乳腺癌腋窝淋巴结清扫术后上肢淋巴水肿的危险因素分析

研究背景：乳腺癌是女性常见的恶性肿瘤之一,同时也是治愈率最高的癌症,文献报道早期乳腺癌术后5年生存率达85．16％。上肢淋巴水肿是腋窝淋巴结清扫术后常见并发症,术后10—35％患者出现上肢水肿,就上肢淋巴水肿的风险因素,国内外做了许多研究,但结果不一,分歧较大。方法：抽取60例腋窝淋巴结清扫术后患者,调查统计可能与腋窝淋巴结清扫术后上肢淋巴水肿相关的8个因素（变量）：年龄、临床分期、是否放疗、是否出现延迟愈合／感染／积液等术后其它并发症、术后上肢功能锻炼、是否是优势侧,平时是否参加体育锻炼,是否有高血压等合并症。数据采用SPSS13．0分析软件以logistic回归方法进行分析。结果：四项关联因素分别为：1、是否放疗（OR=8．966）2、延迟愈合／感染／积液等其它术后并发症（0R=8．493）3、术后上肢功能锻炼（OR=0．194）4、高血压（0R=5．609）。结论：放疗、其它术后并发症、高血压为腋窝淋巴结清扫术后上肢淋巴水肿的风险因素,而术后上肢功能锻炼为术后水肿的保护因素。     

乳腔镜腋窝淋巴结清扫术与常规淋巴结清扫术治疗乳腺癌的临床效果

目的:通过对比两种不同的临床治疗乳腺癌的效果,提出临床治疗乳腺癌更可靠的方案,为临床治疗和相关研究提供参考。方法:选取我院2010年12月至2014年12月期间我院临床收治的乳腺癌患者56例,根据患者临床治疗手术方法情况,分成了研究组和对照组,研究组患者给予乳腔镜腋窝淋巴结清扫术,对照组患者均给予常规的腋窝淋巴结清扫术,观察和比较两者患者实施不同手术治疗后的手术时间、住院费用、术中出血量和并发症发生情况。结果:研究组患者的手术时间长于对照组,研究组患者的住院费用高于对照组,而患者术中出血量研究组患者也低于对照组患者,组问比较差异均具有统计学意义(P0.05);两组患者术后并发症的发生率比较,差异无统计学意义(P0.05)。结论:与常规腋窝淋巴结清扫术相比较,乳腔镜手术所需时间较长,并且治疗费用偏高,临床上应给予患者的个体差异情况有针对性的选择实施。     

超声评估乳腺癌腋窝淋巴结的临床分析

目的 探讨超声技术评估乳腺癌腋窝淋巴结(ALN)的临床价值.方法 选取2017年8月～2020年8月经我院确诊的96例乳腺癌患者为研究对象,其中非转移性淋巴结50例,转移性淋巴结46例,均行彩色多普勒超声检查,并对检查结果进行分析.结果 非转移性淋巴结患者与转移性淋巴结患者的超声影像学特征(病灶象限、乳腺后间隙、前方脂...     

自拟温阳利水汤联合地奥司明治疗乳腺癌术后上肢淋巴水肿的疗效观察

摘要 目的：探究自拟温阳利水汤联合地奥司明治疗乳腺癌术后上肢淋巴水肿的疗效。方法：选择2013年1月至2019年6月在我院经病理确诊为乳腺癌术后上肢淋巴水肿的住院患者80例,根据治疗方式不同分为两组,每组各40例,其中,对照组采用地奥司明进行治疗,研究组在对照组基础上联合自拟温阳利水汤进行治疗,两组均连续治疗15 d;对比两组的治疗总有效率,对比两组治疗前后的腕横纹、肘横纹、腕横纹上10 cm、肘横纹上10 cm处臂围;对比两组患者治疗前后的前屈、后伸、外展、内收等活动角度。结果：研究组治疗总有效率95.00 %（38/40）显著高于对照组75.00 %（30/40）,对比有显著差异（P＜0.05）;治疗前,两组的腕横纹、肘横纹、腕横纹上10 cm、肘横纹上10 cm处臂围对比无统计学差异（P＞0.05）;治疗后,两组的腕横纹、肘横纹、腕横纹上10 cm、肘横纹上10 cm处臂围均比治疗前有所减小,且研究组更小（P＜0.05）;治疗前,两组的前屈、后伸、外展、内收等活动角度对比无统计学差异（P＞0.05）;治疗后,两组患者的前屈、后伸、外展、内收等活动角度均比治疗前有所增大,且研究组更大（P＜0.05）。结论：自拟温阳利水汤联合地奥司明治疗乳腺癌术后上肢淋巴水肿的疗效显著,该方法可有效改善患者的肩关节活动度,临床应用价值较高。     

初诊腋窝淋巴结阳性乳腺癌新辅助化疗后对腋窝淋巴结转阴性前哨活检的影响分析

摘要 目的：探究对初诊腋窝淋巴结阳性乳腺癌行新辅助化疗患者开展腋窝前哨淋巴结活检的临床意义。方法：选择2017年1月至2020年10月于我院接受改良根治术或保乳术治疗的100例初诊腋窝淋巴结阳性乳腺癌患者,将其中50例病理检测II B、III期行4~8个疗程新辅助化疗后实施前哨淋巴结活检患者设为研究组,将50例I、II A期直接行前哨淋巴结活检患者设为对照组,对比两组患者前哨淋巴结检出率、准确率、假阴性率和灵敏度,同时就患者病理特征与前哨淋巴结检出率的相关性开展分析。结果：（1）比较显示研究组患者与对照组患者在前哨淋巴结检出数、前哨淋巴结检出率以及前哨淋巴结假阴性率方面组间差异不大（P>0.05）;（2）病理学特征分析显示肿瘤直径以及临床N分期同新辅助化疗后患者前哨淋巴结检出阳性率密切相关（P<0.05）。结论：对初诊腋窝淋巴结阳性行新辅助化疗乳腺癌患者实施前哨淋巴结活检具有较显示的临床意义,能够较好的预测患者腋窝淋巴结状况,同时化疗前肿瘤直径、临床N分期是影响前哨淋巴结检出率的重要影响因素。     

早期乳腺癌腋窝淋巴结转移风险因素及风险预测模型的建立

目的:探究早期乳腺癌腋窝淋巴结转移的独立危险因素,并建立有效的风险预测模型。方法:回顾性分析辽宁省肿瘤医院2016年6月至2017年12月收治的404例早期乳腺癌患者的临床资料,采用x2检验或Fisher确切概率法对临床病理特征与腋窝淋巴结转移情况进行单因素分析,采用多元逐步Logistic回归分析探索腋窝淋巴结转移的独立危险因素,根据各危险因素的回归系数进行赋值,建立风险预测模型,采用ROC曲线验证其检验效能并绘制校准曲线评估其与真实情况的一致性。结果:早期乳腺癌发生腋窝淋巴结转移与肿瘤大小、病理分级、脉管侵袭、ER表达、KI67大小、分子亚型和淋巴结总数≥14枚(14枚为淋巴结平均数)之间存在统计学差异(P0.05),而与年龄、绝经与否、肿瘤位置、病理类型、PR等因素无关(P0.05)。单因素及多因素分析结果显示肿瘤2 cm、病理分级Ⅲ级、存在脉管侵袭及ER表达≧50%是早期乳腺癌发生腋窝淋巴结转移的独立危险因素(P0.05)。风险预测模型ROC曲线下面积为0.852(95%CI为(0.812,0.892),P0.01)。校准曲线R2=0.9086(P0.05)。结论:肿瘤2 cm、病理分级Ⅲ级、存在脉管侵袭、ER表达≧50%早期乳腺癌患者发生腋窝淋巴结转移风险较高。     

BRMS1与乳腺癌腋窝淋巴结微转移的临床研究

目的:探讨BRMS1的表达与乳腺癌腋窝淋巴结微转移的关系.方法:采用连续切片和CK-19联合检测86例腋窝淋巴结转移阴性的所有淋巴结微转移灶的情况,术后随访其复发情况,免疫组化检测乳腺癌组织中BRMS1的表达并分析其与淋巴结微转移及术后复发率的关系.结果:86例乳腺癌腋窝淋巴结转移阴性的689淋巴结中有48粒(6.97％)检测到微转移,其中阳性病例22例(25.58％),BRMS1的表达阴性的乳腺癌患者腋窝淋巴结微转移病例率(43.24％)和术后复发率(54.05％)远高于BRMS1表达阳性的乳腺癌患者(12.24％,8.16％),差异具有显著性,且呈明显的负相关.结论:BRMS1与腋窝淋巴结微转移密切相关,可以成为乳腺癌腋窝淋巴结微转移分子指标,并对乳腺癌的分期、预后、治疗具有重要的指导意义.     

高频彩色多普勒超声对乳腺癌腋窝淋巴结性质的鉴别价值

目的:研究高频彩色多普勒超声对乳腺癌腋窝良性淋巴结与腋窝转移性淋巴结的鉴别价值。方法:选择2015年2月~2016年6月在我院进行诊治的乳腺癌患者150例,应用高频二维超声结合彩色多普勒血流显像技术,观察腋窝肿大淋巴结的声像图及血流情况。结果:经二维超声发现,乳腺癌腋窝良性淋巴结的皮质多向心增厚(68.93%)、长短径比L/S多2.0(70.58%)、多不融合(93.14%)、多无钙化斑(97.06%);腋窝转移性淋巴结的皮质多偏心增厚(68.48%)、长短径比L/S多2.0(69.57%)、多融合(68.48%)、多有钙化斑(77.17%);两者相比有明显差异(P0.05);经彩色多普勒血流显像技术发现,乳腺癌腋窝良性淋巴结的血流信号分布多呈门型(63.17%),血流丰富程度多为Ⅱ级(54.35%);腋窝转移性淋巴结的血流信号分布多呈周边型(68.93%),血流丰富程度多为Ⅲ级(72.83%);两者相比有明显差异(P0.05)。结论:乳腺癌腋窝良性淋巴结与腋窝转移性淋巴结在内部回声、形态、血流分布特点等方面有显著的差异,高频彩色多普勒超声对乳腺癌腋窝良性淋巴结与腋窝转移性淋巴结具有较高的鉴别价值。     

直肠癌的淋巴结转移的危险因素

目的:本研究主要目的为确定直肠癌的淋巴结转移的危险因素。方法:通过对1250例于2004年-2008年行直肠癌根治性切除的患者进行单因素和多因素分析,以确定淋巴结转移相关的危险因素,同时对PT分期和肿瘤大小之间的关系进行了相关性分析。结果:直肠癌患者淋巴结转移发生率为41%。在单因素分析中,患者年龄(P=0.008)、肿瘤大小(P=0.003)、PT分期(P<0.0019)以及分化程度(P<0.001)和淋巴结转移相关。在多因素分析中,年龄(P=0.017,OR=0.988,95%可信区间:0.978-0.998)、PT分期(P<0.001,OR=1.952,95%可信区间:1.656-2.302)和分化程度(P<0.001,OR=3.697,95%可信区间:2.112-6.472)是淋巴结转移的独立因素。结论:在直肠癌相关分析中,肿瘤的大小和PT分期呈正相关。年龄、PT分期和肿瘤分化程度是淋巴结转移的独立因素。在直肠癌中,肿瘤的大小和PT分期呈正相关。     

系统性淋巴结清扫术对子宫内膜癌患者预后的影响及安全性分析*

目的:分析系统性淋巴结清扫术对子宫内膜癌患者预后的影响及安全性。方法:选择2010年6月~2012年6月我院收治的68例子宫内膜癌患者作为研究对象,将其随机分为研究组与对照组。对照组行两侧附件+全子宫切除+盆腔淋巴结清扫术,研究组行两侧附件+全子宫切除+系统性腹腔、盆腔主动脉旁淋巴结清扫术。观察和比较两组患者术后3年内的生存率、疾病复发转移率以及并发症的发生率。结果:研究组检出阳性淋巴结15枚,发现4例患者淋巴结转移;对照组患检出阳性淋巴结3枚,发现1例患者淋巴结转移。两组阳性淋巴结检出率及淋巴结转移发现率比较差异无统计学意义(P0.05)。研究组3年内生存率为88.24%,显著高于对照组的67.65%(P0.05);复发转移率为14.71%,显著高于对照组的35.29%(P0.05)。研究组患者术后发生不全性肠梗阻发生率为17.65%,显著高于对照组(P0.05);但两组术后下肢水肿、深静脉血栓、淋巴囊肿、输尿管尿瘘、体温转复时间5 d的发生率对比差异均无统计学意义(P0.05)。结论:系统性淋巴结清扫术可以延长子宫内膜癌患者的3年生存率,降低病灶的复发及转移率,虽然术后不全性肠梗阻的发生率有所增加,但仍在可控范围内。     

Prognostic Value of Metastatic Axillary Lymph Node Ratio for Chinese Breast Cancer Patients

Objective

The prevalence of breast cancer varies among countries and regions. This retrospective study investigated the prognostic value of the lymph node ratio (LNR) compared with the number of positive lymph nodes (pN) in Chinese breast cancer patients.

Methods

The medical records of female breast cancer patients (N = 2591) were retrospectively evaluated. The association of LNR and TMN staging system were compared with respect to overall, disease-free, and distant metastasis-free survival.

Results

Out of 2591 patients, 2495 underwent modified radical surgery and 96 received breast conserving surgery. All patients had adjuvant chemotherapy following surgery. The median follow up period 66.9 months (range 5–168 months). The 5-year and 10-year overall survival rates were 89.3% and 78.8%, respectively, and 5-year disease-free survival and distant metastasis-free survival rates were 81.6% and 83.5%, respectively. Univariate analysis indicated that in general T, pN, LNR, as well as tumor expression of the estrogen receptor, progesterone receptor, and HER2 were associated with overall, disease-free, and distant metastasis-free survival (all P-values <0.05). Mutlivariate analysis found pN stage and LNR were independent predictors of overall, disease-free, and distant metastasis-free survival (all P-values <0.001). If pN stage and LNR were both included in a multivariate analysis, LNR was still an independent prognostic factor for overall, disease-free, and distant metastasis-free survival (all P-values <0.001).

Conclusion

Our findings support the use of LNR as a predictor of survival in Chinese patients with breast cancer, and that LNR is superior to pN stage in determining disease prognosis.     

Quantitative Molecular Analysis of Sentinel Lymph Node May Be Predictive of Axillary Node Status in Breast Cancer Classified by Molecular Subtypes

To determine the performance of intraoperative one-step nucleic acid amplification (OSNA) assay in detecting sentinel lymph node metastases compared to postoperative histology taking into account breast cancer molecular classification and to evaluate whether the level of cytokeratin 19 mRNA copy number may be useful in predicting the likelihood of a positive axillary lymph node dissection. OSNA assay was performed in a prospective series of 903 consecutive sentinel lymph nodes from 709 breast cancer patients using 2 alternate slices of each sentinel lymph node. The remaining 2 slices were investigated by histology. Cytokeratin 19 mRNA copy number, which distinguishes negative cases (<250 copies), micrometastases (+, ≥250≤5000 copies) and macrometastases (++, >5000 copies), was compared to axillary lymph node dissection status and to the biological tumor profile. Concordance between OSNA and histopathology was 95%, specificity 95% and sensitivity 93%. Multiple Corresponce Analysis and logistic regression evidenced that positive axillary lymph node dissection was significantly associated with a higher cytokeratin 19 mRNA copy number (>5000; p<0.0001), HER2 subtype (p = 0.007) and lymphovascular invasion (p<0.0001). Conversely, breast cancer patients with cytokeratin 19 mRNA copy number <2000 mostly presented a luminal subtype and a negative axillary lymph node dissection. We confirmed that OSNA assay can provide standardized and reproducible results and that it represents a fast and quantitative tool for intraoperative evaluation of sentinel lymph node. Omission of axillary lymph node dissection could be proposed in patients presenting a sentinel lymph node with a cytokeratin 19 mRNA copy number <2000 and a Luminal tumor phenotype.     

Effect of Implant vs. Tissue Reconstruction on Cancer Specific Survival Varies by Axillary Lymph Node Status in Breast Cancer Patients

BackgroundTo compare the breast cancer-specific survival (BCSS) between patients who underwent tissue or implant reconstruction after mastectomy.MethodWe used the database from Surveillance, Epidemiology, and End Results (SEER) registries and compared the BCSS between patients who underwent tissue and implant reconstruction after mastectomy. Cox-regression models were fitted, adjusting for known clinicopathological features. The interaction between the reconstruction types (tissue/implant) and nodal status (N-stage) was investigated.ResultsA total of 6,426 patients with a median age of 50 years were included. With a median follow up of 100 months, the 10-year cumulative BCSS and non-BCSS were 85.1% and 95.4%, respectively. Patients who underwent tissue reconstruction had tumors with a higher T-stage, N-stage, and tumor grade and tended to be ER/PR-negative compared to those who received implant reconstruction. In univariate analysis, implant-reconstruction was associated with a 2.4% increase (P = 0.003) in the BCSS compared with tissue-reconstruction. After adjusting for significant risk factors of the BCSS (suggested by univariate analysis) and stratifying based on the N-stage, there was only an association between the reconstruction type and the BCSS for the N2-3 patients (10-year BCSS of implant vs. tissue-reconstruction: 68.7% and 59.0%, P = 0.004). The 10-year BCSS rates of implant vs. tissue-reconstruction were 91.7% and 91.8% in N0 patients (P>0.05) and 84.5% and 84.4% in N1 patients (P>0.05), respectively.ConclusionsThe implant (vs. tissue) reconstruction after mastectomy was associated with an improved BCSS in N2-3 breast cancer patients but not in N0-1 patients. A well-designed, prospective study is needed to further confirm these findings.     

The Influence of Arm Swelling Duration on Shoulder Pathology in Breast Cancer Patients with Lymphedema

Purpose

To evaluate the pathological effect of the duration of arm swelling on the shoulder pathology in patients with breast cancer-related lymphedema.

Methods

Forty seven breast cancer patients with unilateral arm lymphedema were assessed. The duration of the arm swelling and shoulder pain were recorded. Ultrasound examination of the shoulder joint was performed in all patients to detect any lesions.

Results

Abnormalities were detected by ultrasound in 41/47 (87.2%) study participants. Subacromial subdeltoid bursal thickening was found in 26/47 (55.3%) participants, distension of the biceps brachii tendon sheath was found in 14/47 (29.8%) and a supraspinatus tendon tear was found in 13/47 (27.7%). Patients with a supraspinatus tendon tear were found to have a significantly longer duration of lymphedema (1310 days vs. 398 days, p = 0.032).

Conclusions

The duration of arm lymphedema has a progressive pathological effect on rotator cuff. Clinicians should adopt an early management approach of shoulder pain in patients with breast cancer-related lymphedema.