Navigating breast cancer brain metastasis:Risk factors,prognostic indicators,and treatment perspectives

In this editorial,we comment on the article by Chen et al.We specifically focus on the risk factors,prognostic factors,and management of brain metastasis(BM)in breast cancer(BC).BC is the second most common cancer to have BM after lung cancer.Independent risk factors for BM in BC are:HER-2 positive BC,triplenegative BC,and germline BRCA mutation.Other factors associated with BM are lung metastasis,age less than 40 years,and African and American ancestry.Even though risk factors associated with BM in BC are elucidated,there is a lack of data on predictive models for BM in BC.Few studies have been made to formulate predictive models or nomograms to address this issue,where age,grade of tumor,HER-2 receptor status,and number of metastatic sites(1 vs>1)were predictive of BM in metastatic BC.However,none have been used in clinical practice.National Comprehensive Cancer Network recommends screening of BM in advanced BC only when the patient is symptomatic or suspicious of central nervous system symptoms;routine screening for BM in BC is not recommended in the guidelines.BM decreases the quality of life and will have a significant psychological impact.Further studies are required for designing validated nomograms or predictive models for BM in BC;these models can be used in the future to develop treatment approaches to prevent BM,which improves the quality of life and overall survival.

Analysis of Clinicopathological Factors Associated with Bone Metastasis in Breast Cancer

Breast cancer is the second leading cause of cancer death in women today. Once breast can- cer metastasizes to bone, mortality increases. Thus, there is an urgent need to identify patients with high risk of bone metastasis, and to find predictive factors for the occurrence of bone metastasis at an earlier stage of breast cancer. Three hundred and sixty patients with pathologically proved breast cancer visit- ing the Department of Nuclear Medicine for whole body bone scan from January 2006 and January 2009 were investigated in this study. Clinicopathological information was obtained, which consisted of age, menopausal status, clinical staging, lymph node stage, histological grade, the expression of estro- gen receptor （ER）, progesterone receptor （PR） and epidermal growth factor receptor 2 （HER2）. Correla- tion between bone metastasis and the associated factors was tested by using the Chi-square test. A Cox multivariate analysis was used to assess the factors which independently contributed to survival after bone metastasis in breast cancer patients. Survival curves were drawn for metastasis-free interval and the independent factors which contributed to survival, using the Kaplan-Meier method. Twenty-four pa- tients were excluded from subsequent analysis. Three hundred and thirty-six enrolled patients ranged in age from 22 to 77 years （mean, 47.8 years）. ER/PR status [ER（＋） vs. ER（-）, 2,2=4.328, P=0.037; ER（＋）PR（＋） vs. ER（＋）PR（-）, ;（2=4.425, P=-0.035] and histological grade （;（2=7.131, P=0.028） were sig- nificantly associated with bone metastasis. ER status （;（2=8.315, P=0.004） and metastasis-free interval （;（2=6.863, P=-0.009） were independent prognostic factors for survival in breast cancer patients with bone metastasis. Our study suggested that ER/PR status and histological grade are risk factors for the development of bone metastasis in breast cancer patients. However, ER status and metastasis-free inter- val are independent prognostic factors for survival in breast cancer patients with bone metastasis. Breast cancer bone metastasis has its unique characteristics, which is helpful to choose the appropriate treat- ment for breast cancer patients with bone metastasis.

Analysis of clinicopathological features and prognostic factors of breast cancer brain metastasis

BACKGROUND Breast cancer(BC)has become the most common malignancy in women.The incidence and detection rates of BC brain metastasis(BCBM)have increased with the progress of imaging,multidisciplinary treatment techniques and the extension of survival time of BC patients.BM seriously affects the quality of life and survival prognosis of BC patients.Therefore,clinical research on the clinicopathological features and prognostic factors of BCBM is valuable.By analyzing the clinicopathological parameters of BCBM patients,and assessing the risk factors and prognostic indicators,we can perform hierarchical diagnosis and treatment on the high-risk population of BCBM,and achieve clinical benefits of early diagnosis and treatment.AIM To explore the clinicopathological features and prognostic factors of BCBM,and provide references for diagnosis,treatment and management of BCBM.METHODS The clinicopathological data of 68 BCBM patients admitted to the Air Force Medical Center,Chinese People’s Liberation Army(formerly Air Force General Hospital)from 2000 to 2022 were collected.Another 136 BC patients without BM were matched at a ratio of 1:2 based on the age and site of onset for retrospective analysis.Categorical data were subjected to χ^(2) test or Fisher’s exact probability test,and the variables with P<0.05 in the univariate Cox proportional hazards model were incorporated into the multivariate model to identify high-risk factors and independent prognostic factors of BCBM,with a hazard ratio(HR)>1 suggesting poor prognostic factors.The survival time of patients was estimated by the Kaplan-Meier method,and overall survival was compared between groups by log-rank test.RESULTS Multivariate Cox regression analysis showed that patients with stage Ⅲ/Ⅳ tumor at initial diagnosis[HR:5.58,95% confidence interval(CI):1.99–15.68],lung metastasis(HR:24.18,95%CI:6.40-91.43),human epidermal growth factor receptor 2(HER2)-overexpressing BC and triple-negative BC were more prone to BM.As can be seen from the prognostic data,52 of the 68 BCBM patients had died by the end of follow-up,and the median time from diagnosis of BC to the occurrence of BM and from the occurrence of BM to death or last follow-up was 33.5 and 14 mo,respectively.It was confirmed by multivariate Cox regression analysis that patients with neurological symptoms(HR:1.923,95%CI:1.005-3.680),with bone metastasis(HR:2.011,95%CI:1.056-3.831),and BM of HER2-overexpressing and triple-negative BC had shorter survival time.CONCLUSION HER2-overexpressing,triple-negative BC,late tumor stage and lung metastasis are risk factors of BM.The presence of neurological symptoms,bone metastasis,and molecular type are influencing prognosis factors of BCBM.

Changing trends and influencing factors of the quality of life of chemotherapy patients with breast cancer

Objective： To understand the changing trajectory of quality of life（QOL） during the treatment courses of breast cancer patients during chemotherapy and to investigate the factors in each treatment course that affect QOL.Methods： The M.D. Anderson Symptom Inventory Scale, the Hospital Anxiety and Depression Scale（HADS）, and the Functional Assessment of Cancer Therapy-Breast（FACT-B） scale were used to perform a survey on 174 breast cancer patients who received the TAC（docetaxel, Adriamycin, and cyclophosphamide） chemotherapy regimen before postoperative chemotherapy and 5-7 days after each chemotherapy course.Results： The QOL scores of the breast cancer patients were the lowest before the postoperative chemotherapy（81.2 ± 19.6） and the highest after the second chemotherapy course（94.5 ± 14.4）. After the fourth and fifth chemotherapy courses, the scores were much lower again, with values of 82.7 ± 13.9and 82.6 ± 13.1, respectively. The scores improved again after the sixth chemotherapy course（93.9 ± 18.7）. Furthermore, each treatment course had different related symptoms that affected the QOL of the patients.Conclusions： More attention should be paid to the changing trajectory of QOL of patients in all treatment courses and to the influence of treatment-related symptoms on the QOL of patients; moreover, interventions should be adopted by medical care personnel to increase QOL in cancer patients.

Efficacy and prognostic factors of neoadjuvant chemotherapy for triple-negative breast cancer

BACKGROUND Breast cancer mainly occurs in young and premenopausal women;its incidence is increasing annually. Patients with triple-negative breast cancer(TNBC) have relatively high recurrence and transfer rates during the operation and 3 years after postoperative adjuvant chemotherapy. Currently, the treatment for patients with TNBC is mainly based on a comprehensive combination of surgery and chemotherapy. Therefore, identifying additional effective treatments to improve patient prognosis is important.AIM To explore and discuss the effects and prognostic factors of neoadjuvant chemotherapy in TNBC.METHODS In total, 118 patients diagnosed with TNBC from January 2016 to January 2020 in our hospital were selected and divided into the observation(n = 60) and control(n = 58) groups according to therapeutic regimen. The control group received routine chemotherapy, and the observation group received neoadjuvant chemotherapy. The therapeutic effects of the two groups were observed, and the survival of patients was followed up.RESULTS The karyopherin A2(KPNA2)-positive and SRY-related HMG box-2(SOX2)-positive expression rates of patients with TNBC with intravascular tumor thrombus and tumor-node-metastasis(TNM) stage IV were 92.00% and 91.67% and 96.00% and 95.83%, respectively, which were significantly higher than those of patients with no intravascular tumor thrombus and TNM stage Ⅲ(P < 0.05). KPNA2 was positively associated with SOX2 expression(rs = 0.514, P < 0.50). The short-term curative effect of the observation group was better than that of the control group(P < 0.05), and the total effective rate was 58.33%. After treatment, carcinoembryonic antigen, cancer antigen(CA) 19-9, and CA125 Levels in the observation group were 11.40 ± 2.32 mg/L, 19.92 ± 3.42 kU/L, and 54.30 ± 12.28 kU/L, respectively, which were significantly lower than those in the control group(P < 0.05). The median survival time of the observation group was 33 mo(95%CI: 31.21-34.79), which was significantly longer than that of the control group(P < 0.05). TNM stage, degree of differentiation, lymph node metastasis, KPNA2 and SOX2 expressions, and treatment plan were prognostic factors of TNBC(relative risk = 1.575, 1.380, 1.366, 1.433, 1.411, and 0.581, respectively, P < 0.05).CONCLUSION Neoadjuvant chemotherapy for TNBC treatment can achieve good curative effects. TNM stage, differentiation degree, lymph node metastasis, KPNA2 and SOX2 expressions, and treatment plan are prognostic factors of TNBC.

Factors predicting upstaging from clinical N0 to pN2a/N3a in breast cancer patients

BACKGROUND With sentinel node metastasis in breast cancer(BC)patients,axillary lymph node(ALN)dissection is often omitted from cases with breast-conserving surgery.Omission of lymph node dissection reduces the invasiveness of surgery to the patient,but it also obscures the number of metastases to non-sentinel nodes.The possibility of finding≥4 lymph nodes(pN2a/pN3a)preoperatively is important given the ramifications for postoperative treatment.AIM To search for clinicopathological factors that predicts upstaging from N0 to pN2a/pN3a.METHODS Patients who were sentinel lymph node(SLN)-positive and underwent ALN dissection between September 2007 and August 2018 were selected by retrospective chart review.All patients had BC diagnosed preoperatively as N0 with axillary evaluation by fluorodeoxyglucose(FDG) positron emission tomography/computed tomography and ultrasound (US)examination. When suspicious FDG accumulation was found in ALN, the presence of metastasiswas reevaluated by second US. We examined predictors of upstaging from N0 to pN2a/pN3a.RESULTSAmong 135 patients, we identified 1-3 ALNs (pN1) in 113 patients and ³4 ALNs (pN2a/pN3a) in22 patients. Multivariate analysis identified the total number of SLN metastasis, the maximaldiameter of metastasis in the SLN (SLNDmax), and FDG accumulation of ALN as predictors ofupstaging to pN2a/pN3a.CONCLUSIONWe identified factors involved in upstaging from N0 to pN2a/pN3a. The SLNDmax and numberof SLN metastasis are predictors of ≥ 4 ALNs (pN2a/pN3a) and predictors of metastasis to nonsentinelnodes, which have been reported in the past. Attention should be given to axillaryaccumulations of FDG, even when faint.

Psychological evaluation of patients after breast cancer surgery and care strategies improvement

Objective: The aim of the study was to investigate the level of self-image of patients after breast cancer surgery, and explore factors influencing self-image among patients who have experienced different types of surgeries, and set out a foundation for the improvement of care strategies. Methods: The 538 patients with primary breast cancer who underwent surgery in the Department of Breast Surgery, First Hospital of China Medical University, Shenyang, China, from January 2004 to January 2009 were included in the study. The psychological status of the patients was evaluated by body image after breast cancer questionnaire (BIBCQ), social support rating scale (SSRS), self-rating anxiety scale (SRAS), depression rating scale (DRS), and general information questionnaire. The factors influencing the self-image were selected by a stepwise regression analysis. Results: The patients who underwent breast-conserving surgery were the most satisfied with their body image, followed by those underwent surgery of modified radical mastectomy with reconstruction. However, cases treated by modified radical mastectomy without reconstruction had negative outcomes. Regardless of operation type, the self-image was influenced by anxiety, level of abuse by husband, and sexual satisfaction after operation. Conclusion: The self-image of patients who underwent different breast cancer surgeries was influenced by different factors, and individualized nursing should be offered in accordance with the specific situation.

Role of TGF-<i>β</i>in breast cancer bone metastases

Breast cancer is the most prevalent cancer among females worldwide leading to approximately 350,000 deaths each year. It has long been known that cancers preferentially metastasize to particular organs, and bone metastases occur in ~70% of patients with advanced breast cancer. Breast cancer bone metastases are predominantly osteolytic and accompanied by increased fracture risk, pain, nerve compression and hypercalcemia, causing severe morbidity. In the bone matrix, transforming growth factor-β (TGF-β) is one of the most abundant growth factors, which is released in active form upon tumor-induced osteoclastic bone resorption. TGF-β, in turn, stimulates bone metastatic tumor cells to secrete factors that further drive osteolytic bone destruction adjacent to the tumor. Thus, TGF-β is a crucial factor responsible for driving the feed-forward vicious cycle of cancer growth in bone. Moreover, TGF-β activates epithelial-to-mesenchymal transition, increases tumor cell invasiveness and angiogenesis and induces immunosuppression. Blocking the TGF-β signaling pathway to interrupt this vicious cycle between breast cancer and bone offers a promising target for therapeutic intervention to decrease skeletal metastasis. This review will describe the role of TGF-β in breast cancer and bone metastasis, and pre-clinical and clinical data will be evaluated for the potential use of TGF-β inhibitors in clinical practice to treat breast cancer bone metastases.

The Study on the Clinical Features and Prognosis of Pregnancy-related Breast Cancer

Objective: To explore the clinical features ofpregnancy-related breast cancer and the related factorsaffecting the prognosis. Methods: The research workwas carried out in our hospital from January 2018 toJanuary 2019. In this study, 50 patients were selectedas related breast cancer patients and 50 non-pregnancyrelated breast cancer patients were selected as controlgroup. The clinical characteristics and prognosis ofthe two groups were compared and analyzed. Results:According to the incidence of pregnancy-related breastcancer, the onset of breast cancer is in pregnancy andlactation, with more than half of the total number ofpatients having two or more pregnancies and 74.0%of the patients having breast feeding history. In thetwo groups, most of the patients went to see a doctorbecause of palpable breast masses, and the averagemaximum diameter of tumors in PBC group was (5.13± 3.22)cm, including 5 cases accompanied by dimplesign, 7 cases accompanied by nipple depression, 8cases accompanied by inflammatory changes of skin,3 cases with pathological changes involving wholemilk, and 27 cases (54.00%) with palpable axillaryenlarged lymph nodes on the same side. The averagemaximum value of tumor in Non-PABC group was(3.94 ± 2.11) cm, with 5 cases accompanied by dimplesign, 4 cases accompanied by nipple depression, and 9cases (18.00%) with palpable axillary lymph nodes onthe same side. Conclusion: As far as pregnancy-relatedbreast cancer is concerned, the clinical misdiagnosisrate is relatively high and the prognosis is poor.Prenatal examination and breast-feeding breast cancerexamination are needed to ensure early detection anddiagnosis. This is the key factor to ensure the survivalrate of pregnancy-related breast cancer patients and haspositive significance for clinical development.

Hypoxia-inducible factor 1 and breast cancer metastasis

Accumulating evidence has shown that the hypoxic microenvironment, which is critical during cancer development, plays a key role in regulating breast cancer progression and metastasis. The effects of hypoxia-inducible factor 1 （HIF-1）, a master regulator of the hypoxic response, have been extensively studied during these processes. In this review, we focus on the roles of HIF-1 in regulating breast cancer cell metastasis, specifically its effects on multiple key steps of metastasis, such as epithelial-mesenchymal transition （EMT）, invasion, extravasation, and metastatic niche formation. We also discuss the roles of HIF-l-regulated non-coding RNAs in breast cancer metastasis, and therapeutic opportunities for breast cancer through targeting the HIF-1 pathway,

Effects of Brucine on Vascular Endothelial Growth Factor Expression and Microvessel Density in A Nude Mouse Model of Bone Metastasis Due to Breast Cancer

Objective： To study the effects of brucine on vascular endothelial growth factor （VEGF） expression and microvessel density （MVD） in a nude mouse model of bone metastasis due to breast cancer, and to assess the possible antitumor mechanism of brucine. Methods： A syringe needle was used to directly inject 0.2 mL monoplast suspension （with 2 × 106 human breast cancer cells contained） into the bony femoral cortex of the right hind leg for modeling. Twenty-five nude mice were randomized into five groups and administered with an intraperitoneal injection of saline or drug for 8 consecutive days： model group （0.2 mL normal saline）, low-dose brucine group （1.73 mg-kg^-1）, medium-dose brucine group （3.45 mgokg^-1）, high-dose brucine group （6.90 mg.kg^-1）, and thalidomide group （200 mg.kg^-1）. Diet and activity were recorded, and the tumors were harvested 5 weeks later. The percentage of VEGF-positive cells was determined with hematoxylin and eosin staining and immunohistochemical staining, and MVD expression was determined by optical microscopy. Results： The VEGF expressions in brucineor thalidomide-treated mice were significantly reduced as compared with mice in the model group （P〈0.01）. There were no significant difference between the high-dose brucine group and the thalidomide group （P〉0.05）. Significant difference was between the high- and low-dose brucine group （P〈0.05）. Further, VEGF expression was significantly increased in the low- and medium-dose brucine groups compared with the thalidomide group （P〈0.05）. The MVD values in the three brucine and thalidomide groups were significantly lower than that in the model group （P〈0.01）. The MVD values in the medium- and high-dose brucine groups were not significantly different from those in the thalidomide group （P〉0.05）, while the MVD value showed a significant increase in the low-dose group compared with the thalidomide group （P〈0.05）. Conclusion： Brucine could inhibit the growth of breast cancer to bone metastases, possibly by inhibiting tumor angiogenesis.

乳腺癌患者腋窝淋巴结转移的危险因素及行X线摄影与CT检查的诊断效能分析

目的:探讨乳腺癌患者腋窝淋巴结转移的危险因素及X线与CT检查的诊断效能比较。方法:选取2021年1月至2023年5月在我院治疗的乳腺癌患者112例,分析发生和未发生腋窝淋巴结转移患者临床资料差异;同时分析X线、CT检查诊断腋窝淋巴结转移的价值。结果:112例患者中,腋窝淋巴结转移患者32例,腋窝淋巴结转移率为28.57%;发生腋窝淋巴结转移患者组织低分化比例、组织类型为浸润性癌比例、有脉管浸润比例、肿瘤直径≥5cm比例、组织Ki-67表达≥14%比例分别为68.75%、90.63%、28.13%、31.25%和84.38%,明显高于未发生腋窝淋巴结转移患者(P<0.05);Logistic回归分析显示:分化程度、病灶组织类型、脉管浸润、Ki-67表达是乳腺癌患者发生腋窝淋巴结转移的影响因素(P<0.05);X线诊断腋窝淋巴结转移与病理结果一致性Kappa值为0.500,P<0.05,一致性较差;CT诊断腋窝淋巴结转移与病理结果一致性Kappa值为0.825,P<0.05,一致性较好;CT诊断腋窝淋巴结转移的准确性、灵敏性和阴性预测值分别为92.86%、87.50%和95.00%,明显高于X线检查(P<0.05)。结论:乳腺癌患者腋窝淋巴结转移受分化程度、病灶组织类型、脉管浸润、Ki-67表达的影响;相较于X线,CT诊断腋窝淋巴结转移的价值较高。

乳腺癌病人社交焦虑和病耻感在家庭关怀度与孤独感间的中介作用

目的:探讨乳腺癌病人社交焦虑和病耻感在家庭关怀度与孤独感间的作用机制,为乳腺癌病人孤独感干预提供参考。方法:选取2021年12月—2022年7月在安徽省8所医院就诊的乳腺癌病人328例为研究对象,采用社交焦虑量表、社会影响量表、家庭关怀度指数问卷、孤独感量表对其进行调查。结果:乳腺癌病人社交焦虑、病耻感、家庭关怀度、孤独感总分分别为(11.72±5.33)分、(59.51±12.98)分、(6.84±3.67)分、(49.20±9.14)分。乳腺癌病人家庭关怀度与孤独感呈负相关(P<0.05),社交焦虑、病耻感与孤独感呈正相关(均P<0.05)。社交焦虑和病耻感在家庭关怀度与孤独感间起中介作用。结论:乳腺癌病人家庭关怀度可通过社交焦虑和病耻感的链式中介作用间接影响孤独感。

乳腺癌根治术后淋巴水肿患者康复护理模式构建

目的分析乳腺癌根治术后患者发生淋巴水肿的影响因素,基于独立影响因素构建风险预测模型,并以此构建有针对性的康复护理模式。方法选取2020年9月—2022年8月医院接受乳腺癌根治术治疗的患者212例为研究对象,根据患者术后1年内是否发生淋巴水肿,将患者分为并发淋巴水肿组63例和未并发淋巴水肿组149例,通过单因素分析及多因素Logistic回归分析得出独立影响因素,并基于回归分析法构建风险预测模型,使用R语言软件绘制相应的列线图,采用受试者工作特征(ROC)曲线及校准曲线检验预测效能,并以此构建患者康复护理模式。结果经过多因素Logistic回归分析,本研究结果表明年龄、身体质量指数(BMI)、腋窝淋巴结清扫数量、术后感染、术后规律锻炼、术后健康饮食、抑郁症史均与术后并发淋巴水肿有关(P<0.05),以此构建的风险预测模型其曲线下面积(AUC)0.791,最佳截断值0.335对应的灵敏度、特异度分别为0.698、0.772,校准曲线结果显示,平均绝对误差(MAE)为0.018,校准曲线贴合理想曲线,表示模型具有较好的校准性能,模型较为可靠稳定。结论患者行乳腺癌根治术后发生淋巴水肿受年龄、BMI、腋窝淋巴结清扫数量、术后感染等因素影响,基于各独立影响因素构建的风险预测模型预测性能良好,根据其构建康复护理模式有利于预防或减少术后淋巴水肿的发生。

(+)-丁香树脂酚通过NF-κB信号调节三阴性乳腺癌细胞生长和转移的实验研究

目的:探讨(+)-丁香树脂酚[(+)-Syringaresinol]对三阴性乳腺癌(TNBC)细胞生长和转移的影响,分析其对核因子-κB(NF-κB)信号的影响。方法:根据(+)-丁香树脂酚处理浓度将MDA-MB-231细胞分为0μM组、2μM组、4μM组、8μM组、16μM组、32μM组、64μM组和128μM组。使用相应浓度的(+)-丁香树脂酚孵育各组MDA-MB-231细胞48 h。MTT法检测细胞增殖及(+)-丁香树脂酚半抑制浓度(IC50)值。Annexin V-FITC/PI试剂盒检测细胞凋亡。Transwell检测细胞迁移和侵袭。qRT-PCR检测Bax、Bcl-2、基质金属蛋白酶(MMP)-2、MMP-9、E-cadherin、N-cadherin和Vimentin mRNA相对表达量。Western blot检测NF-κB p65磷酸化水平。结果:与0μM组相比,2~128μM组的MDA-MB-231细胞的生长抑制率升高(P<0.05)。(+)-丁香树脂酚对MDA-MB-231细胞的IC50值为25.24μmol/L。与0μM组相比,2~128μM组的MDA-MB-231细胞的凋亡率升高,Bax mRNA相对表达量升高,Bcl-2 mRNA相对表达量降低,迁移和侵袭数量降低,MMP-2和MMP-9的mRNA相对表达量降低,E-cadherin mRNA相对表达量升高,N-cadherin和Vimentin的mRNA相对表达量降低,p-NF-κB p65/NF-κB p65蛋白相对表达量降低(P<0.05)。结论:(+)-丁香树脂酚抑制了TNBC细胞的生长和转移并呈浓度依赖性,(+)-丁香树脂酚的抗TNBC作用可能与抑制NF-κB信号通路的活化有关。

血清维生素D结合蛋白、FGF23、Klotho与乳腺癌骨转移的相关性分析

目的骨转移是乳腺癌常见的并发症之一,严重影响患者的生存和预后。本研究旨在探究血清维生素D结合蛋白(vitamin D⁃binding protein,VDBP)、成纤维细胞生长因子23(fibroblast growth factor 23,FGF23)和Klotho蛋白在乳腺癌骨转移中的表达及临床意义。方法收集95例来自本院2019⁃08⁃01至2021⁃08⁃01的女性乳腺癌患者作为研究对象,经影像学和组织病理学方式诊断是否发生骨转移,将患者分为骨转移组36例,非骨转移组59例。分析两组患者的临床病理特征;采集患者外周血样本,通过ELISA对血清中VDBP、FGF23和Klotho进行定量分析;使用Spearman相关分析进行指标间的关联性分析;Logistic回归分析乳腺癌发生骨转移的影响因素;ROC曲线分析血清VDBP、FGF23和Klotho水平预测乳腺癌发生骨转移的价值。结果骨转移和非骨转移乳腺癌病理分级比较有统计学意义(P<0.05)。骨转移和非骨转移乳腺癌患者血清中VDBP、FGF23及Klotho的水平依次为:(80.35±29.34)和(115.18±48.69)ng/mL、(658.35±201.19)和(405.36±154.42)pg/mL以及(155.82±40.29)和(229.35±72.46)pg/mL,两组比较差异有统计学意义(P<0.05)。Spearman相关性分析显示,骨转移乳腺癌患者血清中VDBP水平与乳腺癌病理分级相关(P<0.05);FGF23和Klotho水平与病理分级、是否骨痛以及转移部位有关(P<0.05)。VDBP、FGF23和Klotho水平均为乳腺癌骨转移发生的独立影响因素(P<0.05)。ROC曲线结果显示,VDBP、FGF23及Klotho预测乳腺癌患者发生骨转移的曲线下面积依次为:0.733、0.806、0.761,最佳截断值为:81.56 ng/mL、573.501 pg/mL和201.193 pg/mL;3个指标联合诊断的曲线下面积为0.820,高于单一指标诊断的曲线下面积。结论血清VDBP、FGF23及Klotho水平可作为乳腺癌骨转移的参考指标,在乳腺癌骨转移的临床诊断上具有一定应用前景。

HER2低表达乳腺癌组织中p53基因突变与临床病理特征的关系

目的分析人表皮生长因子受体2(human epidermal growth factor receptor 2,HER2)低表达乳腺癌组织中p53基因突变与临床病理特征的关系。方法选择2018年8月—2023年8月厦门市第三医院收治的112例HER2低表达乳腺癌患者为研究对象,所有患者均在厦门市第三医院进行手术切除癌组织,并留取乳腺癌组织。通过银染聚合酶链反应-单链构象多肽性分析法(polymerase chain reaction single strand conformation polymorphism,PCR-SSCP)检测HER2低表达乳腺癌组织p53基因突变情况,分析p53基因突变与HER2低表达乳腺癌临床病理特征的相关性。结果HER2低表达乳腺癌组织中p53基因未突变82例,占比为73.21%;p53基因突变30例,占比为26.79%。p53基因突变与肿瘤直径、淋巴结转移、脉管侵犯、临床分期呈正相关(P<0.05)。将年龄、身体质量指数(body mass index,BMI)、细胞增殖相关抗原(cell proliferation-associated antigens,Ki-67)指数、雌激素受体(estrogen receptor,ER)指数等因素控制后p53基因突变与肿瘤直径、淋巴结转移、脉管侵犯、临床分期相关(P<0.05)。结论HER2低表达乳腺癌组织中p53基因突变率较低,p53基因突变与乳腺癌肿瘤直径、淋巴结转移、脉管侵犯、临床分期相关,为中国抗癌协会乳腺癌诊治指南与规范后期标准制定提供了借鉴内容。

伽玛刀立体定向放射治疗肺癌脑转移瘤患者预后不良的影响因素

目的:分析伽玛刀立体定向放射治疗肺癌脑转移瘤患者预后不良的影响因素。方法:回顾性分析2022年1月至2023年1月在该院接受伽马刀立体定向放射治疗的121例肺癌脑转移瘤患者的临床资料。统计伽玛刀立体定向放射治疗肺癌脑转移瘤患者的预后情况,采用Logistic回归分析伽玛刀立体定向放射治疗肺癌脑转移瘤患者预后不良的影响因素。结果:121例伽马刀立体定向放射治疗肺癌脑转移瘤患者预后不良40例,设为预后不良组,预后良好81例,设为预后良好组;预后不良组脑转移瘤最大直径≥3 cm、血清鳞状细胞癌抗原(SCC-Ag)≥3.80 ng/mL、血清细胞角蛋白19片段(CYFRA21-1)≥7.52 ng/mL、血清神经元特异性烯醇化酶(NSE)≥50.81μg/L占比均高于预后良好组,差异有统计学意义(P<0.05);Logistic回归分析结果显示,血清SCC-Ag≥3.80 ng/mL、血清NSE≥50.81μg/L均为伽玛刀立体定向放射治疗肺癌脑转移瘤患者预后不良的危险因素(OR>1,P<0.05)。结论:血清SCC-Ag≥3.80 ng/mL、血清NSE≥50.81μg/L均为伽玛刀立体定向放射治疗肺癌脑转移瘤患者预后不良的危险因素。

乳腺癌患者疾病感知现状及影响因素

目的 了解乳腺癌患者疾病感知现状,分析影响因素,为相关工作提供参考,为患者提供更好的心理支持和治疗方案。方法 选取2023年2—4月在郑州大学第一附属医院符合纳入和排除标准的145例乳腺癌患者作为研究对象。运用一般资料问卷、简易版疾病感知问卷进行问卷调查,采用SPSS 25.0统计软件进行数据整理和分析。结果 乳腺癌患者疾病感知总得分为(49.28±6.92)分。不同受教育程度、职业、家庭月收入的乳腺癌患者疾病感知差异有统计学意义(P<0.05)。结论 乳腺癌患者存在着消极疾病感知,患者对于疾病关心、治疗控制、病程的感知最为严重,对于疾病了解的感知相对较轻,其中受教育程度越高、家庭月收入越高的患者消极性疾病感知越少。

乳腺癌化疗患者的焦虑抑郁及其与化疗毒副反应的相关性

目的:观察乳腺癌化疗患者抑郁和焦虑的发病率及其影响因素,并研究焦虑抑郁和化疗毒副反应的相关性。方法:本研究回顾性收集了2020年2月至2023年2月在我院腺体外科住院手术并化疗的乳腺癌患者为研究对象,采用自行设计的一般资料调查表、抗癌药物常见毒副反应分级标准(WHO)、不良事件通用术语标准(CTCAE)5.0版、医院焦虑抑郁量表(HADS)进行问卷调查。分析影响乳腺癌术后化疗患者抑郁和焦虑的独立危险因素,以及焦虑抑郁和化疗毒副反应的相关性。结果:141例乳腺癌患者中焦虑症患者为72例(51.06%);抑郁症患者为61例(43.26%)。文化程度高、经济负担重、手术方式为乳房切除术是乳腺癌合并焦虑或抑郁的独立危险因素。焦虑评分与腹泻、口腔黏膜炎、疼痛、手足综合征、间接胆红素升高呈正相关(P<0.05);抑郁评分与腹泻、手足综合征、间接胆红素升高、尿素升高呈正相关(P<0.05)。结论:乳腺癌化疗患者抑郁、焦虑的发病率较高,并受患者的文化程度、经济水平及手术方式的影响。焦虑、抑郁评分与化疗毒副反应存在一定联系。在临床工作中,医护人员可通过患者的一般特征对患焦虑或抑郁的高危人群重点关注,采取有效的心理干预,降低患者焦虑、抑郁等负性情绪的发生,提高患者生活质量,改善其预后。