Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2019-11-15 Cooperative journals: 《协和医学杂志》
Abstract：目的 探讨乳腺原发性神经内分泌癌（primary neuroendocrine carcinoma of the breast, NEBC）和乳腺浸润性癌（非特殊型）（invasive carcinoma of no special type，NST）的临床病理差异以及淋巴结转移的相关影响因素。结果两组患者的年龄、瘤体直径、组织学分级、清扫淋巴结数目及TNM分期均无统计学差异，两组患者基线水平较为一致。50例原发性乳腺神经内分泌癌中有淋巴结转移的患者15例。雌激素受体阳性表达率为96%，孕激素受体阳性表达率为84%，HER-2 阳性表达率为8.5%，嗜铬素A阳性表达率为58%，突触素阳性表达率为97.9%。影响淋巴结转移的相关因素分析中，T分期在对照组NST患者中存在显著的差异（P=0.006），在研究组则没有显著差异（P=0.872），研究组淋巴结转移率与T分期、组织学分级及免疫组化指标尚未发现明确的差异性（P>0.05）。结论在原发性乳腺神经内分泌癌中，雌激素受体、孕激素受体阳性表达率高，HER-2 阳性表达率低，突触素阳性表达率较嗜铬素A高。虽然评估NEBC的预后标准尚有争议，但是仍然需要重视联合检测上述免疫组化指标及淋巴结状况。
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2019-03-11 Cooperative journals: 《协和医学杂志》
Abstract：随人口老龄化，乳腺癌的治疗需要面对更多的老年乳腺癌患者。近年来，乳腺癌的靶向治疗作为人表皮生长因子 2（HER2)阳性乳腺癌的全身治疗重要方法，在乳腺癌治疗中显示出越来越重要的地位。无心脏基础疾病的老年 HER2 阳性乳腺癌患者是否应使用曲妥珠单抗进行靶向治疗存在争议。目前证据表明60-70 岁老年 HER2 阳性乳癌患者可从曲妥珠单抗治疗中获益，心脏事件风险较低且可逆。70 岁以上目前无大规模试验证据支持。在选择辅助治疗方案是需平衡获益与风险，综合考虑患者本人意愿，身体状况，合并疾病情况，进行个体化治疗，如选择使用曲妥珠单抗，需避免与蒽环类化疗药物联用，并监测心功能，及时发现和处理心脏事件。
Subjects: Medicine, Pharmacy >> Preclinical Medicine submitted time 2018-06-14 Cooperative journals: 《协和医学杂志》
Abstract： Objection:To investigate the clinical and pathological features and the follow-ups of 173 patients with pathological nipple discharge,and to provide the evidence of diagnosis and treatment.Methods:We reviewed the data of the patients who suffered pathological nipple discharge and as well underwent surgery in 2015.Statistical analysis was conducted by spss 22.0.T test and Mann-Whitney U test,X2 test and Fisher exact test were engaged in mean comparision,comparision of count data.Result: There were no statistically significant difference in age，unilateral/ bilateral， single/multiple symptoms, duration of symptoms, positive findings of physical examination and Mammography between patients with bloody nipple discharge or not. Ultrasound revealed more positive findings in patients with bloody nipple discharge (P=0.016). Compared with unbloody discharge ,patients with bloody discharge showed higher rate of breast cancer(P=0.048).Among patients with bloody discharge, ages were significantly different between patients with and without breast cancer (P= 0.014) .Other factors showed no difference.Overall, no local or systemic recurrence or death was observed at a median follow-up of 17months. Conclusion: Bloody nipple discharge showed more risk of breast cancer, especially for the elder patients. Ultrasound revealed more lumps than physical examination and mammography. Since the examinations could not find the malignant lesions out of the symptoms of nipple discharge, surgery was always needed.
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