本文選題：乳腺癌　切入點：分化型甲狀腺癌　出處：《大連醫(yī)科大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的:本課題旨在通過研究乳腺癌術后再發(fā)DTC病人甲狀腺癌組織中雌激素受體(ER)表達水平和血清甲狀腺激素水平進行研究,為DTC的內分泌治療和預后分析提供理論基礎。方法:搜集大連醫(yī)科大學第一附屬醫(yī)院普外科與大連大學附屬中山醫(yī)院乳腺甲狀腺外科2010年1月-2016年12月的住院病人資料,經(jīng)納入排除標準篩選后各入組病例數(shù)均為43例,包括乳腺癌術后再發(fā)DTC病人(雙癌組),平均年齡為43.19±12.25歲;首診DTC組(單癌組),平均年齡41.30±12.22歲;甲狀腺良性疾病組(良性組)平均年齡:40.84±7.92歲。每組研究對象資料完整真實,診斷和相應的手術治療均在相應醫(yī)院進行,且保持后期隨訪和根據(jù)病情的繼續(xù)治療。雙癌組根據(jù)中華內分泌代謝雜志2012年發(fā)布的《甲狀腺結節(jié)和分化型甲狀腺癌診治指南》進行分類。采用免疫組織化學方法比較乳腺癌術后再發(fā)DTC病人癌組織和癌旁組織中ER受體的表達情況及甲狀腺激素水平差異,同時分析ER表達情況與DTC癌組織病理學特征之間的關系。結果:1、在雙癌組和單癌組部分病人的DTC癌組織中都發(fā)現(xiàn)了 ER的陽性表達,其中雙癌組ER陽性表達率為25.6%,單癌組為18.6%,且雙癌組ER陽性的甲狀腺癌病人均來自ER陽性的乳腺癌。2、雙癌組部分病人甲狀腺癌組織和癌旁組織ER陽性表達率有顯著性差異(P0.05)。而在雙癌組與單癌組部分患者ER陽性表達率無顯著性差異(P0.05)。3、雙癌組發(fā)生頸部淋巴結轉移與未發(fā)生頸部淋巴結轉移病人的甲狀腺癌組織ER陽性表達率分別為54.5%、15.6%,差異有統(tǒng)計學意義(P0.05)。雙癌組發(fā)生甲狀腺包膜侵及與未發(fā)生包膜侵及病人的癌組織ER陽性表達率分別為46.7%、14.3%,差異有統(tǒng)計學意義(P＜0.05)。4、雙癌組45歲與"g45歲病人甲狀腺癌組織的ER陽性表達率分別為30.0%、24.2%癌組織直徑1cm與"g1cm病人甲狀腺癌組織的ER陽性表達率分別為23.1%、29.4%,癌灶位于雙側葉或峽部與癌灶位于單側葉病人甲狀腺癌組織的ER陽性表達率分別為33.3%、23.5%,以上差異均無統(tǒng)計學意義(P0.05)。5、雙癌組、單癌組病人血清TSH與良性組病人血清TSH比較均有顯著性差異(P＜0.05),雙癌組病人血清TSH和單癌組病人血清TSH比較無顯著性差異(P0.05)。三組病人兩兩比較血清T3、T4均無顯著性差異(P0.05)。結論：1、雙癌組和單癌組中,部分病人的癌組織ER表達陽性,提示甲狀腺乳頭狀癌可能與雌激素有一定關系,推測部分DTC可能也屬于激素依賴性腫瘤,但具體作用機制仍需進一步研究。2、乳腺癌ER陽性可能和部分DTC癌組織ER陽性具有一定聯(lián)系,推測ER可能是甲狀腺癌與乳腺癌發(fā)病機制的連接點。3、甲狀腺乳頭狀癌中ER表達陽性可能與癌的轉移與侵襲行為相關,與年齡,癌灶數(shù)量和位置無關,但相關程度還需大樣本臨床證據(jù)支持。4、甲狀腺乳頭狀癌的發(fā)生可能與血清TSH升高有關,與血清T3、T4無關,具體機制還需進一步研究。
[Abstract]:Objective: to study the expression of estrogen receptor ERR and serum thyroid hormone in patients with DTC after breast cancer operation. Methods: the data of patients in general surgery of the first affiliated hospital of Dalian Medical University and breast thyroid surgery of Zhongshan Hospital affiliated to Dalian University from January 2010 to December 2016 were collected. There were 43 cases in each group after inclusion of exclusion criteria, including 43 patients with recurrent DTC after breast cancer operation (mean age 43.19 鹵12.25 years old in double cancer group, 41.30 鹵12.22 years old in DTC group with first visit), and 41.30 鹵12.22 years old in single cancer group (mean age 41.30 鹵12.22 years). The average age of benign thyroid disease group (benign group) was: 40.84 鹵7.92 years old. The double cancer group was classified according to the guidelines for diagnosis and treatment of thyroid nodules and differentiated thyroid carcinoma published on 2012 by the Chinese Journal of Endocrine Metabolism. Methods to compare the expression of ER receptor and thyroid hormone levels in cancer tissues and adjacent tissues of patients with recurrent DTC after breast cancer operation. At the same time, the relationship between ER expression and pathological features of DTC carcinoma was analyzed. The ER positive expression rate of double cancer group was 25.6 and that of single cancer group was 18.6.The ER positive thyroid cancer patients in double cancer group all came from ER positive breast cancer .2.The ER positive expression rate in thyroid carcinoma and paracancerous tissues of some patients in double cancer group was significant. There was no significant difference in ER positive rate between two cancer groups and one cancer group. The ER positive rate in thyroid cancer tissues of patients with cervical lymph node metastasis or without cervical lymph node metastasis was higher than that of double cancer group. The positive rates of ER were 46.7% and 14.3%, respectively. The difference was statistically significant (P < 0.05). The positive rate of ER in the patients with double cancer was 45 years old and "g45 years old". The positive rates of ER were 46.7% and 14.3%, respectively (P < 0.05), and the difference was statistically significant (P < 0.05). The positive rate of ER expression in both groups was 45 years old and "g 45 years old". The positive rate of ER expression was 46.7% and 14.3% respectively (P < 0.05). The ER positive expression rates of thyroid carcinoma tissues were 30.0% and 24.2%, respectively. The ER positive expression rates of thyroid carcinoma tissues with diameter of 1cm and "g1cm" were 23.1cm and 29.429.429.429..The ER positive expression rates of thyroid cancer tissues in patients with thyroid carcinoma were located in bilateral lobes or in isthmus and in unilateral lobes. The expression rates were 33. 3% and 23. 5%, respectively. There was no significant difference between the two groups (P 0. 05. 5). There was significant difference in serum TSH between patients with single cancer and benign patients (P < 0.05), but there was no significant difference in serum TSH between patients with double cancer and patients with single cancer (P < 0.05). There was no significant difference in serum T _ 3 / T _ 4 between two groups of patients. Conclusion: in the double cancer group and the single cancer group, The positive expression of ER in some patients suggests that thyroid papillary carcinoma may be related to estrogen, and some DTC may also belong to hormone dependent tumors. However, the specific mechanism still needs to be further studied. The ER positive in breast cancer may be related to ER positive in some DTC tissues. It is speculated that ER may be the junction point of thyroid carcinoma and breast cancer. The positive expression of ER in papillary thyroid carcinoma may be related to metastasis and invasive behavior, but not to age, number and location of tumor focus. However, the degree of correlation still needs to be supported by a large sample of clinical evidence. The occurrence of papillary thyroid carcinoma may be related to the elevation of serum TSH, but not to serum T3T4. The specific mechanism needs further study.
【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R736.1
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本文編號：1573531