Intrinsic Wave Velocity Propagation:A Novel Parameter for Assessing the Effect of Anthracycline Chemotherapy Agents on Cardiac Diastolic Function in Breast Cancer Patients

Objective Anthracycline chemotherapeutic agents have significant cardiotoxicity.The present study emphasized the effect of anthracycline chemotherapy drugs on left ventricular(LV)myocardial stiffness in breast cancer patients by measuring the intrinsic wave velocity propagation(IVP),and evaluating the potential clinical value of IVP in detecting early LV diastolic function impairment.Methods A total of 68 newly diagnosed breast cancer patients,who were treated with anthracycline-based chemotherapy,were analyzed.Transthoracic echocardiography was performed at baseline(T0),and after 1,2,3,4 and 8 chemotherapeutic cycles(T1,T2,T3,T4 and T5,respectively).Then,the IVP,LV strain parameters[global longitudinal strain(GLS),longitudinal peak strain rate at systole(LSRs),longitudinal peak strain rate at early diastole(LSRe),longitudinal peak strain rate at late diastole(LSRa),and the E/LSRe ratio],and conventional echocardiographic parameters were obtained and further analyzed.A relative reduction of>15%in GLS was considered a marker of early LV subclinical dysfunction.Results Compared to the T0 stage,IVP significantly increased at the T1 stage.However,there were no significant changes in GLS,LSRs,or LSRe between the T0 and T1 stages.These parameters significantly decreased from the T2 stage.LSRa started to significantly decrease at the T5 stage,and the E/LSRe ratio started to significantly increase at the T3 stage(all P<0.05).At the T0 stage,IVP(AUC=0.752,P<0.001)had a good predictive value for LV subclinical dysfunction after chemotherapy.Conclusions IVP is a potentially sensitive parameter for the early clinical assessment of anthracycline-related cardiac diastolic impairment.

The impact of chemotherapy on cognitive function of breast cancer patient

Objective:Chemotherapy significantly improved the survival of breast cancer,but also brings various symptoms and psychological distresses.Cognitive dysfunction was usually ignored.This study aimed to investigate the changes in cognitive function during chemotherapy and its influence on the quality of life in breast cancer patients.Methods:Female patients with newly diagnosed breast cancer have prospectively enrolled in this study.Participants investigated and completed questionnaires at four-time points:pre-chemotherapy(T1),post-chemotherapy(T2),6 months(T3)and 12 months(T4)after the completion of chemotherapy.The Functional Assessment of Cancer Therapy-Cognitive scale and the Functional Assessment of Cancer Therapy-Breast Cancer scale used was to assess the cognitive function and the quality of life,respectively.Data were analyzed using descriptive and repeated-measures analysis of variance statistics.Results:One hundred and eighty-three patients participated in the study and completed questionnaires at least 2 times.The mean score of cognitive function and the quality of life were significantly different at a different time point(P<0.05 for all).The trends of cognitive scores shown that the most serious damage of cognitive function appeared after beginning chemotherapy and followed by a slowly turn back after the completion of chemotherapy.The trend of the mean score of the quality of life after chemotherapy was similar to that of the cognitive score.The degree of cognitive dysfunction was significantly associated with the score of the quality of life at each time point after chemotherapy(P<0.05).Conclusion:Chemotherapy is closely associated with a cognitive impairment,which contributes to a significant decrease in the quality of life of patients with breast cancer.

Effects of neoadjuvant chemotherapy on respiratory function in patients with breast cancer

Objective: To evaluate changes in chest X-rays, pulmonary function tests(PFTs) and quality of life in female breast cancer patients who had been treated with four cycles of neoadjuvant chemotherapy consisting of a regimen of cyclophosphamide, epirubicin and 5-fluorouracil(CEF regimen), and to determine the correlation between pulmonary function parameters and declined quality of life.Methods: Twenty-nine eligible female patients diagnosed with breast cancer at the first visit who were 20-60 years old, were classified as the American Society of Anesthesiologists(ASA) Ⅰ-Ⅱ and patients whose body mass index(BMI) <30 kg/m^2 were recruited and subjected to chest X-ray examinations, PFTs and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30(EORTC QLQ-C30)questionnaire before and after receiving 4 cycles of the CEF regimen.Results: In this study, chest X-rays showed no abnormal changes after chemotherapy, but significant decreases in carbon monoxide diffusing capacity(DLCO) and percentage of the DLCO predicted value(DLCO%)(P<0.001). A significant increase in maximal ventilatory volume(MVV)(P=0.004) was observed, and most patients experienced dyspnea(P=0.031) and fatigue(P<0.001). However, there was no significant correlation between the changes in these PFTs parameters and the results of the EORTC QLQ-C30(P>0.05).Conclusions: Neoadjuvant chemotherapy can reduce lung diffusion function and quality of life in females with breast cancer.

Effect of Xiaoaiping combined with neoadjuvant chemotherapy on the pro-proliferation molecule expression and immune function in patients with breast cancer

Objective: To investigate the effect of Xiaoaiping combined with neoadjuvant chemotherapy on the pro-proliferation molecule expression and immune function in patients with breast cancer. Methods: A total of 98 patients with primary breast cancer who were diagnosed and treated in the hospital between December 2015 and February 2017 were collected and divided into control group and Xiaoaiping group by random number table, each with 49 cases. Control group received neoadjuvant chemotherapy + surgery + postoperative chemoradiotherapy, and Xiaoaiping group received Xiaoaiping + neoadjuvant chemotherapy + surgery + postoperative chemoradiotherapy. The differences in pro-proliferation gene expression in intraoperative breast cancer tissue as well as the differences in serum levels of Th1/Th2 cytokines and Th17/Treg cytokines before chemotherapy started (T0) and 1 week after neoadjuvant chemotherapy ended (T1) were compared between the two groups of patients. Results: MTA2, NRP-1, PKM2, TM4SF1 and ZIC1 mRNA expression in breast cancer tissue of Xiaoaiping group were lower than those of control group. At T1, serum IFN-γ and TNF-α levels of Xiaoaiping group were higher than those of control group whereas IL-4, IL-10, IL-17, IL-22, IL-35 and TGF-β levels were lower than those of control group. Conclusion: Xiaoaiping combined with neoadjuvant chemotherapy can effectively improve the curative effect of preoperative chemotherapy, and also significantly inhibit the proliferation activity of breast cancer cells and balance the immune function of the body.

Effect of Xiao Chaihu Tang combined with intravenous chemotherapy on tumor markers and immune function in patients with advanced breast cancer

Objective:To study the effect of Xiao Chaihu Tang combined with intravenous chemotherapy on tumor markers and immune function in patients with advanced breast cancer.Methods: 76 patients with advanced breast cancer treated in our hospital between May 2012 and November 2015 were collected and divided into the combined treatment group (n=34) who accepted Xiao Chaihu Tang combined with intravenous chemotherapy and the control group (n=42) who accepted intravenous chemotherapy alone according to different treatment, and the treatment cycle was 3 months for both groups. Before treatment and 3 months after treatment, ELISA method was used to detect serum levels of broad-spectrum tumor markers and breast cancer-specific tumor markers;flow cytometer was used to detect cellular immune function index levels, and turbidimetric immunoassay was used to detect humoral immune function index levels in peripheral blood.Results: Before treatment, differences in serum tumor marker levels as well as cellular immunity and humoral immunity index levels in peripheral blood were not statistically significant between two groups of patients (P>0.05);after 3 months of treatment, broad-spectrum tumor markers carcinoembryonic antigen (CEA), carbohydrate antigen 153 (CA153) and carbohydrate antigen 125 (CA125) levels in serum of combined treatment group were lower than those of control group, and breast cancer-specific tumor markers insulin-like growth factor-1 (IGF-1), midkine (MK), soluble E-cadherin (sEC) and thymidine kinase 1 (TK1) levels were lower than those of control group (P<0.05);CD3+ and CD4+ T lymphocyte levels as well as CD4+/CD8+ ratio in peripheral blood of combined treatment group were higher than those of control group while CD8+ T lymphocyte level was lower than that of control group, and immunoglobulin G (IgG), immunoglobulin A (IgA) and immunoglobulin M (IgM) levels in peripheral blood were higher than those of control group (P<0.05).Conclusions:Xiao Chaihu Tang combined with intravenous chemotherapy can decrease the severity of advanced breast cancer and optimize the body's immune function.

Current medical treatment of estrogen receptor-positive breast cancer

Approximately 80% of breast cancers(BC) are estrogen receptor(ER)-positive and thus endocrine therapy(ET) should be considered complementary to surgery in the majority of patients. The advantages of oophorectomy, adrenalectomy and hypophysectomy in women with advanced BC have been demonstrated many years ago, and currently ET consist of(1) ovarian function suppression(OFS), usually obtained using gonadotropinreleasing hormone agonists(Gn RHa);(2) selective estrogen receptor modulators or down-regulators(SERMs or SERDs); and(3) aromatase inhibitors(AIs), or a combination of two or more drugs. For patients aged less than 50 years and ER+ BC, there is no conclusive evidence that the combination of OFS and SERMs(i.e., tamoxifen) or chemotherapy is superior to OFS alone. Tamoxifen users exhibit a reduced risk of BC, both invasive and in situ, especially during the first 5 years of therapy, and extending the treatment to 10 years further reduced the risk of recurrences. SERDs(i.e., fulvestrant) are especially useful in the neoadjuvant treatment of advanced BC, alone or in combination with either cytotoxic agents or AIs. There are two types of AIs: type Ⅰ are permanent steroidal inhibitors of aromatase, while type Ⅱ are reversible nonsteroidal inhibitors. Several studies demonstrated the superiority of the third-generation AIs(i.e., anastrozole and letrozole) compared with tamoxifen, and adjuvant therapy with AIs reduces the recurrence risk especially in patients with advanced BC. Unfortunately, some cancers are or became ET-resistant, and thus other drugs have been suggested in combination with SERMs or AIs, including cyclin-dependent kinase 4/6 inhibitors(palbociclib) and mammalian target of rapamycin(m TOR) inhibitors, such as everolimus. Further studies are required to confirm their real usefulness.

Peritoneal carcinomatosis from advanced ovarian cancer: To treat or not to treat ethical issues suggested by a case study

This article provides a brief description of an epithelial ovarian cancer （EOC） case （stage Ⅳ） treated with the association of complete CytoReductive Surgery and hy-pertermic intraPEritoneal chemotherapy （HIPEC）. The use of HIPEC in EOC makes theoretic sense in view of the high rates of recurrence following standard treat-ment, but there are no randomized clinical trial to date and HIPEC for these patients still represents a radical treatment where the choice of no treatment may be acceptable since defnitive cure is unlikely. We reviewed the entire decision making process considering the risk/beneft of the procedure in term of mortality/morbidity, the quality of life and the psychological profile of the patient 1 year after surgery. The platform World Health Organization-International Classification of Function-ing, Disability and Health that permits evaluation of the person in relation to the psycho-social context is pre-sented. A person-centred approach and assessment of health-related quality-of-life and disability in EOC survi-vors are of central importance for decision making.

Epithelial ovarian cancer:An overview

Ovarian cancer is the second most common gyneco-logical cancer and the leading cause of death in the United States. In this article we review the diagnosis and current management of epithelial ovarian cancer which accounts for over 95 percent of the ovarian malignancies. We will present various theories about the potential origin of ovarian malignancies. We will discuss the genetic anomalies and syndromes that may cause ovarian cancers with emphasis on Breast cancer type 1/2 mutations. The pathology and pathogenesis of ovarian carcinoma will also be presented. Lastly, we provide a comprehensive overview of treatment strategies and staging of ovarian cancer, conclusions and future directions.

扶正驱邪方联合新辅助化疗对三阴性乳腺癌患者肿瘤复发、血清TK1 水平及免疫功能的影响

【目的】探究扶正驱邪方联合新辅助化疗对三阴性乳腺癌(TNBC)患者肿瘤复发、血清胸苷激酶1(TK1)水平及免疫功能的影响。【方法】将80例TNBC气阴两虚型患者随机分为联合组和对照组,每组各40例。对照组给予AC-T序贯化疗方案(多柔比星与环磷酰胺联合并序贯多西他赛)治疗,联合组在对照组的基础上加用扶正驱邪方治疗。1个疗程为21 d,连续治疗4个疗程。观察2组患者治疗前后中医证候积分、生活质量Karnofsky功能状态(KPS)评分、肿瘤标志物[糖类抗原125(CA125)、糖类抗原153(CA153)、TK1]水平及T淋巴细胞亚群的变化情况,比较2组患者的临床疗效以及肿瘤的转移、复发情况。【结果】(1)治疗4个疗程后,联合组的总有效率为87.50%(35/40),对照组为67.50%(27/40),组间比较(χ2检验),联合组的疗效明显优于对照组(P<0.05)。(2)治疗后,2组患者的中医证候积分均较治疗前明显降低(P<0.05),KPS评分均较治疗前明显升高(P<0.05),且联合组对中医证候积分的降低幅度及对KPS评分的升高幅度均明显优于对照组(P<0.05或P<0.01)。(3)治疗后,2组患者的血清CA125、CA153、TK1水平均较治疗前明显降低(P<0.05),且联合组对血清CA125、CA153、TK1水平的降低幅度均明显优于对照组(P<0.01)。(4)治疗后,2组患者的T细胞CD3+、CD4+水平和CD4+/CD8+比值均较治疗前明显升高(P<0.05),CD8+水平均较治疗前明显降低(P<0.05),且联合组对T细胞CD3+、CD4+水平和CD4+/CD8+比值的升高幅度及对CD8+水平的降低幅度均明显优于对照组(P<0.05或P<0.01)。(5)经过1年的随访调查,联合组的肿瘤复发率和肿瘤转移率分别为7.50%(3/40)和12.50%(5/40),明显低于对照组的25.00%(10/40)和35.00%(14/40),组间比较,差异均有统计学意义(P<0.05)。【结论】扶正驱邪方联合新辅助化疗对于TNBC气阴两虚型患者的治疗效果较好,能有效改善患者的免疫功能,降低血清肿瘤标志物水平,提高患者的生活质量,降低肿瘤复发和转移的发生率。

亮丙瑞林对ER阳性绝经前乳腺癌化疗患者卵巢功能及骨密度的影响

目的:探讨亮丙瑞林对雌激素受体(ER)阳性绝经前乳腺癌化疗患者卵巢功能及骨密度(BMD)的影响。方法:选取2020年1月—2022年8月丰城市人民医院收治的82例ER阳性绝经前乳腺癌患者的病历资料进行回顾性分析,根据治疗方式分为化疗组(n=41)和亮丙瑞林组(n=41)。化疗组患者予以AC-T辅助化疗,亮丙瑞林组在化疗组的基础上联合亮丙瑞林治疗。比较两组患者疗效、卵巢功能、BMD及月经情况。结果:亮丙瑞林组的总有效率高于化疗组(P<0.05)。治疗后,两组血清雌二醇(E2)水平均明显降低,血清促黄体生成素(LH)、卵泡刺激素(FSH)水平均明显升高(P<0.05);亮丙瑞林组患者的血清LH、FSH水平均明显高于化疗组,血清E2水平明显低于化疗组(P<0.05)。治疗后,两组左髋部、腰椎的BMD水平均明显降低(P<0.05);两组比较差异均无统计学意义(P>0.05)。亮丙瑞林组的闭经时间、月经恢复正常时间均较化疗组短,月经复潮率较化疗组高(P<0.05)。结论:亮丙瑞林可保护ER阳性绝经前乳腺癌化疗患者卵巢功能,可有效提高疗效,但可能会导致患者BMD下降,需要在治疗期间注意监测BMD变化,降低骨质疏松发生风险。

中国早期乳腺癌卵巢功能抑制临床应用专家共识(2024年版)

中国乳腺癌患者发病年龄较轻,60%的女性患者在诊断时为绝经前。与绝经后相比,未绝经女性卵巢功能旺盛,可持续大量分泌雌激素、促进乳腺癌细胞增殖。卵巢功能抑制(ovarian function suppression,OFS)已用于乳腺癌临床治疗数十年,大量循证证据表明,单用OFS和加用OFS均可降低未绝经女性乳腺癌的复发风险并改善生存。部分OFS研究的长期随访数据(SOFT/TEXT研究12和13年随访、STO-5研究20年随访、亚裔人群的ASTRRA研究8年随访)近期陆续公布,进一步证实对于早期乳腺癌患者加用OFS可显著降低10年以上的复发风险,提高治愈可能。monarchE和NATALEE研究显示,部分CDK4/6抑制剂叠加在绝经前早期乳腺癌患者含有药物去势[促性腺激素释放激素类似物(gonadotropin releasing hormone analog,GnRHa)]的辅助内分泌治疗方案时仍可进一步增加生存获益。中国抗癌协会乳腺癌专业委员会召集了国内乳腺癌治疗领域的临床专家,在2021年版的基础上共同商讨编制了《中国早期乳腺癌卵巢功能抑制临床应用专家共识(2024年版)》。本共识建议,GnRHa仍作为绝经前激素受体阳性早期乳腺癌OFS方式的首选。GnRHa联合内分泌治疗基础上添加特定CDK4/6抑制剂的激素受体阳性绝经前乳腺癌获益人群包括:淋巴结阳性,淋巴结阴性且满足任一条件[G3,G2伴Ki-67增殖指数≥20%,G2伴多基因检测(21基因评分、Prosigna PAM50、MammaPrint、EndoPredict)高危]。本共识也认可将2023年St.Gallen共识中有化疗指征的风险因素作为OFS适用判定标准之一。GnRHa用药推荐根据激素受体阳性乳腺癌患者化疗前的卵巢功能状态进行决策。如果考虑卵巢保护,推荐GnRHa同步化疗,不影响患者生存获益;如果不考虑卵巢保护,GnRHa同步化疗和GnRHa在化疗结束后序贯使用均被认可,后者更为推荐。围绝经期患者的内分泌治疗建议参照绝经前方案。GnRHa辅助内分泌治疗的时长建议为5年。中高危患者完成5年联合GnRHa的内分泌治疗后,如果未绝经且耐受性良好,可考虑继续2~5年联合GnRHa的内分泌治疗或单用2~5年选择性雌激素受体调节剂(selective estrogen receptor modulator,SERM)治疗。辅助治疗方案中添加GnRHa安全可耐受,推荐应用前和患者充分沟通药物的使用方法和可能的不良事件,安全性管理有助于提高患者的依从性。对于接受药物去势的患者,在去势过程中不推荐常规监测雌激素水平,如怀疑不完全的OFS(包括改变用法如注射人员缺乏该药物熟练注射经验、更换剂型或出现某些可能提示卵巢功能恢复的生理变化如月经恢复或更年期症状的周期性波动时),可进行雌激素水平测定以辅助决策。绝经前乳腺癌患者如有需求,无论激素受体阳性或阴性,均可使用GnRHa保护卵巢功能,降低卵巢功能早衰的发生风险,减少生育能力损害,推荐化疗前至少1周开始使用GnRHa,每28 d 1次,直至化疗结束后2周给予最后1剂。针对激素受体阳性乳腺癌患者开展的临床试验,不推荐仅纳入绝经后人群,也应当探索GnRHa应用条件下的绝经前人群,以明确试验药物对这类患者的实际效应。另外本共识还新增了早期/局部晚期乳腺癌患者OFS药物应用的全程管理路径,以期进一步助力临床决策。

影像检查对早期检测及评估乳腺癌患者化疗后相关心功能障碍的价值

乳腺癌已发展为全球第一大癌,随着诊治手段的进步,乳腺癌患者生存时间不断延长,但抗肿瘤治疗会引发心脏相关并发症,出现癌症治疗相关心功能障碍(cancer therapy related cardiac dysfunction,CTRCD)。CTRCD始于亚临床心肌细胞损伤,最终发展为有症状的心力衰竭。因此,准确评估CTRCD的发生和严重程度对于肿瘤患者的治疗和康复至关重要。随着医疗技术的不断进步,心脏影像学成为评估和管理心脏健康的关键工具,包括超声心动图、心脏计算机断层扫描(cardiac computed tomography,CCT)、心脏磁共振成像(cardiac magnetic resonance imaging,CMRI)等,在提供心脏结构和功能信息的基础上,组织特定性成像、应变成像、灌注成像等在早期识别和评估CTRCD中发挥关键作用。本文就不同影像检查技术在乳腺癌患者化疗后心功能障碍研究中的进展进行文献综述,重点论述磁共振技术在此方面的进展,以期为早期检测CTRCD提供更为精确的影像生物信息。

蠲毒化浊益肾汤预防年轻乳腺癌化疗相关卵巢功能损伤的临床研究

目的评价蠲毒化浊益肾汤预防年轻乳腺癌患者化疗相关卵巢功能损伤的效果。方法63例经病理确诊的年轻乳腺癌患者,采用随机数字表法分为治疗组(31例)和对照组(32例)。对照组采用单纯化疗,治疗组化疗期间联合蠲毒化浊益肾汤口服。比较两组化疗后月经情况,化疗后围绝经期症状,血清雌二醇(E_(2))、卵泡刺激素(FSH)水平及低抗苗勒管激素(AMH)发生率。结果治疗组化疗后月经正常率29.03%,月经减少率54.84%,闭经率16.13%;对照组化疗后月经正常率12.50%,月经减少率43.75%,闭经率43.75%。两组化疗后月经变化情况比较差异有统计学意义(P<0.05)。治疗组闭经患者化疗后(4.40±1.14)个月发生闭经晚于对照组的(2.50±0.94)个月,具有显著性差异(P<0.05)。化疗后,治疗组22.58%患者出现围绝经期症状,对照组50.00%患者出现围绝经期症状;两组化疗后有围绝经期症状患者占比有统计学差异(P<0.05)。化疗前治疗组和对照组血清E_(2)[(49.65±15.27)pg/ml VS(46.06±12.99)pg/ml]、FSH[(6.15±1.78)U/L VS (5.93±1.55)U/L]比较均无统计学差异(P>0.05)。化疗后6个月治疗组血清E_(2)水平为(27.01±7.89)pg/ml,血清FSH水平为(21.94±10.54)U/L;对照组血清E_(2)水平为(19.64±8.55)pg/ml,血清FSH水平为(32.91±17.81)U/L。治疗组血清E_(2)下降水平少于对照组,血清FSH上升水平少于对照组,差异有统计学意义(P<0.05)。治疗组化疗后1年低AMH发生率35.48%(11/31),对照组化疗后1年低AMH发生率62.50%(20/32),两组比较差异具有统计学意义(χ^(2)=4.598,P=0.032<0.05)。结论年轻乳腺癌患者化疗期间服用蠲毒化浊益肾汤对卵巢功能具有保护作用,可减少月经紊乱及闭经的发生率、围绝经期症状的发生率及血清低AMH发生率,抑制血清E_(2)下降及FSH上升。

西黄丸辅助白蛋白结合型紫杉醇联合环磷酰胺化疗对乳腺癌患者免疫功能的影响

目的:观察西黄丸辅助白蛋白结合型紫杉醇联合环磷酰胺(TC)化疗方案对乳腺癌患者术后免疫功能的影响。方法:选取2021年1月1日~2023年5月1日某院甲乳外科收治的78例乳腺癌术后行TC化疗方案的患者为研究对象,采用随机数字表法分为对照组和观察组,每组39例。对照组给予TC化疗方案进行治疗,观察组在对照组治疗基础上加用西黄丸。治疗2个周期后,比较两组患者免疫指标[CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)、自然杀伤(NK)细胞]水平变化。结果:治疗后,观察组CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)、NK细胞水平均高于对照组(P<0.05),CD8^(+)水平低于对照组(P<0.05)。结论:西黄丸辅助TC化疗可通过调节CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)、NK细胞水平,改善行TC化疗的乳腺癌患者术后免疫功能,建议临床推广。

δ-连环蛋白高表达状态对乳腺癌患者化疗后短期脑认知功能影响的静息态功能MRI研究

目的利用静息态功能MRI探讨δ-连环蛋白(catenin)不同表达状态的乳腺癌患者采用蒽环联合环磷酰胺(anthracyclines cyclophosphamide,AC)化疗方案2个周期后的脑认知功能改变。材料与方法前瞻性收集66例经病理证实乳腺癌并首次进行标准化化疗患者,根据组织血清δ-catenin水平,分为δ-catenin高表达组31例和低表达组35例,同时收集健康对照(healthy control,HC)组36例。所有受试者在化疗前及2个化疗周期后进行神经心理学评分并行脑静息态功能MRI、3D-T1加权成像,分析脑静息态功能MRI指标,包括低频振幅(amplitude of low frequency fluctuation,ALFF)值、分数低频振幅(fractional amplitude of low frequency fluctuation,fALFF)值、局部一致性(regional homogeneity,ReHo)值,并对患者化疗前后神经心理学评分以及脑静息态功能MRI指标进行对比分析。结果化疗前δ-catenin高表达组人表皮生长因子受体2(human epidermal growth factor receptor 2,HER-2)显著高于低表达组,差异有统计学意义(P<0.05)。乳腺癌患者化疗前后神经心理学评分显示,δ-catenin高表达组患者化疗后癌症治疗认知功能评估(Functional Assessment of Cancer Therapy-Cognitive,FACT-Cog)总分、感知认知能力(Perceived Cognitive Abilities,PCA)、简易智力状态检查评分(Mini Mental State Examination,MMSE)、蒙特利尔认知评估评分(Montreal Cognitive Assessment,MOCA)、数字符号转化测验(Digital Symbol Substitution Test,DSST)以及中文听觉词语学习测验(Auditory Verbal Learning Test,AVLT)、数字连线实验B(Line-B)评分较化疗前差异有统计学意义,而低表达组只有AVLT-长时记忆(AVLT-long)评分差异有统计学意义(P均<0.05)。与化疗前相比,化疗2周期后部分脑区ALFF及ReHo值改变差异有统计学意义(P<0.05)。δ-catenin低表达组患者化疗后右侧前扣带和旁扣带脑回ALFF值下降,而δ-catenin高表达组右侧小脑半球4-5区、双侧脑岛、左侧舌回化疗后ALFF值下降。ReHo指标中,δ-catenin低表达组患者化疗后左侧眶部额下回ReHo值下降;而δ-catenin高表达组则左侧缘上回、左侧三角部额下回ReHo值下降(P均<0.05)。结论δ-catenin高表达进一步加重化疗对乳腺癌患者脑认知功能的损伤,主要涉及执行认知功能调控等相关脑区。

乳腺癌化疗患者脑结构及功能磁共振成像研究

目的探讨乳腺癌化疗患者的脑灰质体积(gray matter volume,GMV)变化及静息状态下部分脑区与全脑功能连接(functional connectivity,FC)的改变。材料与方法本研究共纳入29名术后化疗前的乳腺癌患者(without chemotherapy treatment,C−)和30名化疗后乳腺癌患者(chemotherapy treatment,C+),分别进行了心理认知测试、结构及静息态功能MRI扫描,运用基于体素的形态学测量(voxel-based morphometry,VBM)方法对GMV进行分析,并选择体积变化脑区为感兴趣区(region of interest,ROI)进行全脑FC的分析。GMV比较及FC比较均采用双样本t检验分析方法。采用Spearman偏相关分析来探讨差异脑区GMV及FC值与心理认知测试结果之间的关系。结果与C−组相比,C+患者左侧枕中回(MNI:X,Y,Z=−10.5,−105.0,0.0)、右侧距状裂周围皮层(MNI:X,Y,Z=15.0,−103.5,−1.5)GMV减小(P<0.001,cluster size>90)。以左侧枕中回为种子点,与右侧颞极:颞上回(MNI:X,Y,Z=63,3,−3)、左侧颞上回(MNI:X,Y,Z=−54,−12,3)FC减弱;以右距状裂周围皮层为种子点,与左侧舌回(MNI:X,Y,Z=−33,−87,−15)FC减弱(P<0.001,FWE-corrected<0.05)。C+患者GMV与FC值与心理认知结果之间未存在明显相关性(P>0.05)。结论乳腺癌患者化疗后大脑部分区域GMV改变,与大脑多个脑区存在FC受损,这可能是其认知、情感及行为障碍的神经病理基础之一。

积极心理学联合多模态运动干预在乳腺癌化疗患者中的应用

目的探究积极心理学联合多模态运动干预在乳腺癌化疗患者中的应用价值。方法将住院行化疗的360例乳腺癌患者,按病区随机分为对照组和观察组各180例;对照组行常规化疗护理,观察组在对照组的基础上实施积极心理学干预联合多模态运动干预。两组均化疗3个疗程,连续干预12周后评价效果。结果干预后观察组希望水平得分及应对方式的面对维度得分显著高于对照组,屈服、回避维度,癌因性疲乏得分显著低于对照组(均P<0.05);CD^(3+)、CD^(4+)含量、CD^(4+)/CD^(8+)显著优于对照组(均P<0.05)。结论积极心理学联合多模态运动干预可改善患者心理与应对方式,缓解疲乏和改善免疫功能。

戈舍瑞林对绝经前乳腺癌患者卵巢功能保护的meta分析

目的通过meta分析方法系统评价戈舍瑞林对绝经前乳腺癌患者卵巢功能保护的能力。方法检索中国知网、万方数据库、维普数据库、PubMed、Web of Science、Scopus及Cochrane Library,提取从建库至2023年10月戈舍瑞林治疗绝经前乳腺癌的对照试验。由2名研究者根据纳入与排除标准独立筛选文献、提取数据,并采用Cochrane协作网风险偏倚评价工具对纳入研究质量进行评价,运用RevMan 5.3软件进行数据分析。结果共纳入28项研究,共8782例研究对象,其中试验组4372例,对照组4410例。meta分析结果显示:试验组总有效率高于对照组(OR=2.87,95%CI 1.94~4.26,P<0.00001);试验组基础卵泡刺激素(bFSH)水平低于对照组(MD=-3.81,95%CI-4.35~-3.27,P<0.00001);试验组窦状卵泡数(bAFC)水平高于对照组(MD=3.27,95%CI 2.83~3.72,P<0.00001);两组雌二醇(E2)水平比较,差异无统计学意义(SMD=0.85,95%CI-0.69~2.40,P=0.28);试验组促黄体生成素(LH)高于对照组(MD=8.75,95%CI 7.84~9.67,P<0.00001);试验组卵巢早衰(POI)低于对照组(OR=0.24,95%CI 0.08~0.73,P=0.01);试验组月经复潮率高于对照组(OR=3.09,95%CI 1.01~9.46,P=0.05);试验组无病生存期(DFS)高于对照组(OR=1.91,95%CI 1.28~2.85,P=0.002);试验组总生存期(OS)高于对照组(OR=1.35,95%CI 1.14~1.59,P=0.0004);试验组无进展生存时间(PFS)高于对照组(MD=30.15,95%CI 29.47~30.83,P<0.00001);试验组不良反应发生率低于对照组(OR=0.48,95%CI 0.25~0.90,P=0.02)。结论戈舍瑞林治疗绝经前乳腺癌患者能有效保护其卵巢功能,提高患者生存时间,同时具有较好的安全性。

基于QFD构建乳腺癌术后化疗患者体重管理模式

目的构建乳腺癌术后化疗患者体重管理模式,降低超重或肥胖发生率,提高患者自我管理能力。方法从乳腺癌术后化疗患者需求出发,运用KJ法、Kano模型、质量屋等工具,结合TRIZ理论及FMEA方法构建乳腺癌术后化疗患者体重管理模式,包括联动整合体重管理资源、精准制订体重管理方案、全面落实“1+1+N”体重管理方案、搭建体重管理智能随访平台等。结果患者自我管理能力得分提高至170.67分,体重管理依从率提高至90.00%,甘油三酯水平降低至1.25 mmol/L,体脂率降低至28.67%,超重或肥胖发生率降低至16.67%,生活质量得分提高至112.03分。结论将质量功能展开(QFD)与品管圈结合可有效识别乳腺癌术后化疗患者需求,降低超重或肥胖发生率,提高患者自我管理能力及生活质量。

卵巢功能抑制联合芳香化酶抑制剂治疗绝经前乳腺癌的短期预后效果评价

目的:分析卵巢功能抑制与芳香化酶抑制剂联合应用于绝经前年轻乳腺癌治疗中的临床价值。方法:选取惠州市第三人民医院乳腺外科2020年4月~2021年10月收治的60例绝经前乳腺癌患者为研究对象,根据治疗方案的不同将患者分为试验组和对照组各30例。对照组使用他莫昔芬治疗,试验组采用卵巢功能抑制联合芳香化酶抑制剂治疗,比较两组的治疗效果。结果:试验组骨质疏松、关节痛、阴道不规则出血、胃肠道反应等不良反应发生率均低于对照组,差异有统计学意义(P<0.05)。化疗结束后6个月,试验组卵巢功能恢复率(93.33%)高于对照组(73.33%),差异有统计学意义(P<0.05),化疗结束后12个月两组卵巢功能恢复率比较,差异无统计学意义(P>0.05)。试验组化疗6个月、12个月的卵巢囊肿发生率和子宫内膜增厚率均低于对照组,差异有统计学意义(P<0.05),化疗3个月两组比较差异无统计学意义(P>0.05)。结论:卵巢功能抑制联合芳香化酶抑制剂联合方案治疗绝经前乳腺癌的近期效果优于他莫昔芬单独治疗方案。