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Objective@#We aimed to examine the feasibility and toxicity of EC-T dose-dense regimen and to demonstrate the suitable dose of epirubicin in a Chinese early-stage breast cancer population with high recurrence risk.@*Methods@#370 patients with early-stage breast cancer at high risk of recurrence were treated with EC-T dose-dense adjuvant chemotherapy and prophylactic administration of recombinant human granulocyte stimulating factor (G-CSF). The incidence of delayed chemotherapy, drug reduction and adverse reactions were retrospectively analyzed.@*Results@#370 patients completed the planned eight cycles of chemotherapy, 50 patients experienced chemotherapy delay, and 90 had chemotherapy dose reductions. Overall, 61.1% of the patients experienced grade 3 or 4 hematology toxicities, 4.1% of the patients experienced grade 3 gastrointestinal toxicity, 16.3% experienced grade 3 or 4 liver malfunction, and 1.9% experienced grade 3 alopecia. In the multivariate analysis, pretreatment epirubicin levels were associated with comprehensive and hematology toxicity risk (OR=1.268, P=0.046; OR=1.244, P=0.036). With G-CSF support, the probability of grade 3-4 dose limiting toxicity, i. e. neutropenia, abnormal liver function, and gastrointestinal adverse effects did not increase as the epirubicin dose level increased(P>0.05). However, there were no statistically significant associations between epirubicin grade and treatment delay (P=0.814) or dose reduction (P=0.282).@*Conclusions@#EC-T dose-dense chemotherapy shows tolerable toxicity. High dose level is not a limiting factor for this regimen. With G-CSF support, epirubicin 85-90 mg/m2 is appropriate tolerance dose for Chinese early breast cancer patients with high recurrence risk.
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Objective@#To investigate the clinical outcome of expression discordance of estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER-2) in primary breast cancer and the corresponding metastatic lesions.@*Methods@#A retrospective analysis was performed on 178 breast cancer patients with metastasis confirmed by the National Cancer Center & Cancer Hospital, Chinese Academy of Medical Sciences in the past 6 years. The data of expressions of ER, PR and HER-2 in primary and metastatic breast cancer, the metastatic sites, disease progression were collected and the relationships of the expression discordance of receptors with prognosis were analyzed.@*Results@#The discordance rates of ER, PR and HER-2 between the primary tumor and the metastatic sites were 27.0%, 39.8% and 18.7%, respectively. The discordance rates of ER, PR and HER-2 of patients with locoregional recurrence were 21.9%, 36.6% and 12.7%, respectively, while those of patients with distant metastases were 31.3%, 42.7% and 23.8%. The median progression free survivals (PFS) of ER+/+、ER+/-、ER-/+、ER-/- of primary tumor and metastatic sites were 17.7 months, 10.3 months, 14.0 months and 9.0months, respectively (P=0.025). The median PFS of PR+/+, PR+/-, PR-/+, PR-/- were 23.0 months, 10.7 months, 14.0 months and 9.2months, respectively (P=0.002). The median PFS of HER-2+/+, HER-2+/-, HER-2-/+, HER-2-/- were 14.9 months, 15.2 months, 12.3 months and 14.0 months, respectively, without significant differences (P=0.588).@*Conclusions@#This study confirms that expression discordances of ER, PR and HER-2 between primary breast cancer and the corresponding metastatic lesions are dramatic, especially in the patients with distant metastasis. The unstable levels of ER and PR seem to be significantly associated with prognosis of breast patients.
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Objective To observe the influence of subarachnoid space associated with epidural anesthesia at different posture on the hemodynamics during cesarean section.Methods One hundred and twenty uterine-incision delivery patients were chosen,the patients were separated into the left lateral decubitus group(LL group) and right lateral decubitus group(RL group) with 60 cases each by random digits table method,all the patients were blocked by subarachnoid space associated with epidural anesthesia after puncturation 2 ml 0.5％ ropivacaine was given.Then the head end epidural catheter insertion in 3-4 cm,asked maternal supine after fixed catheter enjoin.Systolic blood pressure (SBP),diastolic blood pressure (DBP),heart rate were recorded before anesthesia and at 3,5,10,15 min after anesthesia.Apgar scores of 1 and 5 min were observed as well.Results SBP and DBP at 3,5 min after anesthesia were significantly lower than those before anesthesia in RL group,SBP was (120.1 ± 11.2),(106.7 ± 17.2),(127.3 ± 13.6)mmHg (1 mmHg =0.133 kPa) respectively,DBP was (77.5 ± 6.3),(55.2 ± 21.2),(80.3 ± 10.5) mmHg,respectively,and there were significant differences (P ＜0.05).And SBP,DBP in RL group were also significantly lower than those in LL group,SBP was (123.2 ± 12.4),(110.3 ± 16.3) mmHg,DBP was (80.1 ± 9.9),(63.1 ± 13.2) mmHg,and there was significant difference (P ＜ 0.05).There was no significant difference in Apgar scores of 1 and 5 min between two groups.Conclusion The left lateral decubitus position could effectively reduce the incidence of hypotension during caesarean section under subarachnoid space associated with epidural anesthesia.