Objective:The spectrum and risk of cancer in relatives of BRCA1/2 pathogenic variant carriers in the Chinese population have not been established.Methods:A family history of cancer in 9903 unselected breast cancer pat...Objective:The spectrum and risk of cancer in relatives of BRCA1/2 pathogenic variant carriers in the Chinese population have not been established.Methods:A family history of cancer in 9903 unselected breast cancer patients was retrospectively analyzed.BRCA1/2 status was determined for all patients and relative risks(RRs)were calculated to evaluate cancer risk in relatives of the patients.Results:The incidences of breast cancer in female relatives of BRCA1 carriers,BRCA2 carriers,and non-carriers were 33.0%,32.2%,and 7.7%,respectively.The corresponding incidences of ovarian cancer were 11.5%,2.4%,and 0.5%,respectively.The incidences of pancreatic cancer in male relatives of BRCA1 carriers,BRCA2 carriers,and non-carriers were 1.4%,2.7%,and 0.6%,respectively.The corresponding incidences of prostate cancer were 1.0%,2.1%,and 0.4%,respectively.The risks of breast and ovarian cancers in female relatives of BRCA1 and BRCA2 carriers were significantly higher than female relatives of non-carriers(BRCA1:RR=4.29,P<0.001 and RR=21.95,P<0.001;BRCA2:RR=4.19,P<0.001 and RR=4.65,P<0.001,respectively).Additionally,higher risks of pancreatic and prostate cancers were noted in male relatives of BRCA2 carriers than non-carriers(RR=4.34,P=0.001 and RR=4.86,P=0.001,respectively).Conclusions:Female relatives of BRCA1 and BRCA2 carriers are at increased risk for breast and ovarian cancers,and male relatives of BRCA2 carriers are at increased risk for pancreatic and prostate cancers.展开更多
目的探究真实世界中程序性死亡蛋白1(Programmed Death Protein 1,PD-1)/程序性死亡蛋白配体1(Programmed Death Protein Ligand 1,PD-L1)抑制剂治疗对晚期非小细胞肺癌(Non-Small Cell Lung Cancer,NSCLC)二线及以上患者预后转归的影...目的探究真实世界中程序性死亡蛋白1(Programmed Death Protein 1,PD-1)/程序性死亡蛋白配体1(Programmed Death Protein Ligand 1,PD-L1)抑制剂治疗对晚期非小细胞肺癌(Non-Small Cell Lung Cancer,NSCLC)二线及以上患者预后转归的影响。方法选取2019年1月—2023年7月涟水县人民医院就诊的112例晚期NSCLC二线及以上患者为研究对象,依据治疗方法分为两组,每组56例,对照组接受二线及以上单药化疗,观察组接受PD-1/PD-L1抑制剂免疫治疗,对比两组生存质量、无进展生存期、总生存期及不良反应发生率。结果化疗4个周期后,观察组生存质量评分显著高于对照组,差异有统计学意义(P<0.05)。观察组无进展生存期、总生存期显著优于对照组,差异有统计学意义(P均<0.05)。观察组不良反应发生率显著低于对照组,且观察组高血压发生人数显著少于对照组,差异有统计学意义(P均<0.05)。结论晚期NSCLC患者二线治疗中PD-1/PD-L1抑制剂免疫治疗能提升患者生存质量,降低其不良反应发生率。展开更多
BACKGROUND It is estimated that about 30%of esophageal cancer(EC)patients are over 70 years old.Therefore,there is less evidence on the diagnosis and management of elderly EC patients.It is important to explore how el...BACKGROUND It is estimated that about 30%of esophageal cancer(EC)patients are over 70 years old.Therefore,there is less evidence on the diagnosis and management of elderly EC patients.It is important to explore how elderly EC patients benefit from radical radiochemotherapy regimens,including the target area of radiotherapy(RT),radiation dose and fraction,and choice of chemotherapy drugs.AIM To compare the efficacy of involved-field intensity-modulated RT(IF-IMRT)combined with S-1 vs RT alone in the treatment of elderly EC patients in terms of safety,short-term response,and survival.METHODS Thirty-four EC patients aged>70 years were prospectively enrolled between December 2017 and December 2019.Based on the random number table,they were divided into an IF-IMRT+S-1 group and an IF-IMRT alone group,with 17 patients in each group.All patients were treated with IF-IMRT at a dose of 50.4-56 Gy in 28-30 fractions(1.8-2 Gy/fraction,5 fractions/wk).Oral S-1 was administered concomitantly in the IF-IMRT+S-1 group for 14 consecutive days,and a second cycle was started 7 d after drug withdrawal.After RT,4 cycles of S-1 treatment were offered as the consolidation chemotherapy.The safety,short-term response,and survival were observed after the treatment.RESULTS As of April 2022,these 34 patients had been followed up for 15.2-32.5 mo,with a median follow-up period of 24.5 mo.Complete efficacy indicators were obtained from all the patients.The objective response rate was 88.2%vs 76.5%,respectively,in the IF-IMRT+S-1 group and the RT alone group,where as the disease control rate was 100%vs 82.4%,respectively.The incidence of adverse events including grade 1-2 fatigue,granulocytopenia,thrombocytopenia,anemia,radiation esophagitis,radiation-induced skin injury,and radiation-induced lung injury was not significantly different between these two groups,so was the incidence of the grade 3 radiation esophagitis(0%vs 5.7%).The rate of progressive disease(PD)was 52.9%(n=9)in the IF-IMRT+S-1 group and 64.7%(n=11)in the RT alone group.The median progression-free survival(PFS)was 23.4 mo vs 16.3 mo,and the 2-year PFS rate was 42%vs 41.2%.The median overall survival(OS)was 27.0 mo vs 23.0 mo,and the 2-year OS rate was 58.8%vs 47.1%.Multivariate analysis showed that age was a significant prognostic factor(P=0.0019);patients aged<75 years had a significant survival advantage over patients aged≥75 years.The locations of EC also affected the prognosis.In the IFIMRT+S-1 group,the number of chemotherapy cycles was a significant prognostic factor(P=0.0125),and the risk of PD was significantly lower in EC patients who had received 6 cycles of chemotherapy than those who had received 2-5 cycles of chemotherapy.CONCLUSION Compared with IF-IMRT alone,IF-IMRT+S-1 shows the benefits of preventing PD and prolonging survival without increasing adverse reactions.Therefore,this concurrent radiochemotherapy deserves clinical application.展开更多
目的评价程序性细胞死亡蛋白-1(PD-1)抑制剂治疗老年晚期非小细胞肺癌的疗效和安全性。方法检索中国临床肿瘤学会、美国国立综合癌症网络、美国癌症协会、欧洲肿瘤内科学会、PubMed、Ovid(Cochrane Database of Systematic Reviews and ...目的评价程序性细胞死亡蛋白-1(PD-1)抑制剂治疗老年晚期非小细胞肺癌的疗效和安全性。方法检索中国临床肿瘤学会、美国国立综合癌症网络、美国癌症协会、欧洲肿瘤内科学会、PubMed、Ovid(Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials)、中国知网(CNKI)、万方数据库、维普数据库,纳入3个肿瘤学会发布的非小细胞肺癌和老年肿瘤相关指南及PD-1抑制剂治疗老年非小细胞肺癌临床研究,对纳入的文献进行描述性分析。结果共纳入文献9篇,包括系统评价3篇、临床试验2篇、真实世界研究亚组分析1篇、个案报道2篇、队列研究1篇。根据指南,PD-1抑制剂可以引入作为大多数无驱动基因的晚期非小细胞肺癌患者的新标准治疗方案。目前指南暂未根据患者年龄推荐PD-1抑制剂的给药方案。现有研究显示,PD-1抑制剂在老年人群的安全性与全人群相似。60~65岁老年患者可以从PD-1抑制剂治疗中获益,但年龄≥75岁患者人群中免疫检查点抑制剂的疗效存在争议。结论目前老年非小细胞肺癌患者使用PD-1抑制剂证据较多的是帕博利珠单抗和纳武利尤单抗,有限证据显示帕博利珠单抗治疗老年非小细胞肺癌患者有效且安全。PD-1抑制剂治疗老年非小细胞肺癌患者的证据匮乏,尤其缺乏真实世界研究。展开更多
目的:探讨YB-1(Y-box binding protein 1)在青年型乳腺癌组织中的表达及意义。方法:应用免疫组织化学方法研究YB-1蛋白在青年型乳腺癌组织中的表达,并结合病理组织学类型、病理分级等临床特征分析YB-1在青年型乳腺癌组织中的表达意义;依...目的:探讨YB-1(Y-box binding protein 1)在青年型乳腺癌组织中的表达及意义。方法:应用免疫组织化学方法研究YB-1蛋白在青年型乳腺癌组织中的表达,并结合病理组织学类型、病理分级等临床特征分析YB-1在青年型乳腺癌组织中的表达意义;依据ER、PR、HER-2、CK5/6表达对青年型乳腺癌进行分子分型(Luminal-A、Luminal-B、HER2+和Basal-like 4个分子亚型),并分析其与YB-1表达的关系。结果:HE结果显示64例青年型乳腺癌病理组织学分类主要为浸润性导管癌,占59.4%。免疫组化结果显示64例青年型乳腺癌组织中YB-1阳性率为92.2%,其中细胞核阳性表达率53.1%,细胞浆阳性表达率39.1%。肿瘤>2cm的患者占59.4%,YB-1主要表达在细胞核(40.6%),患者肿瘤?2cm占37.5%,YB-1则主要在细胞浆表达(20.3%),YB-1表达类型与肿瘤大小有显著统计学意义(P=0.036)。组织学3级所占比例最高,占48.4%,且多为YB-1细胞核表达(37.5%),乳腺癌不同的组织学分级间YB-1的表达率不同(P=0.000);青年型乳腺癌患者发生淋巴结转移的比例高(84.4%),其中N3期所占比例最高,占40.6%,YB-1主要在细胞核表达,占31.3%,胞浆表达占7.8%。青年型乳腺癌分子分型中主最多见的是Luminal-B型,占46.9%,YB-1主要表达在细胞核(32.8%),浆表达仅占9.4%,统计分析显示YB-1表达的核浆分布特点与青年型乳腺癌分子分型有关(P=0.04)。结论:YB-1在青年型乳腺癌组织中的表达特点与肿瘤大小、病理组织分级及淋巴结状态有一定关系,细胞核阳性主要见于肿瘤>2cm的患者,而细胞浆阳性主要见于肿瘤?2cm的患者,且YB-1细胞核表达主要为组织学3级,且青年型乳腺癌淋巴结转移率高,YB-1主要在细胞核表达;青年型乳腺癌不同分子分型中YB-1蛋白表达存在差异,YB-1可能成为青年型乳腺癌防治的新的分子靶点。展开更多
We report the case of a 90-year-old female patient who was suffering from c-ros oncogene 1(ros-1)rearrangement adenocarcinoma and breast cancer.After about 14 months of a reduced dose of crizotinib treatment,she had a...We report the case of a 90-year-old female patient who was suffering from c-ros oncogene 1(ros-1)rearrangement adenocarcinoma and breast cancer.After about 14 months of a reduced dose of crizotinib treatment,she had a stable disease according to the Response Evaluation Criteria in Solid Tumors version 1.1(RECIST 1.1).This patient’s case demonstrates that ros-1 rearrangements are not limited to patients of young age.In addition,this case indicates that crizotinib,as second-line,or even first-line,treatment may be effective and manageable in elderly patients.Furthermore,for elderly patients carrying a ros1 fusion,a reduced dose of crizotinib may be efficacious rather than a resistance factor.Based on our findings,we recommend that elderly patients with advanced lung adenocarcinoma should be considered for inclusion in molecular screening for ros-1 translocation,especially for never-smokers negative for epidermal growth factor receptor(egfr)mutation and the fusion between echinoderm microtubule associated protein-like 4(EML4)and anaplastic lymphoma kinase(ALK).This deserves attention because the population is aging,with increasing incidence and morbidity of multiple primary malignant tumors.Neglect of breast nodules at the onset is one of the limitations of our case,as combination of primary lung cancer with breast cancer is common.Above all,use of antiestrogens before and after the diagnosis of non-small-cell lung cancer is related to a reduced risk of lung cancer mortality.Therefore,careful attention should always be paid to these cases.展开更多
基金supported by grants from National Natural Science Foundation of China(Grant Nos.81974422,81772824,and 81802635)。
文摘Objective:The spectrum and risk of cancer in relatives of BRCA1/2 pathogenic variant carriers in the Chinese population have not been established.Methods:A family history of cancer in 9903 unselected breast cancer patients was retrospectively analyzed.BRCA1/2 status was determined for all patients and relative risks(RRs)were calculated to evaluate cancer risk in relatives of the patients.Results:The incidences of breast cancer in female relatives of BRCA1 carriers,BRCA2 carriers,and non-carriers were 33.0%,32.2%,and 7.7%,respectively.The corresponding incidences of ovarian cancer were 11.5%,2.4%,and 0.5%,respectively.The incidences of pancreatic cancer in male relatives of BRCA1 carriers,BRCA2 carriers,and non-carriers were 1.4%,2.7%,and 0.6%,respectively.The corresponding incidences of prostate cancer were 1.0%,2.1%,and 0.4%,respectively.The risks of breast and ovarian cancers in female relatives of BRCA1 and BRCA2 carriers were significantly higher than female relatives of non-carriers(BRCA1:RR=4.29,P<0.001 and RR=21.95,P<0.001;BRCA2:RR=4.19,P<0.001 and RR=4.65,P<0.001,respectively).Additionally,higher risks of pancreatic and prostate cancers were noted in male relatives of BRCA2 carriers than non-carriers(RR=4.34,P=0.001 and RR=4.86,P=0.001,respectively).Conclusions:Female relatives of BRCA1 and BRCA2 carriers are at increased risk for breast and ovarian cancers,and male relatives of BRCA2 carriers are at increased risk for pancreatic and prostate cancers.
文摘目的探究真实世界中程序性死亡蛋白1(Programmed Death Protein 1,PD-1)/程序性死亡蛋白配体1(Programmed Death Protein Ligand 1,PD-L1)抑制剂治疗对晚期非小细胞肺癌(Non-Small Cell Lung Cancer,NSCLC)二线及以上患者预后转归的影响。方法选取2019年1月—2023年7月涟水县人民医院就诊的112例晚期NSCLC二线及以上患者为研究对象,依据治疗方法分为两组,每组56例,对照组接受二线及以上单药化疗,观察组接受PD-1/PD-L1抑制剂免疫治疗,对比两组生存质量、无进展生存期、总生存期及不良反应发生率。结果化疗4个周期后,观察组生存质量评分显著高于对照组,差异有统计学意义(P<0.05)。观察组无进展生存期、总生存期显著优于对照组,差异有统计学意义(P均<0.05)。观察组不良反应发生率显著低于对照组,且观察组高血压发生人数显著少于对照组,差异有统计学意义(P均<0.05)。结论晚期NSCLC患者二线治疗中PD-1/PD-L1抑制剂免疫治疗能提升患者生存质量,降低其不良反应发生率。
基金Supported by the Youth PhD Advancement Project of Air Force Medical Center,PLA,No.21ZT01the Clinical Project of Air Force Medical Center,PLA,No.2021LC009.
文摘BACKGROUND It is estimated that about 30%of esophageal cancer(EC)patients are over 70 years old.Therefore,there is less evidence on the diagnosis and management of elderly EC patients.It is important to explore how elderly EC patients benefit from radical radiochemotherapy regimens,including the target area of radiotherapy(RT),radiation dose and fraction,and choice of chemotherapy drugs.AIM To compare the efficacy of involved-field intensity-modulated RT(IF-IMRT)combined with S-1 vs RT alone in the treatment of elderly EC patients in terms of safety,short-term response,and survival.METHODS Thirty-four EC patients aged>70 years were prospectively enrolled between December 2017 and December 2019.Based on the random number table,they were divided into an IF-IMRT+S-1 group and an IF-IMRT alone group,with 17 patients in each group.All patients were treated with IF-IMRT at a dose of 50.4-56 Gy in 28-30 fractions(1.8-2 Gy/fraction,5 fractions/wk).Oral S-1 was administered concomitantly in the IF-IMRT+S-1 group for 14 consecutive days,and a second cycle was started 7 d after drug withdrawal.After RT,4 cycles of S-1 treatment were offered as the consolidation chemotherapy.The safety,short-term response,and survival were observed after the treatment.RESULTS As of April 2022,these 34 patients had been followed up for 15.2-32.5 mo,with a median follow-up period of 24.5 mo.Complete efficacy indicators were obtained from all the patients.The objective response rate was 88.2%vs 76.5%,respectively,in the IF-IMRT+S-1 group and the RT alone group,where as the disease control rate was 100%vs 82.4%,respectively.The incidence of adverse events including grade 1-2 fatigue,granulocytopenia,thrombocytopenia,anemia,radiation esophagitis,radiation-induced skin injury,and radiation-induced lung injury was not significantly different between these two groups,so was the incidence of the grade 3 radiation esophagitis(0%vs 5.7%).The rate of progressive disease(PD)was 52.9%(n=9)in the IF-IMRT+S-1 group and 64.7%(n=11)in the RT alone group.The median progression-free survival(PFS)was 23.4 mo vs 16.3 mo,and the 2-year PFS rate was 42%vs 41.2%.The median overall survival(OS)was 27.0 mo vs 23.0 mo,and the 2-year OS rate was 58.8%vs 47.1%.Multivariate analysis showed that age was a significant prognostic factor(P=0.0019);patients aged<75 years had a significant survival advantage over patients aged≥75 years.The locations of EC also affected the prognosis.In the IFIMRT+S-1 group,the number of chemotherapy cycles was a significant prognostic factor(P=0.0125),and the risk of PD was significantly lower in EC patients who had received 6 cycles of chemotherapy than those who had received 2-5 cycles of chemotherapy.CONCLUSION Compared with IF-IMRT alone,IF-IMRT+S-1 shows the benefits of preventing PD and prolonging survival without increasing adverse reactions.Therefore,this concurrent radiochemotherapy deserves clinical application.
文摘目的评价程序性细胞死亡蛋白-1(PD-1)抑制剂治疗老年晚期非小细胞肺癌的疗效和安全性。方法检索中国临床肿瘤学会、美国国立综合癌症网络、美国癌症协会、欧洲肿瘤内科学会、PubMed、Ovid(Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials)、中国知网(CNKI)、万方数据库、维普数据库,纳入3个肿瘤学会发布的非小细胞肺癌和老年肿瘤相关指南及PD-1抑制剂治疗老年非小细胞肺癌临床研究,对纳入的文献进行描述性分析。结果共纳入文献9篇,包括系统评价3篇、临床试验2篇、真实世界研究亚组分析1篇、个案报道2篇、队列研究1篇。根据指南,PD-1抑制剂可以引入作为大多数无驱动基因的晚期非小细胞肺癌患者的新标准治疗方案。目前指南暂未根据患者年龄推荐PD-1抑制剂的给药方案。现有研究显示,PD-1抑制剂在老年人群的安全性与全人群相似。60~65岁老年患者可以从PD-1抑制剂治疗中获益,但年龄≥75岁患者人群中免疫检查点抑制剂的疗效存在争议。结论目前老年非小细胞肺癌患者使用PD-1抑制剂证据较多的是帕博利珠单抗和纳武利尤单抗,有限证据显示帕博利珠单抗治疗老年非小细胞肺癌患者有效且安全。PD-1抑制剂治疗老年非小细胞肺癌患者的证据匮乏,尤其缺乏真实世界研究。
文摘目的:探讨YB-1(Y-box binding protein 1)在青年型乳腺癌组织中的表达及意义。方法:应用免疫组织化学方法研究YB-1蛋白在青年型乳腺癌组织中的表达,并结合病理组织学类型、病理分级等临床特征分析YB-1在青年型乳腺癌组织中的表达意义;依据ER、PR、HER-2、CK5/6表达对青年型乳腺癌进行分子分型(Luminal-A、Luminal-B、HER2+和Basal-like 4个分子亚型),并分析其与YB-1表达的关系。结果:HE结果显示64例青年型乳腺癌病理组织学分类主要为浸润性导管癌,占59.4%。免疫组化结果显示64例青年型乳腺癌组织中YB-1阳性率为92.2%,其中细胞核阳性表达率53.1%,细胞浆阳性表达率39.1%。肿瘤>2cm的患者占59.4%,YB-1主要表达在细胞核(40.6%),患者肿瘤?2cm占37.5%,YB-1则主要在细胞浆表达(20.3%),YB-1表达类型与肿瘤大小有显著统计学意义(P=0.036)。组织学3级所占比例最高,占48.4%,且多为YB-1细胞核表达(37.5%),乳腺癌不同的组织学分级间YB-1的表达率不同(P=0.000);青年型乳腺癌患者发生淋巴结转移的比例高(84.4%),其中N3期所占比例最高,占40.6%,YB-1主要在细胞核表达,占31.3%,胞浆表达占7.8%。青年型乳腺癌分子分型中主最多见的是Luminal-B型,占46.9%,YB-1主要表达在细胞核(32.8%),浆表达仅占9.4%,统计分析显示YB-1表达的核浆分布特点与青年型乳腺癌分子分型有关(P=0.04)。结论:YB-1在青年型乳腺癌组织中的表达特点与肿瘤大小、病理组织分级及淋巴结状态有一定关系,细胞核阳性主要见于肿瘤>2cm的患者,而细胞浆阳性主要见于肿瘤?2cm的患者,且YB-1细胞核表达主要为组织学3级,且青年型乳腺癌淋巴结转移率高,YB-1主要在细胞核表达;青年型乳腺癌不同分子分型中YB-1蛋白表达存在差异,YB-1可能成为青年型乳腺癌防治的新的分子靶点。
基金This work was supported by the National Science and Technology Major Project(Grant No.2017ZX09304023).
文摘We report the case of a 90-year-old female patient who was suffering from c-ros oncogene 1(ros-1)rearrangement adenocarcinoma and breast cancer.After about 14 months of a reduced dose of crizotinib treatment,she had a stable disease according to the Response Evaluation Criteria in Solid Tumors version 1.1(RECIST 1.1).This patient’s case demonstrates that ros-1 rearrangements are not limited to patients of young age.In addition,this case indicates that crizotinib,as second-line,or even first-line,treatment may be effective and manageable in elderly patients.Furthermore,for elderly patients carrying a ros1 fusion,a reduced dose of crizotinib may be efficacious rather than a resistance factor.Based on our findings,we recommend that elderly patients with advanced lung adenocarcinoma should be considered for inclusion in molecular screening for ros-1 translocation,especially for never-smokers negative for epidermal growth factor receptor(egfr)mutation and the fusion between echinoderm microtubule associated protein-like 4(EML4)and anaplastic lymphoma kinase(ALK).This deserves attention because the population is aging,with increasing incidence and morbidity of multiple primary malignant tumors.Neglect of breast nodules at the onset is one of the limitations of our case,as combination of primary lung cancer with breast cancer is common.Above all,use of antiestrogens before and after the diagnosis of non-small-cell lung cancer is related to a reduced risk of lung cancer mortality.Therefore,careful attention should always be paid to these cases.
