤红素对MCF-7/ADR耐药细胞凋亡的诱导作用;应用流式细胞周期分析检测雷公藤红素对MCF-7/ADR耐药细胞周期的影响。结果 MCF-7/ADR细胞对阿霉素耐药指数达14.54;而雷公藤红素能有效抑制阿霉素耐药细胞MCF-7/ADR的生长,并呈现浓度依赖性,作用48 h的IC50是1.04 μmol/L,MCF-7/ADR对雷公藤红素的耐药指数仅为0.87。2 μmol/L雷公藤红素作用8 h后,Annexin V-FITC染色阳性的MCF-7/ADR细胞比例较对照显著升高,差异有统计学意义(P＜0.05)。在1 μmol/L雷公藤红素作用24 h后,G1期细胞比例由对照(59.22±3.78)%升高至(77.44±4.21)%,而S期细胞比例由对照(37.51±2.91)%降至(19.65±2.25)%,差异有统计学意义(P＜0.05)。结论 雷公藤红素能激活MCF-7/ADR细胞凋亡的发生,并诱导MCF-7/ADR发生 G1/S细胞周期阻滞,从而对阿霉素耐药MCF-7/ADR细胞的生长发挥高效抑制作用。

Objective To investigate the effect of celastrol on the growth of adriamycin-resistant MCF-7/ADR breast cancer cells. Methods The resistance situation of MCF-7/ADR cells to adriamycin and the effect of celastrol on the growth of adriamycin-resistant MCF-7/ADR cells were evaluated by MTT assay. The effect of celastrol on apoptosis in MCF-7/ADR breast cancer cells was determined by annexin V-FITC/PI double staining. The effect of celastrol on cell cycle progression was determined by flow cytometry analysis. Results The resistance index of MCF-7/ADR cells to adriamycin was 14.54. After treatment with celastrol for 48 h, MCF-7/ADR cells displayed markedly inhibited growth in a dose-dependent manner, and calculated IC50 was 1.04 μmol/L. Celastrol decreased the resistance index of MCF-7/ADR from 14.54 to 0.87. The numbers of apoptotic MCF-7/ADR cells, as revealed by annexin V binding, significantly increased upon celastrol treatment (P＜0.05). Celastrol treatment caused an increase of cells in G1 phase from (59.22±3.78)% to (77.44±4.21)%, while the percentage of cells in S phase was decreased from(37.51±2.91)% to(19.65±2.25)%(P＜0.05). Conclusion These data demonstrated that celastrol induced apoptosis and G1/S cell cycle arrest in MCF-7/ADR cells and consequently displayed potent cytocidal effect on adriamycin-resistant MCF-7/ADR breast cancer cells.

目的 观察乳腺癌组织中沉默信息调节因子(SIRT1)的表达并探讨其临床意义。方法 选取70例乳腺癌组织和20例乳腺纤维腺瘤组织,应用免疫组化法观察SIRI1在两组中的表达,并分析其与临床病理参数、预后之间的关系。结果 SIRT1在乳腺癌组织中和乳腺纤维腺瘤组织中的阳性表达分别为:62.9%(44/70)、35%(7/20),P＜0.05;SIRT1的表达与乳腺癌的病理分期及淋巴结转移有关,P＜0.05;SIRT1表达阳性和阴性患者2年无疾病进展生存率分别为40.6%和73.7%,P＜0.05。结论 乳腺癌组织中SIRT1的阳性表达率较高,并与乳腺癌的发生、发展、侵袭、转移、预后有关。

Objective To investigate the sirtuin (SIRT1) expression in breast cancer and its relationship with clinicopathological parameters in breast tissue. Methods We used immunohistochemical staining (Envision two-step) to detect the expression of 70 cases of breast cancer and 20 cases of breast fibroadenoma of SIRT1. Results The positive expression of sirt1 in breast cancer and breast fibroadenoma tissues were 62.9 % (44/70) and 35 % (7/20),P<0.05. The expression of sirt1 was correlated with the pathological stage and lymph node metastasis of breast cancer, P<0.05. The 2-year survival rates of sirt1 positive and negative patients were 40.6 % and 73.7 %, respectively, P<0.05. Conclusion The positive expression rate of sirt1 in breast cancer is higher, and is related to the occurrence, development, invasion, metastasis and prognosis of breast cancer.

目的 构建吉西他滨耐药乳腺癌细胞4T1耐药株并建立裸鼠乳腺癌肝转移模型。方法 采用低浓度加量持续诱导法,诱导吉西他滨耐药乳腺癌细胞4T1耐药株,命名为4T1/Gem;CCK-8法测定4T1与4T1/Gem细胞的增殖抑制率,计算耐药指数; Western blot法检测细胞P-gp蛋白表达;B超引导下注射4T1/Gem细胞悬液诱导裸鼠肝脏成瘤;HE染色观察肿瘤组织病理情况,免疫组化法检测瘤组织ER、PR、HER2、Ki-67和P-gp蛋白的表达。结果 经过14个月的诱导成功建立4T1/Gem细胞株,可在含40 μg/mL的Gem培养液中稳定生长。4T1/Gem细胞耐药指数为4T1细胞的788.547倍。与亲代相比,4T1/Gem处于G1期和G2期的细胞增加,S期细胞减少;上调P-gp蛋白的表达。4T1/Gem细胞成功建立裸鼠乳腺癌肝转移模型,瘤组织中ER、PR、HER2蛋白阴性表达,Ki-67阳性10％和P-gp蛋白阳性表达。结论 成功构建吉西他滨耐药乳腺癌细胞4T1耐药株并建立裸鼠乳腺癌肝转移模型,为开发治疗乳腺癌肝转移化疗耐药的药物提供实验基础。

Objective To construct a gemcitabine-resistant variant of the breast cancer cell line (4T1/Gem) and establish a nude mouse model of breast cancer with hepatic metastatic. Methods A gemcitabine-resistant variant of the breast cancer 4T1 cell line was induced by gradually increasing the concentration of gemcitabine; this variant is referred to in this study as 4T1/Gem. The proliferation suppression rates of 4T1 and 4T1/Gem cells were determined by using the CCK-8 essay to evaluate the drug resistance indices of the cell lines. Western blot analysis was used to detect P-gp protein expression. Under ultrasonography, a 4T1/Gem cell suspension was injected into nude mice to induce liver tumors. H&E staining was used to observe tumor pathology, and immunohistochemistry was used to detect the expression of ER, PR, HER-2, Ki-67, and P-gp. Results After 14 months of induction, a 4T1/Gem cell line is established successfully. The cell line can grow stably in culture liquid containing 40 μg/ml gemcitabine. The drug resistance index of 4T1/Gem is 788.547. Compared with the 4T1 cell line, the 4T1/Gem cell line can upregulate P-gp protein expression and successfully establish a nude mouse model of breast cancer with hepatic metastatic. ER, PR, and HER-2 proteins exhibit negative expression in the tumor tissue. The positive expression of P-gp and 10% of Ki-67 proteins is also observed. Conclusion This study successfully constructs a gemcitabine-resistant variant of the breast cancer cell line (4T1/Gem)and establishes a nude mouse model of breast cancer with hepatic metastatic, thereby providing an experimental basis for developing and treating a drug-resistant variant of breast cancer.