目的：探讨高龄Luminal A型乳腺癌内分泌治疗的临床应用。方法该院收治的高龄Luminal A型乳腺癌患者11例，均采用内分泌治疗8～42个月，方案为依西美坦，25 mg／d，评估近期疗效。结果11例患者中临床完全缓解（cCR）2例，部分缓解（PR）6例，稳定（PR）3例，无疾病进展（PD）病例，内分泌治疗总有效率（OR）为72.7％（8／11）；所有患者均未出现严重毒副反应或因无法耐受而停止用药。结论内分泌治疗对于高龄Luminal A型乳腺癌患者安全、有效，尤对年迈、体弱、伴其他重要疾病而不能耐受化疗和手术的患者是很好的治疗选择。

Docetaxel and Carboplatin. In the group treated with the TAC regimen, 25 patients underwent therapy using Docetaxel, Epirubicin, and Cyclophosphamide. Neo-adjuvant chemotherapy was continued for six cycles until a comparison of the therapeutic effects was made. Results: The overall responses (OR) of patients in the two groups-TCG and TAC-were 94.9% (37/39) and 72% (18/25), respectively, P< 0.05. The pathologic complete responses (pCR) were 69.2% (27/39) and 32.0% (8/25), respectively, P<0.05. No significant differences were observed between the two groups in terms of adverse reactions, such as cardiac dysfunction, bone marrow suppression, and liver function impairment. Conclusion: During the treatment of HER-2 over-expressing breast cancer patients with neoadjuvant chemotherapy, Trastuzumab combined with Docetaxel and Carboplatin showed a favorable efficacy and a high pCR rate.

目的：探讨实施临床路径与个案管理在乳腺癌患者治疗中的意义。方法选择行乳腺癌手术的278例患者入组。分为观察组186例（顺利完成治疗181例，5例因变异因素退出）和对照组92例。观察组患者实施临床路径与个案管理治疗模式，对照组接受传统治疗模式。对比两组的住院时间、住院费用、手术并发症发生率及患者满意度。结果观察组与对照组的住院时间分别为（13.27±0.32）和（18.53±0.46） d（ t＝8.84，P＜0.05）；住院费用分别为（12984.73±325.42）和（16703.22±798.56）元（t＝11.75，P＜0.05）；患者满意度分别为（98.39±0.32）％和（82.61±1.25）％（ t＝8.24，P＜0.05）；手术并发症的发生率分别为2.69％和17.39％（礸2＝4.92，P＜0.05）；两组比较差异均有统计学意义。结论在乳腺癌手术住院治疗阶段实施临床路径与个案管理模式，可以明显缩短住院时间，降低医疗成本，减少手术并发症，提高患者满意度，值得临床推广。

Objective To study risk factors of postsurgical local recurrence after breast-conserving surgery in human epidermal growth factor receptor 2(HER-2) positive breast cancer.Methods The follow-up medical data of 82 patients with HER-2 positive breast cancer after breast-conserving therapy in our hospital during 6 years from June 2002 to June 2012 were collected,and the influences of age,HER-2 status,estrogen receptor(ER)/progesterone hormone receptor(PR) status,lymph node metastasis status,tumor size and anti-HER-2 therapy over local recurrences were analyzed.Results The median follow-up period was 52(8~118)months;9 cases(10.97%) had ipsilateral breasts local recurrence,while 11 cases(13.4%) had distant metastasis;5-year disease-free survival was 82.9%,5-year distant metastasis-free survival was 93.9%,and 5-year overall survival was 98.7%.Univariate analysis showed that lymph node status was the risk factor affecting local recurrences;the periods from the 2nd to the 3rd year and from the 5th to the 6th year after surgery were two peak periods for local recurrences;multivariate analysis showed that HER-2 expression status was an independent impact factor for local recurrences.Conclusions There are two peak periods for local recurrences after breast-conserving therapy.HER-2 expression status is an independent impact factor for local recurrences,and anti-HER-2 treatment can reduce local recurrences and distant metastasis.High-risk patients need more aggressive treatment.

Objective To research the relationship and meaning between sex hormones(as E2,FSH and LH) and clinical pathological features(as ER,PR,HER-2 and Ki-67),molecular typing,the recurrence risk of breast cancer,and to find the clinical significance in breast cancer diagnosis and prognosis by 3 sex hormones detection.Methods 86 female patients with breast cancer admitted from November 2011 to May 2013 in our hospital were enrolled in the research,including 31 postmenopausal cases(regarded as postmenopausal group) and 55 premenopausal cases(as premenopausal group).The 3 items of sex hormone(E2,FSH,LH) were detected by acridinium ester chemiluminescence method,the expression of ER,PR,HER-2 and Ki-67 were measured by SP immunohistochemical technique,and their relationships with clinicopathological features and recurrence risk assessment were analyzed by two independent samples t-test,Spearman rank correlation and rank-sum test.Results There was no obvious correlation between the level of three hormones(E2、 FSH、LH) and expression of ER and PR by two independent samples t-test,Spearman rank correlation and ranksum test(P > 0.05).There was direct correlation between FSH level and HER-2 expression in all 86 patients(t =2.167,P =0.034).In postmenopausal group,FSH level was not relevant with HER-2 status(t =1.751,P = 0.102),but higher than the value of E2 and LH.While in premenopausal group,FSH level was relevant with HER-2 status(t = 2.172,P = 0.036).LH levels and Ki-67 expression levels were correlated positively(the correlation coefficient =0.546,P =0.043),and both FSH and LH levels were significant positive correlated to molecular typing(the correlation coefficient = 0.644 or 0.632 respectively,P = 0.013 or 0.015 respectively) in postmenopausal group.FSH level is significant related to recurrence risk of breast cancer in postmenopausal group(χ2= 7.610,P = 0.022) and in premenopausal patients(χ2= 6.030,P = 0.049).Conclusions Status and level of expression of ER and PR has nothing to do with the 3 sex hormones(E2,FSH and LH) with relatively constant.FSH level in premenopausal breast cancer patients with HER-2 expression is positively correlated.The LH level and Ki-67 expression is positively correlated in postmenopausal breast cancer patients.The FSH,LH level and molecular typing is significant correlation in post-menopausal breast cancer patients.Whether menopause or not,FSH level is significantly related to the risk of recurrence in breast cancer patients.

Objective To investigate the expression of estrogen receptor,progesterone receptor,HER-2,Ki-67 in breast cancer and their clinical significance.Methods The expression of ER,PR,HER-2 and Ki-67 was detected in 372 patients with breast cancer and their correlations with clinicopathological features were analyzed.Results ER,PR positive expression rates were significantly lower in patients with lymph node metastasis than those in patients with no lymph node metastasis(P0.05),while HER-2 and Ki-67 positive expression rates were higher(P0.05).ER,PR positive expression rates were lower in patients with tumor size20 mm than those in patients with tumor size20 mm(P0.05),while HER-2 and Ki-67 positive expression rates were higher(P0.05).Expression of ER,PR was negatively correlated with HER-2,Ki-67 expression(P0.05).Conclusion ER,PR and HER-2,Ki-67 are valuable for predicting the breast cancer prognosis and providing the individualized treatment.

Objective:To evaluate the clinical efficacy of neoadjuvant chemotherapy combined with trastuzumab for HER-2 positive breast cancer. Methods:Thirty-nine patients with HER-2 positive breast cancer were treated with six cycles of docetaxel plus carboplatin based neoadjuvant chemotherapy combined with trastuzumab,and then the overall clinical efficacy was observed and univariate analysis was performed between the estrogen receptor(ER) expression status of the cancer tissues and pathologic complete response(pCR) rate. Results:The overall response(OR) rate of the 39 patients was 94.9%(37/39).Of the patients,clinical complete response(cCR) was achieved in 26 cases,partial response(PR) in 11 cases,stable disease in 2 cases and no case of progressive disease(PD).The pCR was seen in 27 cases(69.2%).The univariate analysis showed that the pCR rate of the ER-negative and ER-positive patients was 82.4% and 59.1% respectively. Conclusion:The docetaxel plus carboplatin based neoadjuvant chemotherapy combined with trastuzumab has demonstrable efficacy for HER-2 positive breast cancer,and the ER-negative patients can obtain a higher response rate.

This study is to explore the indications, procedures, effectiveness, and feasibility of nipple-areola sparing mastectomy followed by immediate breast reconstruction. The nipple-areola sparing mastectomy followed by immediate breast reconstruction was performed in 126 patients with breast cancer from June 2005 to October 2011. The cosmetic outcomes of the reconstructed breasts were evaluated according to objective and subjective criteria. Meanwhile, the postoperative complications were observed and the therapeutic efficacies were followed up. All the operations were successful. Six patients experienced mild complications early after surgery and were resolved after symptomatic treatment. Both the subjective and objective evaluation for the aesthetic outcomes yielded a satisfactory rate of 97.62% during the 6-80-month follow-up. No recurrence or metastasis was found in 118 cases. Nipple-areola sparing mastectomy followed by immediate breast reconstruction is a simple and effective option for significantly improving the cosmetic outcomes and quality of life of patients, without serious complications or impact on the comprehensive treatment and long-term effect against breast cancer.

为了在矫正乳头内陷的同时,避免切口的瘢痕,保持乳头的美观,保留乳头的感觉和哺乳功能,以20ml灭菌注射器自制成简易牵引器,用持续牵引的方法治疗乳头内陷.结果:2006年以来,本组56例乳头内陷患者,共97个乳头,持续牵引3-5个月,随访3月-1年,除2例提前取出牵引器,乳头回缩较多,效果不理想,其余乳头凸起美观自然,达到满意的效果.结论:持续牵引法根治乳头内陷,方法简便易行,对Ⅰ、Ⅱ、Ⅲ型乳头内陷都能治愈,牵出的乳头外形自然美观,感觉及哺乳功能良好.

Objective To investigate the clinical application value of immediate breast reconstruction using silicon implant after skin-sparing modified radical mastectomy for patients with breast cancer.Methods A total of 28 patients with breast cancer undergoing immediate breast reconstruction using silicon implant after skin-sparing modified radical mastectomy from January 2006 to December 2009 were included in this study.The perioperative results,breast appearance evaluation and follow-up results were analyzed.Results All 28 patients received axillary lymph node dissection and the number of lymph node dissected was 14-32(median 21).The operation time was 117-140 min(mean 126 min),blood loss was 82-124 ml(mean 98 ml),and the time to drainage tube removal was 3-5 d.No wound infection,skin necrosis,and foreign body reaction occurred in all the patients,especially in 22 patients underwent nipple-areola complex-sparing mastectomy,no ischemia or necrosis occurred in nipple-areola complex.For evaluation of breast appearance,excellent was in ten cases and good in 18 cases,thus,the excellent and good rate was 100%.All patients were followed up for 12-48 months(median 24 months) after operation,and distant metastasis,local recurrence,upper extremity edema,and dysfunction were not found.No fiber kystis contracture was found and all patients were satisfied with breast appearance and good handfeels.Conclusions Immediate breast reconstruction using silicon implant after skin-sparing modified radical mastectomy has the advantage of minimal invasion,safety,simple operation,and quick postoperative recovery for patients with breast cancer and the appearance of reconstructed breast is excellent,which can be clinically used widely.

表皮生长因子受体-2（human epidermal growth factor receptor 2，HER-2）过表达的乳腺癌患者其生物学行为恶性度高，无瘤生存期和总生存期较短[1]。深圳市第二人民医院乳房疾病诊疗中心2008年1月至2010年6月收治的34例HER-2过表达乳腺癌患者，采用曲妥珠单抗联合多西他赛及卡泊新辅助化疗，治疗6个周期后手术，疗效良好，现报道如下。

Background and purpose:It has been reported that neoadjuvant endocrine therapy(NET) for old hormone-dependent breast cancer patients is safe and effective.This study was to investigate the efficacy of NET for older patients with breast cancer.Methods:Forty-five cases of older patients with breast cancer with ER(+) and/or PR(+) were treated with exemestane for 25?mg/d as a NET option for 4 months.Results:Clinical overall response rate(OR) was 75.6% in 45 cases.Clinical complete response was occured in 2 cases whereas partial response in 32 cases,and stable disease in 11 cases,no disease progress during NET.The overall response(OR) was associated with both ER and PR strong positive patients,and lower histological grade.Conclusion:NET with exemestane for older breast cancer patients with ER(+) and/or PR(+) is safe and effective.

Objective To explore the influence of case management on endocrine treatment compliance of patients with breast cancer.Methods Control group involved 63 patients receiving endocrine treatment from September 2008 to August 2009 and experiment group included 63 patients who accepted endocrine treatment September 2009 to March 2010.Case manager offered comprehensive nursing for patients in experiment group.Results Patients' compliance to endocrine treatment in two groups indicated remarkably statistic difference(P0.05).Conclusion The application of case management in endocrine treatment among breast cancer patients can effectively improve patients' compliance and lower the risk of disease recurrence,which eventually extend their lifetime.

目的 探讨乳腺癌组织中ER,PR与HER-2,p53的表达及它们的相关性.方法 对收治的368例乳腺癌患者ER,PR,HER-2及p53的表达及它们的相关性进行回顾性分析.结果 淋巴结转移患者ER,PR阳性表达率低,HER-2及p53阳性表达率高,差异有统计学意义(P＜0.05);ER与PR表达呈显著正相关(r=0.644,P＜0.05),HER-2与p53表达呈低度正相关(r=0.197,P＜0.05);ER,PR与HER-2,p53表达呈负相关(r=-0.312,r=-0.511,r=-0.300,r=-0.464,P＜0.05).结论 ER,PR与HER-2,p53的检测对乳腺癌预后评估有重要意义.

Objective To evaluate the cancer-residual status in the margins following Mammotome biopsy for early-stage breast cancer.Methods A total of 283 patients with nonpalpable breast lesions underwent high-frequency ultrasound-guided mammotome biopsy.Among them,the margins status of patients with breast cancer finally diagnosed by mammotome biopsy was evaluated.Results In total,52 breast cancer patients were diagnosed by mammotome biopsy,included 38 cases of ductal carcinoma in situ(DCIS) and 14 cases of invasive ductal carcinoma.There were 43 cases of negative margins and 9 cases of positive margins.The 9 cases with positive margins underwent lumpectomy for residual carcinoma.Of these 9 cases,5 cases had negative margins and 4 cases had positive margins after lumpectomy,and the latter 4 cases with positive margins underwent simple mastectomy with a diagnosis of extensive intraductal component(EIC).The diagnosis by Mammotome biopsy was consistent with biopsy in 48 cases.Conclusions High-frequency ultrasound-guided Mammotome biopsy is a safe and effective method to diagnose early-stage breast cancer of nonpalpable breast lesions,and could effectively excise the lesions.

<正>随着人类基因表达谱分析及分子生物学技术研究的深入,人们对肿瘤的发病机制及治疗研究愈显透彻。乳腺癌属实体肿瘤中疗效较满意的肿瘤[1],相关研究活跃在前列。肿瘤专家逐渐形成共识,认为乳腺癌不是一

OBJECTIVE:To evaluate the clinical effect and prognosis of preoperative solid superselective intra-arterial targeted neoadjuvant chemotherapy in triple-negative breast cancer characterized by negative estrogen receptor,progesterone receptor and HER-2 receptor.METHODS:Forty-seven cases of triple-negative breast cancer patients(including stage Ⅱ 29 cases,stage Ⅲ 13 cases and stage Ⅳ 5 cases)were randomly selected to two groups:targeted chemotherapy group(24 cases)and control group(23 cases).The patients of the targeted chemotherapy group received preoperative solid superselective intra-arterial chemotherapy of MEF(10 cases)and EP(14 cases)and the patients of the control group received routine neoadjuvant chemotherapy of CMF,CEF and EP,respectively.The course of treatment,the change of focus and the prognosis were observed.RESULTS:The average course of treatment was 15 days in the targeted chemotherapy group which was significantly lower than that in the control group(31 days,P0.01).The remission rate of focus(CR+PR)was 91.6% in the targeted chemotherapy group and 85% in the control group respectively.Among these patients,9 cases died in two years,which conclude 2 cases(both Ⅳ stage)of the targeted chemotherapy group and 7 cases(stage Ⅱ 2 cases,stage Ⅲ 4 cases and stage Ⅳ 1 case)of the control group.CONCLUSION:As an assistant therapy method,the solid superselective intra-arterial neoadjuvant chemotherapy is an effective targeted therapy method of triple-negative breast cancer,which has the advantage of shorter course of treatment,better effect and prognosis.

目的 探讨立体超选择动脉灌注区域靶向新辅助化疗对"三阴"乳腺癌的临床疗效以及预后影响.方法 "三阴"乳腺癌患者47例,其中Ⅱ期32例,Ⅲ期10例,Ⅳ期5例.随机分为2组:靶向化疗组(24例),术前行立体超选择动脉灌注化疗,其中10例采用MEF方案,14例采用EP方案;对照组(23例):分别采用CMF,CEF,EP方案进行常规新辅助化疗.观察其疗程、病灶变化和预后情况.结果 靶向化疗组平均疗程(14.3±2.4)d,病灶缓解率(CR+PR)为91.6%;对照组平均疗程(30.5±3.8)d,病灶缓解率(CR+PR)为85%.靶向化疗组平均疗程明显低于对照组(P＜0.01).47例患者中9例在2年内死亡,其中靶向化疗组2例(均为Ⅳ期患者),对照组7例(Ⅱ期2例,Ⅲ期4例,Ⅳ期1例).结论 立体超选择动脉灌注新辅助靶向化疗作为"三阴"乳腺癌的辅助治疗,具有效果好、疗程短、预后佳等优点,是一种有效的"三阴"乳腺癌靶向治疗方法.

Objective To investigate the possibility of the generation of large numbers of autologous Dendritic cells and Cytokine-induced killer cells from breast cancer patients by peripheral blood stem cells mobilized. Methods Peripheral blood stem cells of breastcancer patients were mobilized by using rh GM-CSF. Peripheral blood mononuclear cells (PBMC) from 50 mL peripheral blood of breast cancer patients (experiment) and healthy donors (control) were isolated by Ficoll gradient centrifugation respectively. Dcs from adherent PBMC were generated by using rhGM-CSF、IL-4 and TNF-α in medium AIM-V (experiment) or RPMI 1640 (control). CIK cells from non-adherent PBMC were generated by using INF-γ, IL-1β, IL-2 and anti-CD3 MoAb in medium AIM-V (experiment) or RPMI 1 640 (control). Results The number of PBMC, DCs and CIK cells is 2×108, 1.2×107 and 2×109 in experimental group, which is significant higher than that in control group (P 0.01). The percentage of CD3+CD56+ cells in CIK cells is 14.41%. DCs highly expressed CD86、CD11 cand HLA-DR in bothgroups. Cytotoxic activity of CIK cell against Bel-7402 is 20.36%, 26.62%, 34.09% and 36.12% in the rate of effect and target cells 5:1, 10:1, 20:1 and 40:1. Conclusion The study suggested that large numbers of full mature autologous Dendritic cells and Cytokine-induced killer cells can generate from breast cancer patients by peripheral blood stem cells mobilized and suit for adoptive immunotherapy of breast cancer patients.

Objective To study the value of BCSG1 on evaluating the curative effect of neoadjuvant chemotherapy(NC) for breast cancer.Methods The expression of BCSG1 in cancer tissue was assayed by immunohistochemistry and RT-PCR in 36 cases of breast cancer patients before and after receiving NC of CEF(cyclophosphamide,epirubicin and fluorouracil) regimen.The therapeutic response of NC was evaluated by morphological and pathological observation.The relationship between expression of BCSG1 and morphological response to NC was analyzed.Results Among the studied cases,the diameter of tumor significantly decreased(P0.01)and the improvment rate of the treatment effect(CR+PR) was 85.6%.The expression of BCSG1 mRNA(P0.05)and the high expression rate of BCSG1(P0.01)were decreased significantly after receiving NC than that before NC.Conclusions After NC,the expression of BCSG1 mRNA and protein was decreased significantly,which had negative relation to the therapeutic effect of NC.BCSG1 can be a prognosticate gene to evaluate the effect of NC in breast cancer patients.