乳腺癌内科治疗新进展

2020年WHO国际癌症研究机构最新的癌症报告显示,乳腺癌新发病例数快速增长,首次超过肺癌,一跃成为全球发病人数最多的恶性肿瘤,其中全球18.4%的乳腺癌新发病例在我国。近年来我国乳腺癌的发病率呈持续上升趋势,已经位居我国女性恶性肿瘤发病率的第1位,2020年我国新诊断42万乳腺癌患者。     

2023年美国癌症统计报告和全球最新癌症统计数据解读及启示

美国癌症协会发布的2023年美国癌症统计报告通过高级算法预测2023年度美国癌症新发病例和死亡例数,并基于癌症发病率和死亡率的最新人群数据及趋势变化对癌症的发生作出全面概述。本文对该报告数据进行整理,对目前美国癌症的分布和流行趋势进行简要分析,并结合世界卫生组织（World Health Organization,WHO）2020年癌症统计数据和全球47个国家最新的癌症近期死亡率和趋势数据,分析常见癌种在全球各国家和地区的流行趋势,以期为我国癌症防治策略提供思路。     

发达与发展中国家癌症发病率与死亡率的比较与分析

  目的  分析发达国家与发展中国家的常见癌症发病情况与死亡率, 并将中国的癌症现状与之比较, 明确我国面临的主要癌症负担类型。  方法  各国家常见肿瘤的发病人数、发病率、死亡率及世界标化发病率等数据均来源于GLOBOCAN 2008。  结果  发达国家和发展中国家的恶性肿瘤发病第1位均是肺癌, 其次发达国家为结直肠癌、乳腺癌、前列腺癌, 发展中国家的胃癌、乳腺癌和肝癌; 发达国家死亡率最高的分别依次为肺癌、结直肠癌、乳腺癌、前列腺癌, 发展中国家为肺癌、肝癌、胃癌、食管癌。中国的肺癌发病率和死亡率均居第1位, 胃癌、肝癌发病及死亡率均高于发展中国家和发达国家, 乳腺癌的死亡率远低于发达国家亦低于其他发展中国家。预计到2020年, 中国新增发病和死亡人数最多的癌症是肺癌、胃癌和肝癌。  结论  不同国家的癌谱不同, 中国癌谱具有发达国家和发展中国家的双重特征。肺癌、胃癌及肝癌是威胁我国居民健康的主要恶性肿瘤, 并且未来十几年其增长速度较快, 是我国恶性肿瘤防控的重点。      

国内外癌症防制现状

癌症是全球的主要疾病负担,每年约发生新病例1 100万;全球最常见的癌症发病为肺癌、乳腺癌和结直肠癌,最常见的癌症死亡为肺癌、胃癌和肝癌。中国癌症发病占全球的20.3%,每年新发病例超过220万,最常见的癌症男性为:肺癌、胃癌、肝癌、食管癌,女性为:乳腺癌、食管癌、胃癌、肺癌、肝癌、宫颈癌。全球癌症发病总体呈上升趋势,显著上升的癌症有肺癌、乳腺癌、结直肠癌;显著下降的癌症有胃癌、宫颈癌。癌症的主要危险因素包括烟草、酒精、病毒与感染、放射与辐射、膳食与营养、环境暴露、遗传易感性等。烟草和酒精消费的增加以及现代生活方式对于肺癌、消化道癌症、乳腺癌的影响正在加剧,饮食和营养的改变导致了胃癌和食道癌的下降。病毒感染的控制和乙肝疫苗、HP疫苗的应用将对肝癌、宫颈癌的下降产生积极的作用。我国癌症监测与防控体系正在形成和加强,专业研究、现场研究和多学科的协作研究将继续在癌症防控中发挥重要作用。     

乳腺癌发病率和死亡率的全球模式:一项基于人群的2000–2020年肿瘤登记数据分析研究

背景与目的乳腺癌是全球女性最常见的恶性肿瘤,也是导致女性癌症死亡的主要原因,然而不同国家和地区乳腺癌的发病特点和趋势也不尽相同。本研究旨在评估乳腺癌发病率和死亡率的全球模式并分析其时间趋势变化,为乳腺癌预防和控制提供科学依据。方法2020年乳腺癌发病率和死亡率数据来自GLOBOCAN 2020数据。乳腺癌趋势分析数据来源于五大洲发病率数据库、国际癌症研究署肿瘤死亡数据和中国肿瘤登记乳腺癌死亡数据,通过Joinpoint回归分析2000±2015年乳腺癌发病率和死亡率的年平均变化百分比。通过线性回归估计人类社会发展指数与乳腺癌发病率和死亡率的相关性。结果2020年,全球有230万乳腺癌新发病例和685,000例乳腺癌死亡病例。其发病率和死亡率因国家而异,年龄标化发病率范围从最高的比利时的112.3/100,000到最低的伊朗的35.8/100,000,年龄标化死亡率从最高的斐济的41.0/100,000到最低的韩国的6.4/100,000。部分亚非国家的乳腺癌发病高峰年龄比欧美国家早10年以上。就乳腺癌的趋势而言,2000±2012年期间,中国和韩国的年龄标化发病率显著上升,而美国则呈下降趋势。2000±2015年,中国和韩国的年龄标化死亡率显著上升,英国、美国和澳大利亚呈下降趋势。结论全球乳腺癌疾病负担迅速上升,各国之间差异较大。中国和韩国的乳腺癌发病率和死亡率迅速上升,美国则下降。提高公众健康意识、有效的预防策略和改善获得医疗的机会对于遏制快速增加的乳腺癌疾病负担尤为重要。     

外泌体对乳腺癌诊疗一体化影响的研究进展

根据2020年全球最新的癌症数据显示,乳腺癌新发病例数已经取代了肺癌,随着其病例数的快速增长,乳腺癌取代肺癌成为了全球第一大癌症。由此可见,如何加强乳腺癌诊治的灵敏性对于乳腺癌的预后至关重要,而外泌体,因其与乳腺癌发生发展过程中的细胞侵袭转移、药物载体运输以及机体耐药、细胞因子分泌表达和免疫应答等方面息息相关,所以对乳腺癌的诊疗一体化及预后有很大的影响。本文对外泌体的诊断及其对乳腺癌治疗预后的研究进展进行综述。     

2020年全球癌症最新数据解读

近日,世界卫生组织国际癌症研究机构(Iternational Agency forResearch on Cancer,IARC)发布2020年全球最新癌症负担数据,涵盖了全球185个国家36种癌症的新发病例数和死亡病例数等情况。全球:乳腺癌新发病例数首超肺癌位列第一,肺癌死亡病例数仍居榜首。2020年全球癌症新发病例数近2000万例,死亡病例数近1000万例,全球癌症负担非常重。值得注意的是,乳腺癌新发病例数226万例,首次超过肺癌,成为全球“第一癌”。令人欣慰的是,在发达国家中,乳腺癌五年生存率近90%,我国亦达83%。肺癌新发病例数虽位居第二,但其死亡病例数高达180万,仍居榜首。其中,男性肺癌的新发病例数和死亡病例数均为女性的两倍左右,主要由主动吸烟等因素差异所致。     

肿瘤浸润性淋巴细胞在乳腺癌预后评估及免疫治疗中的应用进展

2020年女性乳腺癌已超越肺癌成为全球最常见的癌症,大量研究证实肿瘤浸润性淋巴细胞（TILs）对肿瘤具有杀伤力,并在识别肿瘤抗原中发挥重要作用,因此TILs在临床免疫治疗及乳腺癌预后评估中的应用受到广泛关注。本文综述了近期TILs在不同分子分型乳腺癌中的基础研究进展和临床应用现状,评估了TILs对乳腺癌预后评估及临床免疫治疗的价值。     

女性乳腺癌流行病学趋势及危险因素研究进展

乳腺癌是全球女性最常见的癌症,也是女性癌症死亡的主要原因。2018年全球新确诊女性乳腺癌病例约209万,死亡人数约63万。世界各地区乳腺癌发病率各不相同,但均呈上升趋势。虽然中国女性乳腺癌发病率（36.1/10⁵）和死亡率（8.8/10⁵）在世界范围内相对较低,但是中国女性乳腺癌发病人数及死亡人数均居世界首位,而且近年来中国女性乳腺癌发病率和死亡率呈上升趋势。乳腺癌是多因素共同作用的疾病,主要包括遗传因素、环境因素以及行为生活方式因素等。本综述旨在探讨世界范围内乳腺癌的流行病学、相关危险因素等,以期了解乳腺癌的流行现状,为乳腺癌的预防干预和早期发现提供帮助。     

全球女性乳腺癌发病趋势及年龄变化情况分析

目的根据国际癌症登记协会发布的全球女性乳腺癌发病数据, 分析全球不同地区女性乳腺癌的发病趋势及不同地区人群乳腺癌发病年龄结构的变化情况。方法从《五大洲癌症发病率》时间趋势数据库提取1998—2012年的恶性肿瘤连续监测数据, 提取数据库中ICD-10编码为C50的全部女性乳腺癌发病信息, 采用年度变化百分比及平均年度变化百分比(AAPC)分析发病趋势, 并采用标化平均发病年龄和发病构成等指标分析女性乳腺癌发生与年龄的关系。结果 1998—2012年, 除了北美洲, 其他各洲女性乳腺癌发病均呈现上升趋势, 亚洲上升趋势最明显, AAPC为4.1%(95%CI:3.9%～4.3%);标化人口年龄结构后, 亚洲、拉丁美洲和欧洲发病上升趋势有所减慢, 大洋洲和非洲趋势趋于平稳, 北美洲则呈现下降趋势, APPC为-0.6%(95%CI:-1.0%～-0.1%)。1998—2012年全球女性乳腺癌发病平均年龄在亚洲、拉丁美洲、大洋洲和欧洲表现出逐年递增的趋势, 年增幅依次为0.12、0.09、0.04、0.03岁;标化人口年龄结构后, 只有欧洲女性乳腺癌发病平均年龄依然保持逐年递增的趋势, 年增...     

Bacteria and cancer--antagonisms and benefits

There is considerable historical and recent evidence concerning the antagonisms between acute bacterial infections or their toxins and cancer and allied diseases. These data provide renewed incentives to undertake clinical programmes with mixed bacterial vaccines in many countries at the present time.     

Religiosity and physical and emotional functioning among African American and White colorectal and lung cancer patients

The literature suggests that religiosity helps cope with illness. The present study examined the role of religiosity in functioning among African Americans and Whites with a cancer diagnosis. Patients were recruited from an existing study and mailed a religiosity survey. Participants (N = 269; 36% African American, 56% women) completed the mail survey, and interview data from the larger cohort was utilized in the analysis. Multivariate analyses indicated that in the overall sample religious behaviors were marginally and positively associated with mental health and negatively with depressive symptoms. Among women, religious behaviors were positively associated with mental health and negatively with depressive symptoms. Religiosity was not a predictor of study outcomes for men. Among African Americans, religious behaviors were positively associated with mental health and vitality. Among Whites, religious behaviors were negatively associated with depressive symptoms. These findings suggest a mixed role of religious involvement in cancer outcomes. The current findings may have applied potential in the areas of emotional functioning and depression.     

Genetic polymorphisms of alcohol and aldehyde dehydrogenases and risk for esophageal and head and neck cancers

Alcoholic beverages are causally related to cancer of the oral cavity, pharynx, larynx and esophagus. Ethanol is oxidized to acetaldehyde and then to acetate by alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH), both of which have genetic polymorphisms. A review of case-control studies of the effects of ALDH2, ADH2 and ADH3 genotypes shows consistently positive associations between inactive heterozygous ALDH2 and the less-active ADH2 genotypes and the risk for esophageal cancer in East Asian heavy drinkers and this enzyme-related vulnerability may extend to light-to-moderate drinkers. Some studies suggest similar associations with the risk for head and neck cancer in moderate-to-heavy-drinking Japanese. An established carcinogen in experimental animals, acetaldehyde can interact with human DNA. ALDH2-associated cancer susceptibility fits into a scenario in which acetaldehyde plays a critical role in the development of human cancer. Alcohol flushing and drinking behavior may partly explain this carcinogenic effect in carriers of less-active ADH2 genotypes. Whether the ADH3 genotype influences head and neck cancer risk in Western nations is controversial. Professional and public education about risky conditions connected to the ALDH2 and ADH2 genotypes and environmental factors is important in a new strategic approach to the prevention of alcohol-related cancers in East Asians. The use of simple tests to identify inactive ALDH2 on the basis of alcohol flushing responses could benefit many people, by helping them to identify their own cancer risks. Such testing could also help clinicians diagnose esophageal cancer earlier, through the use of endoscopic screening in the high-risk population.     

Religiosity and Physical and Emotional Functioning Among African American and White Colorectal and Lung Cancer Patients

The literature suggests that religiosity helps cope with illness. The present study examined the role of religiosity in functioning among African Americans and Whites with a cancer diagnosis. Patients were recruited from an existing study and mailed a religiosity survey. Participants (N = 269; 36% African American, 56% women) completed the mail survey, and interview data from the larger cohort was utilized in the analysis. Multivariate analyses indicated that in the overall sample religious behaviors were marginally and positively associated with mental health and negatively with depressive symptoms. Among women, religious behaviors were positively associated with mental health and negatively with depressive symptoms. Religiosity was not a predictor of study outcomes for men. Among African Americans, religious behaviors were positively associated with mental health and vitality. Among Whites, religious behaviors were negatively associated with depressive symptoms. These findings suggest a mixed role of religious involvement in cancer outcomes. The current findings may have applied potential in the areas of emotional functioning and depression.     

Renal irradiation and the pharmacology and toxicity of methotrexate and cisplatinum

We used a rat model to study the effects of renal irradiation on the pharmacology of methotrexate (MTX) and cisplatinum (cis-Pt). Unanesthetized rats were given bilateral kidney irradiation (20 Gy in 9 fractions). At 9 months after irradiation, 3% of the animals had died and survivors showed moderately impaired renal function. At 15 months, 30% of the animals had died and survivors showed severely impaired renal function. Some animals were given i.v. MTX 1 week to 15 months after irradiation. In irradiated rats, the area under the MTX plasma clearance curve equaled that of controls through 6 months, and was significantly above controls from 9 months on. Other animals were given i.p. cis-Pt 1 week to 9 months after irradiation. The acute toxicity of cis-Pt was the same in control and irradiated rats when cis-Pt was given immediately before or after irradiation. Beginning 3 months after irradiation there was a progressive increase in cis-Pt toxicity and a simultaneous decrease in urinary platinum excretion. Irradiated animals that survived cis-Pt treatment showed increased radiation nephritis; the greatest effect occurred when cis-Pt was given 3 months or more after irradiation. MTX and cis-Pt clearance decreased when renal dysfunction was first observed and changes in renal function preceded changes in drug clearance and toxicity.