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Objective:To investigate the influencing factors of breakthrough cancer pain (BTcP) in patients with advanced pancreatic cancer.Methods:According to the inclusion and exclusion criteria, patients with advanced pancreatic cancer who were diagnosed and followed up by outpatient service in the 909th Hospital of the Joint Logistic Support Force from January 2019 to December 2020 were prospectively selected as the study subjects. According to whether breakthrough cancer pain occurred, all patients were divided into observation group (breakthrough cancer pain) and control group (no breakthrough cancer pain). The relevant clinical data of the included patients including age, gender, presence or absence of vomit, constipation, sleep disruption, frequency of basic pain every week, with or without regular medication, heavy physical labor, with or without vascular invasion, bone metastasis, abdominal metastasis and lung metastasis, as well as whether surgery, radiotherapy or chemotherapy were collected and the data of evaluation indicators during follow-up were recorded. Digital pain score (NRS) and visual analog score (VAS) were used as pain evaluation score. Univariate and logistic regression were used to analyze the related influencing factors of breakthrough cancer pain. Receiver operating characteristic curve (ROC) was drawn, and area under curve (AUC), sensitivity and specificity were calculated to analyze the predictive value for breakthrough cancer pain.Results:A total of 173 patients were included in the study, with 49 cases in the observation group and 124 cases in the control group. Univariate analysis showed that aged ≥50 years old, constipation, sleep disruption, frequency of basic pain ≥3 times, irregular medication, heavy physical labor, bone metastasis, lung metastasis, radiochemotherapy, high NRS score and high VAS score were the influencing factors for breakthrough cancer pain (all P value <0.05). Multivariate analysis showed that irregular medication ( OR=1.879, 95% CI 2.473-4.757, P=0.002), basal pain ≥3 times ( OR=2.067, 95% CI 1.364-6.825, P=0.004), bone metastasis ( OR=2.756, 95% CI 1.153-5.846, P<0.001), NRS score ( OR=3.787, 95% CI 2.647-5.958, P<0.001), VAS score ( OR=2.684, 95% CI 1.545-7.878, P<0.001), were the risk factors for breakthrough cancer pain. The AUC of NRS score for predicting the occurrence of breakthrough cancer pain was 0.665 (95% CI0.573-0.757, P=0.001), and the cut-off value was 2.5 score with a sensitivity of 61.2% and a specificity of 77.1%. The AUC for predicting breakthrough cancer pain by VAS score was 0.608 (95% CI0.515-0.701, P=0.028), and the cut-off value was 2.5 score with a sensitivity of 67.9% and a specificity of 63.7%. The AUC of NRS+ VAS score for predicting breakthrough cancer pain was 0.692 (95% CI0.604-0.780), and the cut-off value was 4.5 score with a sensitivity of 81.6% and a specificity of 79.8%. Conclusions:Patients with advanced pancreatic cancer have a high incidence of breakthrough cancer pain, which was related to a variety of factors. NRS combined with VAS score can effectively predict the occurrence of breakthrough cancer pain.
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Objective:To investigate the efficacy of different conversion therapies for colorectal cancer with unresectable simultaneous liver metastasis.Methods:A total of 170 patients of colorectal cancer complicated with liver metastasis who were admitted to the First Affiliated Hospital of Nanchang University from Jan 2015 to Dec 2020 were included in the study. Patients were divided into an initial resectable group (42 cases) and an initial non-resectable group (128 cases).Results:There were no significant differences in OS and PFS between patients with CRLM (colorectal cancer with liver metastasis) who were resected initially and those successfully underwent transformation therapy ( P>0.05). The median OS was 36 months in the group with successful transformation, while it was 21 months in the group with simple primary tumor resection and no liver metastasis resection ( P=0.014), HR=0.48 (0.27-0.86). The median PFS was 28 months in the successful conversion group, while it was 10 months in the primary tumor resection only and no liver metastasis resection ( P=0.005), HR=0.43 (0.24-0.77). The OS difference between the group with simple primary tumor resection and no resected liver metastasis and the group with neither primary tumor nor liver metastasis resection was statistically significant: (21 months vs.13 months), HR=0.52 (0.32-0.86) ( P=0.01), while the PFS between the two groups was not statistically significant, ( P>0.05). Conclusions:Chemotherapy combined with targeted therapy has the best effect among the conversion therapies, and can improve the resection rate and survival rate of patients undergoing R 0 surgery. Resection of the primary lesion alone can also prolong the patient's survival.
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Objective:To investigate the value of counting microvessel density (MVD) and lymphatic vessel density (LVD) in predicting distant metastasis of pancreatic cancer within 1 year after surgery.Methods:The clinicopathological data of 47 patients with pancreatic cancer who underwent surgery in Laibin People's Hospital from January 2020 to December 2021 were retrospectively analyzed. The patients were divided into non-metastasis group( n=24) and metastasis group( n=23) according to whether distant metastasis occurred during 1-year follow-up. Immunohistochemistry was used to detect the CD 34 expression in microvascular epithelial cells and D2-40 level in lymphatic epithelial cells from pancreatic cancer tissues. MVD and LVD in cancer tissues and adjacent normal tissues were counted. The relationship between MVD and LVD in cancer tissues and clinicopathological characteristics such as gender, age, tumor diameter, tumor differentiation, lymph node metastasis, vascular invasion, nerve invasion and tumor stage were analyzed. The receiver operating characteristic curve (ROC) was drawn and the area under the curve (AUC) was calculated to evaluate the value of MVD and LVD in predicting distant metastasis of pancreatic cancer within 1 year after surgery. The effects of MVD and LVD on the distant metastasis rate of pancreatic cancer within one year after operation were evaluated. Univariate and multivariate logistic regression were used to analyze the independent influencing factors for distant metastasis of pancreatic cancer within 1 year after surgery. Results:MVD and LVD in metastatic cancer tissues were higher than those in adjacent normal tissues [(72.52±9.73) vs (51.73±7.95)/400 times field of view, (23.78±6.87) vs (14.00±5.66)/400 times field of view]. MVD and LVD in the non-metastasis group were also higher than those in the adjacent normal tissues [(63.20±6.52) vs (54.79±5.80)/400 times field of view, (16.25±5.15) vs (13.62±5.03)/400 times field of view], and all the differences were statistically significant ( P<0.05). MVD in cancer tissue was significantly increased in patients with tumor diameter ≥2 cm, lymph node metastasis, vascular invasion and high TNM stage ( P<0.05), and LVD was significantly increased in patients with tumor diameter ≥2 cm, lymph node metastasis, moderate and low differentiation, vascular invasion, nerve invasion and high TNM stage ( P<0.05). The AUC values of MVD and LVD in predicting distant metastasis of pancreatic cancer within 1 year after surgery were 0.799 (95% CI 0.659-0.939) and 0.803(95% CI 0.676-0.929), and the cut-off values were 70.5 and 20.5/400 times field of view, respectively. The sensitivity was 73.9% and 69.6%, and the specificity was 87.5% and 83.7%. The cumulative distant metastasis rate within 1 year after operation in high MVD and high LVD groups was significantly higher than that in low MVD and low LVD groups ( P<0.05). Multivariate logitic regression analysis showed that tumor diameter ≥2 cm ( OR=1.757, 95% CI 1.536-3.846, P<0.05), lymph node metastasis ( OR=2.364, 95% CI 1.036-4.175, P<0.05), high MVD ( OR=4.345, 95% CI 1.245-3.736, P<0.05) and high LVD ( OR=3.637, 95% CI 1.426-4.035, P<0.05) were independent risk factors for distant metastasis of pancreatic cancer within 1 year after surgery. Conclusions:Increased MVD and LVD in pancreatic cancer tissues are independent influencing factors for distant metastasis within 1 year after surgery, which can be used to predict whether patients have distant metastasis within 1 year after surgery.
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Tumor metastasis is an important cause of tumor treatment failure. Its molecular mechanism is closely related to tumor cells remodeling immune cells and immunosuppressive microenvironment, so as to create a suitable soil for tumor cell invasion and growth. "Huoxue Huayu" is one of the important therapeutic principles in cancer treatment, but the influence of Huoxue drugs on tumor metastasis has been controversial in clinical application. In this paper, we systematically summarized the comparative study of Huoxue drugs and Yiqi Huoxue drugs in tumor metastasis in recent years, and discussed the differences of molecular mechanisms of Huoxue drugs and Yiqi Huoxue drugs in anti-tumor metastasis from the perspective of immune remodeling, so as to provide scientific basis for clinical rational application of Huoxue drugs and Yiqi Huoxue drugs.
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Objective:To evaluate the diagnostic efficacy of contrast enhanced computed tomography (CT) at early arterial phase and late arterial phase for detecting pancreatic carcinoma with small liver metastases (<1 cm).Methods:The enhanced CT data of 93 patients with pathologically confirmed pancreatic carcinoma admitted in the First Affiliated Hospital of Nanjing Medical University were retrospectively analyzed. The patients were randomly divided into the early arterial phase group (47 patients with the early arterial phase and portal venous phase scanning) and the late arterial phase group (46 patients with the late arterial phase and portal venous phase scanning) according to random number method. Number, maximum diameter, enhancement features of small liver metastases in two groups were observed. The receiver operating characteristic curve (ROC) was drawn and the area under the curve was calculated. The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value were also evaluated.Results:In the early arterial phase group, 21 of 47 patients had 28 small liver metastases with the maximum diameter of (7.33±1.40)mm. And in the late arterial phase group, 20 of 46 patients had 29 small liver metastases with the maximum diameter of (7.69±1.67)mm. There was not significantly statistical difference between the two groups ( P>0.05). Small liver metastases were more likely to present rim enhancement at the late arterial phase (69.0%). The area under curve of ROC of diagnostic performance in the early and late arterial phase were 0.657(95% CI 0.531-0.782), 0.810(95% CI 0.672-0.947), respectively. For the early phase group, the accuracy, sensitivity, specificity, positive predictive value, and negative predictive value were 68.1%, 61.9%, 75.0%, 88.5%, 42.9%, respectively. The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value in the late group were 82.6%, 65.7%, 100%, 100%, 75.8%, respectively. Compared with the early arterial phase group, the late arterial phase group showed higher performance in detecting small liver metastases. Conclusions:Enhanced CT at the late arterial phase improves the detection of small liver metastases in patients with pancreatic carcinoma, aiding in accurate staging preoperatively.
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Multidisciplinary therapy is considered as an acceptable option for gastric cancer patients with liver metastases currently, while the effectiveness of surgery is still controversial. Although there was no improved survival for cytoreductive surgery, some evidences showed that some selected patients with the combination surgery of gastric cancer and liver metastases could benefit from curative resection. Compared to cytoreductive surgery for gastric cancer patients with liver metastasis, curative resection did not increase the incidence of complications or mortality. Therefore, surgery-based multidisciplinary therapy would be appropriate for some seleted gastric cancer patients with liver metastasis. In highly selected patients with neoadjuvant chemotherapy, curative resection with both primary and metastatic tumor could improve long-term survival benefits. Furthermore, the long-term survival and quality of life should be considered of equal importance in future studies.
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Ovary is one of the common metastatic sites of gastric cancer. In the female patients, ovarian relapse is one of the most important causes of treatment failure for gastric cancer. The most likely mechanism of Krukenberg tumor development is via retrograde lymphatic spreading from gastric cancer. However, neither optimal treatment strategy nor standard treatment guideline for Krukenberg tumor from gastric cancer has been clearly established.The diagnostic key points consist of the previous or concomitant history of gastric cancer and the detection of ovarian solid tumors.The therapeutic regimens mainly include the metastasectomy, chemotherapy, radiotherapy and comprehensive treatment. Surgical resection of metastatic tumor combined with adjuvant chemotherapy can improve the prognosis and survival.
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Background: The clinical manifestations of some rare diseases of the stomach are nonspecific, which may lead to missed diagnosis, misdiagnosis, and delayed or inappropriate management. Aims: To investigate the clinicopathological features and immunohistochemistry of some rare diseases of the stomach and their application in diagnosis and differential diagnosis. Methods: Gastroscopic biopsy specimens from Jan. 2017 to Dec. 2017 at the First Hospital of Harbin were reviewed. Twelve pathology-proved rare and easily misdiagnosed cases were screened out for analysis of clinicopathological features and immunohistochemical markers retrospectively. Results: Twelve rare diseases of the stomach, including one case of primary squamous cell carcinoma, 8 cases of metastatic carcinoma, two cases of primary neuroendocrine tumor, and one case of cytomegalovirus (CMV) infection were enrolled. In 8 cases of metastatic carcinoma, 2 were mammary origin, 3 were kidney origin, 2 were lung origin and 1 was liver origin. Each lesion had its unique histomorphological appearance and specific immunohistochemical markers. Conclusions: Tissue obtained from gastroscopic biopsy is limited. Familiar with the histomorphology and immunohistochemical markers of rare diseases of the stomach may avoid misdiagnosis and inappropriate management.
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Objectives To study the clinical characteristics,diagnosis,treatment and prognosis of cancer metastases to the thyroid gland.Methods At Tianjin Medical University Cancer Hospital,from 1980 to 2016 30 patients were identified with a metastatic malignant tumor of the thyroid gland.Results Primary tumor sites were in the esophagus (26.7％),lung (16.7％),and kidney (13.3％).The median age at discovery of thyroid metastasis was 56 years old.The time lapse ranged from 0 to 108 months.There were 18 patients with metachronous metastasis with median survival of 36 months,12 patients were with synchronous metastasis,and the median survival was 8 months (P ＜ 0.01).20 patients were treated with thyroid surgery,and of which 15 patients were given post-op radiotherapy and chemotherapy.Patients who underwent thyroid resection had a median survival of 15 months,while that was 8 months in those without thyoid surgery (P ＜ 0.01).Conclusions Metastases to the thyroid gland is a rare clinical phenomenon,the prognosis of patients is mainly related to the biological behavior of primary tumors,but surgical resection and combined treatment can increase the survival rate.
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ABSTRACT Uveal melanoma is the most common adult primary intraocular cancer. Although liver metastasis is common to the natural history of the disease, metastasis to the fellow eye is extremely rare. Here we report the case of a 59-year-old man with choroidal melanoma in his right eye who underwent enucleation at a different center. The patient was referred to our service 21 months postoperatively, complaining of decreased vision. He was found to have a new pigmented choroidal tumor in his left eye associated with liver disease. Ocular ultrasonography and liver biopsy with histopathological and immunohistochemical analysis were performed and confirmed the diagnosis. Few similar cases have been described in the literature. The differential diagnosis included primary bilateral choroidal melanoma and metastatic choroidal tumor from a primary skin melanoma.
RESUMO O melanoma uveal é o câncer intraocular primário mais frequente em adultos. Embora a metástase hepática seja comum à história natural da doença, a metástase para o outro olho é extremamente rara. Aqui relatamos o caso de um homem de 59 anos com melanoma de coroide em seu olho direito que foi submetido à enucleação em um centro diferente. O paciente foi encaminhado ao nosso serviço 21 meses após a cirurgia, com queixa de diminuição da visão. Foi encontrado um novo tumor de coróide pigmentado em seu olho esquerdo associado com doença hepática. Ultrassonografia ocular e biópsia hepática com exame histopatológico e imuno-histoquímico foram realizadas e confirmaram o diagnóstico. Poucos casos semelhantes foram descritos na literatura. O diagnóstico diferencial incluiu melanoma de coróide bilateral orimário e tumor coroidal metastático de um melanoma primário da pele.
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Humans , Middle Aged , Uveal Neoplasms/secondary , Choroid Neoplasms/pathology , Melanoma/pathology , Uveal Neoplasms/diagnostic imaging , Choroid Neoplasms/surgery , Ultrasonography , Fatal Outcome , Rare Diseases/diagnosis , Diagnosis, Differential , Liver/pathology , Melanoma/surgery , Melanoma/secondary , Melanoma/diagnostic imagingABSTRACT
O carcinoma de células escamosas cutâneo é resultante da proliferação maligna dos queratinócitos. Costuma surgir da evolução de lesões precursoras, mas pode crescer espontaneamente na pele normal ou cronicamente inflamada. O carcinoma de células escamosas invasivo corresponde à segunda forma mais comum de câncer da pele não melanoma e representa 20% de todas as neoplasias cutâneas. Este trabalho relata um caso clínico de carcinoma de células escamosas cutâneo, rapidamente progressivo e com metástases regionais, que mesmo com a ressecção completa e esvaziamento ganglionar, apresentou pouca resposta terapêutica e evoluiu a óbito.
Cutaneous squamous cell carcinoma (SCC) results from malignant proliferation of keratinocytes. It usually arises from the development of precursor lesions, however it may grow spontaneously on normal or chronically inflamed skin. Invasive SCC is the second most common type of non-melanoma skin cancer and accounts for 20% of all cutaneous neoplasms. The present paper reports a clinical case of cutaneous SCC, rapidly progressive and with regional metastases, which, even after complete resection of the tumor and regional lymph nodes, showed little therapeutic response and evolved to death.
Subject(s)
Humans , Male , Middle Aged , Skin Neoplasms/surgery , Thoracic Vertebrae/pathology , Carcinoma, Squamous Cell/surgery , Cervical Vertebrae/pathologyABSTRACT
Objective To compare the dose distribution between volumetric-modulated arc therapy ( VMAT ) and intensity-modulated radiotherapy ( IMRT ) in patients with brain metastases receiving hippocampus-sparing whole brain radiotherapy. Methods Forty-six patients with brain metastases admitted to our hospital from 2013 to 2016 were recruited in this study. After fusing the CT and MRI images, the hippocampus was delineated on the fusion images. The three-grade hippocampal avoidance regions were created by using a volumetric expansion of 3,5 and 10 mm surrounding the hippocampus. The planning target volume ( PTV) was calculated by subtracting the 5-mm expansion surrounding the hippocampus from the whole brain. The prescription dose was 30 Gy/10 fractions. The 7-field IMRT and single arc VMAT were designed for each case. The dose distribution of PTV,hippocampus and other organs at risk ( OARs) were evaluated in both plans. Results The PTV was statistically compared between VMAT and IMRT:V95:95. 90％ and 94. 97％( P=0. 000 );V90:98. 17％ and 97. 48％( P=0. 000 );CI:0. 825 and 0. 813 ( P=0. 013);HI:0. 277 and 0. 289(P=0. 025).The hippocampal dose was also compared between VMAT and IMRT:the Dmax of hippocampus was 1698. 9 cGy for VMAT and 1784. 9 cGy for IMRT (P=0. 002).TheDmean of hippocampus was 1183. 8 cGy for VMAT and 1112. 7 cGy for IMRT (P=0. 000).No statistical significance was observed between IMRT and VMAT in protecting the OARs except the chiasma opticum ( 3262. 6 cGy and 3529. 3 cGy,P=0. 000).The MU and treatment time of VMAT and IMRT were 651 and 2768( P=0. 000) ,and 188 s and 504 s ( P=0. 000) . Conclusions The dose distribution of PTV in VMAT is significantly better than that in IMRT. VMAT is advantageous in protecting the hippocampus than IMRT. VMAT can significantly shorten treatment time and MU and enhance the equipment utilization. Besides, VMAT can achieve the goal of protecting the hippocampus and meet the prescription dose requirement of PTV.
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Objective To preliminary investigate the clinical efficacy of whole brain simultaneous integrated boost intensity-modulated radiotherapy ( SIB-IMRT ) in patients diagnosed with brain metastases ( BM) . Methods Fifty-two cases of BM admitted to our hospital from January 2016 to December 2017 were equally recruited and randomly divided into the observation and control groups. Patients in the observation group were treated with SIB-IMRT, and those in the control group received conventional whole brain radiotherapy (WBRT).The clinical efficacy and prognosis were statistically compared between two groups. Results The ORR in the observation group was 77％, significantly higher than 27％ in the control group (P=0. 00).The median survival in the observation group was 384 d,significantly longer compared with 211 d in the control group (P=0. 00).All patients in both groups successfully completed corresponding treatment. Acute adverse reactions were mainly 1-2 grade reactions. Conclusions SIB-IMRT is an efficacious and safe treatment of BM,which yields tolerable adverse events and deserves application in clinical practice.
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Objective To evaluate the clinical efficacy of prophylactic cranial irradiation (PCI) in the treatment of surgically resected small cell lung cancer (SCLC).Methods Clinical data of SCLC patients undergoing radical resection surgery in Zhejiang Cancer Hospital from 2003 to 2015 were retrospectively analyzed.According to the treatment modality,all patients were allocated into the PCI and non-PCI groups.A total of 52 patients were finally included,including 19 patients in the PCI group (5 cases of stage Ⅰ,5 stage Ⅱ and 9 stage Ⅲ) and 33 in the non-PCI group (12 cases of stage Ⅰ,5 stage Ⅱ and 16 stage Ⅲ).Kaplan-Meier method was utilized for survival analysis.Cox proportional hazards model was adopted to analyze clinical prognosis.Results The median survival time was 32.9 months in the PCI group,and 20.4 months in the non-PCI group.The 2-year overall survival rate was 72％ in the PCI group,significantly higher than 38％ in the non-PCI group (P=0.023).The median brain metastasis-free survival (BMFS) was 32.5 months in the PCI group,and 17.1 months in the non-PCI group.In the PCI group,the 2-year BMFS rate was 89％,significantly better than 53％ in the non-PCI group (P=0.026).Subgroup analysis demonstrated that PCI could confer survival benefit to patients with p-stage Ⅲ (p=0.031) rather than p-stage Ⅰ (P=0.924) and Ⅱ (P=0.094) counterparts.Multivariate analysis revealed that PCI (HR=0.330,P=0.041) was an independent prognostic factor of the overall survival.Conclusions PCI can reduce thr risk of brain metastasis rate and improve the overall survival of patients with surgically resected SCLC.
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Objective To investigate the clinical efficacy and safety of erlotinib combined with concurrent whole brain radiotherapy (WBRT) in the treatment of multiple brain metastases from lung adenocarcinoma,and to provide objective evidence for improving the prognosis of patients.Methods Eighty-nine patients with brain metastases from epidermal growth factor receptor (EGFR)-mutant lung adenocareinoma who were admitted to our hospital were divided into experimental group (n =45) and control group (n=44) according to the different treatment methods.The experimental group received erlotinib combined with concurrent WBRT.The control group received oral administration of erlotinib alone for 28 d and then received concurrent WBRT.The survival rates were calculated using the Kaplan-Meier method and analyzed using the log-rank test.The other data were analyzed by the chi-square test.Results The objective response rate was significantly higher in the experimental group than in the control group (78％ vs.55％,P=0.000).The median progression-free survival (PFS) time in the experimental group and the control group were 9.1 months (95％ confidence interval [CI]:5.18-12.47) and 5.6 months (95％CI:3.46-9.12),respectively (P=0.078).The median overall survival (OS) time in the experimental group and the controlgroup were 14.3 months (95％CI:9.51-17.82) and 9.7 months (95％CI:4.59-16.74),respectively (P=0.032).The incidence rates of headache and dizziness were significantly higher in the experimental group than in the control group (38％ vs.14％,P=0.029;33％ vs.9％,P=0.020).Conclusions In the treatment of multiple brain metastases from EGFR-mutant lung adenocarcinoma,erlotinib combined with concurrent WBRT is superior to erlotinib alone.The combination therapy increases PFS and OS time of the nervous system in patients.
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Innate immune cells are highly represented in the tumor microenvironment,and among the most abundant of these are macrophages.However,macrophages are broadly categorized as"classically activated"pro-inflammatory M1 macrophages and"alter-natively activated"anti-inflammatory M2 macrophages,which might be too simplified to describe the various phenotypes and func-tions of tumor-associated macrophages(TAMs).Most TAMs are now reclassified into CD68+TAM,CD163+TAM,CD204+TAM,CD169+TAM,and CCL18+TAM,among others,according to the different expression of surface proteins.These surface proteins have different types of ligands and regulate different signaling pathways and cytokines.Therefore,even if these subtypes of TAMs have similar ef-fects of promoting or inhibiting tumors,the mechanisms involved and the induced clinical manifestations are different.In this paper, the effects of various phenotypes of TAMs on tumor growth,metastasis,prognosis,and clinical relevance are reviewed.
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Objective To compare the application value between PET/CT and PET/MR in diagnosing primary cervical cancer and pelvic lymph node metastasis.Methods Forty cases of cervical cancer were prospectively enrolled.PET/CT and PET/MR examinations were performed before treatment.All imaging data were evaluated by two experienced radiologists.The diagnostic consistency and difference of PET/CT and PET/MR were evaluated with Cohen's Kappa and paired Chi-square test.ROC curve was adopted to observe the value in diagnosing pelvic lymph node metastasis of cervical cancer.The lesions' visibility and diagnostic confidence of metastatic lymph nodes on PET/CT and PET/MR images were compared with Wilcoxon signed ranks test.Results Compared with the gold standard,the diagnostic consistency of PET/MR staging was much higher than that of PET/CT (x2 =10.286,P=0.002).The area under ROC curve of PET/CT and PET/MR on lymph node metastasis had no significant difference (Z=0.83,P＞0.05).No significant differences in lesion visibility between PET/CT and PET/MR images were detected in the evaluation of metastatic lymph nodes (P=0.157),while PET/MR revealed higher values regarding diagnostic confidence (P=0.014).Conclusion Both PET/CT and PET/MR provide high diagnostic value in detecting primary cervical cancer,but PET/MR has greater diagnostic superiority in the correct identification of cervical cancer stage and pelvic lymph node metastasis.PET/MR is expected to be a new technique for replacement of PET/CT in evaluation of cervical lesions.
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MicroRNAs are non-coding small RNAs that participate in the regulation of post transcriptional gene expression.MicroRNAs play the roles of inhibiting cancer or promoting cancer in different tumors.MicroRNA-373 is one of the members of the microRNA-520/373 family,which is involved in cancer anoxic response and DNA damage repair.MicroRNA-373 is abnormal expressed in breast cancer,glioma,lung cancer,prostate cancer and other tumors,which may play an important role in tumor development process,especially in tumor invasion and migration.
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Osteoblastic metastasis of breast cancer is relatively rare, but there are cases of misdiagnosis and mistreatment in clinical treatment. They can only be diagnosed by X ray or CT bone scan and must be identified from bone repair after effective treatment in patients with osteolytic or mixed bone metastases. Bone metastasis is often seen in the disease-free condition of breast cancer, and very few can occur in stage Ⅳ lesions prior to surgery. Based on the analysis of clinical phenomena, we questioned the evaluation criteria of the therapeutic effect on bone metastasis of breast cancer created by the World Health Organization and the MD Anderson Cancer Center and concluded the formation mechanism of bone metastasis. For patients with simple osteoblastic bone metastasis, we broke through the recommendations of the National Comprehensive Cancer Network guideline and advocated the concept of "noninterference" . Patients with positive hormone receptor can be treated with traditional endocrine therapy. Hormone receptor negative and/or human epidermal growth factor receptor 2 positive patients can be observed first, followed by chemotherapy and/or targeted therapy when there is osteolytic bone metastasis or visceral metastasis. Furthermore, bisphosphonates are not required since osteoblastic bone metastasis is generally not associated with the risk of bone related events. The active treatment of primary lesion should be taken into account in stage Ⅳ patient before operation.
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Objective@#To compare the clinicopathological characteristics of second primary lung cancer following breast cancer and lung metastases from breast cancer, and then to analyze the risk factors in breast cancer patients with second primary lung tumor.@*Methods@#Clinical data of 55 breast cancer patients with second primary lung tumor and 205 breast cancer patients with solitary pulmonary metastasis in Shandong Cancer Hospital from January 2006 to January 2017 were retrospectively analyzed. The risk factors of primary lung cancer following breast cancer were analyzed using logistic regression model.@*Results@#Second primary lung cancer in patients with first breast cancer accounted for approximately 21.2%(55/260) of pulmonary malignant solitary nodules, and 0.84%(55/6 580) of all breast cancer patients. The median intervals between the diagnosis of second primary lung cancer or lung metastasis and first breast cancer were 52 months and 42 months, respectively. These two groups showed significant difference between age, time interval between diagnoses, breast tumor size, axillary lymph node metastasis, estrogen receptor, molecular subtype (luminal B and triple-negative) and history of radiotherapy (P<0.05 for all). A multivariate logistic regression model confirmed that age (OR=1.088, P<0.001), breast tumor size(OR=0.480, P<0.001), and radiotherapy history (OR=3.460, P=0.004) were all independent factors for second primary lung cancer.@*Conclusions@#For isolated pulmonary nodules in patients with breast cancer, especially for those with elder age, larger tumor size and radiotherapy history, we should distinguish the second primary lung cancer from pulmonary metastasis. The treatment regimen for lung metastasis and primary lung cancer in patients with breast cancer are entirely distinct. The timely histopathology examinations for pulmonary nodes in patients with breast cancer are recommended.