Application of contrast-enhanced ultrasonography after radiofrequency ablation for renal cell carcinoma: is it sufficient for assessment of therapeutic response?

PURPOSE: To assess the efficacy of contrast-enhanced ultrasonography (CEUS) with Sonovue in the evaluation of therapeutic response to radiofrequency ablation (RFA) of renal cell carcinoma (RCC). MATERIALS AND METHODS: In a recent 3 years, 63 patients (mean age, 60 years; range 26-81 years) with 64 RCCs were treated by RFA. The lesions had a diameter between 1.8 and 9.8 cm (average diameter, 3.1 cm). The indications for RFA treatment included chronic renal insufficiency (n = 10), presence of solitary kidney (n =3), bilateral renal carcinoma (BRCC) (n =2), advanced age (n =12), significant medical comorbidity (n =29) or refusal of conventional therapy (n =7). Tumors were treated by laparoscopy-assisted (n =41), open surgical (n =18) or percutaneous US guidance (n =4). Follow-up CEUS and contrast-enhanced CT were performed 1 month after treatment to assess the necrotic area. Technical success was defined as elimination of areas that enhanced at imaging within the entire tumor. RESULTS: On the 1-month CEUS and CT imaging after RFA, 62 of 64 tumors (96.9%) were successfully ablated with one session, and residual tumors were found in two RCCs. One of the two tumors was subjected to additional RFA treatment. We could not obtain a complete ablation in the other tumor of a patient with solitary kidney. The diagnostic concordance between the CEUS and 1-month follow-up CT was 100%. Sixty-one patients survived in the follow-up phase which ranged from 2 to 34 months. One patient with solitary kidney died of systemic disease progression and one patient was lost to follow-up. Of the 61 tumors without residual on both CT and CEUS after RFA, four had suspicious findings of recurrence on follow-up CEUS, and two of them were confirmed by subsequent CT examination. With CT as the reference imaging procedure in the assessment of renal tumor ablation, the sensitivity, specificity, positive predictive value, and negative predictive value of CEUS for detecting recurrence during follow-up were 100%, 96.6%, 50%, and 100%. CONCLUSION: Despite its limitation of false-positive value, CEUS is potentially effective in assessing the therapeutic response to RFA of RCC.

Overall survival of patients with advanced pancreatic cancer improved with an increase in second-line chemotherapy after gemcitabine-based therapy.

CONTEXT: In the last decade, gemcitabine-based regimen as first-line therapy has demonstrated low efficacy regarding overall survival benefit for patients with advanced pancreatic cancer. OBJECTIVE: The purpose of this study was to explore a new strategy, such as an increased second-line chemotherapy rate, in order to improve overall survival. DESIGN: Retrospective data analysis. METHODS: The data in the literature on gemcitabine-based therapy for patients with advanced pancreatic cancer were collected by searching databases, such as MEDLINE, EMBASE, the Chinese Biomedical Literature Analysis and Retrieval System, and EBM Reviews (Cochrane Database of Systematic Reviews). Linear regression was used to explore the relationship between overall survival and second-line chemotherapy. The primary endpoint was overall survival. The secondary endpoints were progression-free survival and residual survival. RESULTS: Ten randomized controlled trials, involving 2,679 patients, were included in the present study. The results indicated that overall survival was positively correlated with a combination of chemotherapy, stage of disease and second-line chemotherapy in patients with advanced pancreatic cancer (r = 0.753; P = 0.003). Meanwhile median overall survival would be prolonged about 1.56 days if second-line chemotherapy was increased by 1% (t = 4.33; P = 0.001). Progression-free survival was not significantly correlated with second-line chemotherapy (r = 0.092; P = 0.701); in contrast, residual survival was positively correlated with second-line chemotherapy (r = 0.717; P < 0.001). CONCLUSIONS: Our study indicated that overall survival closely correlated to second-line chemotherapy in patients with advanced pancreatic cancer; more attention should be paid after first-line therapy which must be administered skillfully in order to improve overall survival, and this is worthy of further study.

Gemcitabine-based cytotoxic doublets chemotherapy for advanced pancreatic cancer: updated subgroup meta-analyses of overall survival.

OBJECTIVE: Previous meta-analyses showed a survival advantage with gemcitabine (GEM)-based combinations over GEM in advanced pancreatic cancer. Therefore, it would be valuable to explore the specific active regimens based on a subgroup meta-analysis. METHODS: Updated data by comprehensive search of the literature from databases and conference proceedings. Subgroup meta-analysis compared GEM with GEM-based doublets chemotherapy in terms of 6-month overall survival (OS) and 1-year OS. RESULTS: Eighteen randomized controlled trials with 4237 patients were included, which were divided into five subgroups: GEM/capecitabine, GEM/cisplatin, GEM/5-fluorouracil, GEM/irinotecan and GEM/oxaliplatin. In each subgroup, risk ratios (RRs) for 6-month OS were 0.85 (P = 0.04), 0.99 (P = 0.88), 0.95 (P = 0.46), 1.03 (P = 0.77) and 0.80 (P = 0.001), respectively, and RRs for 1-year OS were 0.94 (P = 0.14), 0.99 (P = 0.75), 0.96 (P = 0.19), 1.00 (P = 0.97) and 0.93 (P = 0.05), respectively. A meta-analysis of the trials with adequate information on performance status (PS) was performed in four trials with 1325 patients. Patients with a good PS did not show a survival benefit when receiving combination chemotherapy. RRs for 6-month and 1-year OS were 0.82 (P = 0.18) and 0.93 (P = 0.08). In contrast, application of combination chemotherapy to patients with a poor PS appeared to be harmful. RRs were 1.17 (P = 0.04) for 6-month OS and 1.09 (P = 0.04) for 1-year OS. CONCLUSIONS: The meta-analysis indicated a significant survival benefit when GEM was either combined with capcitabine or oxaliplatin. On the basis of a preliminary subgroup analysis, pancreatic cancer patients with a poor PS appeared to have a worse survival benefit from GEM-based cytotoxic doublets.

Continuous-wave laser action around 2-microm in Ho3+:Lu2SiO5.

Continuous-wave (cw) laser action around 2 microm in Ho(3+)-doped Lu(2)SiO(5) (LSO) was demonstrated in this paper. Cryogenically cooled by liquid nitrogen, a 10-mm long Tm-sensitized (6% at.) Ho(0.4% at.):LSO produced a maximum output power of 3 W at 2.07 microm for incident diode power of 11 W at 786 nm, and a slope efficiency of 35% with respect to incident pump power. To achieve room-temperature operation of Tm, Ho:LSO laser, a 1-mm long microchip crystal was pumped by a high brightness diode, generating an output power of greater than 80 mW and a slope efficiency of 26% at 2.08 microm. Using a 1.91 microm Tm:YLF laser as an in-band pump source, room-temperature cw operation of singly-doped Ho: Lu(2)SiO(5) laser at 2106 nm was attained with a maximum output power of 2.8 W and a slope efficiency of 35% corresponding to absorbed pump power.

Complete mitochondrial genome of Procapra picticaudata, with phylogenetic implication.

The Tibetan gazelle Procapra picticaudata is endemic to the Tibetan plateau. The species is listed as a Near Threatened (NT) species by the IUCN Red List of Threatened Animals and the Red List of China's Vertebrates. In this study, we sequenced the complete mitochondrial genome of P. picticaudata and examined its phylogenetic position with other nine species in Artiodactyla. The complete mitochondrial genome is 16,620 bp in length and contained 22 transfer RNA genes, 2 ribosomal RNA genes, 13 protein-coding genes, and 1 control region. Our data would provide reference information for further study of this species and be useful for evolutionary and phylogenetics studies for this NT species.

The Use of Apatinib in Treating Nonsmall-Cell Lung Cancer: Case Report and Review of Literature.

Apatinib is a novel tyrosine kinase inhibitor targeting vascular endothelial growth factor receptor-2, which has been proved to be effective and safe in treating heavily pretreated patients with gastric cancer.The aim of the study was to explore the use of apatinib in treatment of nonsmall cell lung cancer and its side effects.We report 2 patients presented with advanced nonsmall-cell lung cancer, who received apatinib after failure in the first- or third-line chemotherapy. They are treated with apatinib in daily dose of 850 mg, 28 days per cycle.Favorable oncologic outcomes were achieved in the 2 cases after the treatment of apatinib. Patient I's progression-free-survival has increased to 4.6 months after palliative therapy of apatinib, whereas Patient II nearly 6 months. The common side effects of apatinib were hypertension and hand-foot syndrome; however, the toxicity of apatinib was controllable and tolerable.Apatinib may be an option for advanced nonsmall cell lung cancer after failure of chemotherapy or other targeted therapy. But that still warrants further investigation in the prospective study.

Smoking Exposure and Survival of Patients with Esophagus Cancer: A Systematic Review and Meta-Analysis.

Smoking is a well-known major risk factor in development of esophageal cancer, but few studies have reported the association between smoking status and prognosis of these patients. We conduct the present study to summarize current evidence. A computerized search of the PubMed and EMBASE was performed up to April 30, 2015. Eight studies, containing 4,286 patients, were analyzed. In the grouping analysis, among esophageal squamous-cell carcinoma patients, current and former smokers, compared to those who have never smoked, seemed to have a poorer prognosis (HR = 1.41, 95% CI 1.22-1.64, and HR = 1.35, 95% CI 0.92-1.97, resp.). In the subgroup analysis, adverse effects on current smoker compared with never smoker were also observed in China and the other countries (HR = 1.5, 95% CI 1.18-1.92, and HR = 1.36, 95% CI 1.12-1.65, resp.). In the group that ever smoked, we could not get a similar result. No significantly increased risk was found in esophageal adenocarcinoma patients compared to the squamous-cell histology ones. In the smoking intensity analysis, heavy smoking was associated with poor survival in esophageal squamous-cell carcinoma. Our pooled results supported the existence of harmful effects of smoking on survival after esophagus cancer diagnosis.

Efficacy of adding bevacizumab in the first-line chemotherapy of metastatic colorectal cancer: evidence from seven randomized clinical trials.

Background. Efficacy of adding bevacizumab in first-line chemotherapy of metastatic colorectal cancer (mCRC) has been controversial. The aim of this study is to gather current data to analyze efficacy of adding bevacizumab to the most used combination first-line chemotherapy in mCRC, based on the 2012 meta-analysis reported by Macedo et al. Methods. Medline, EMBASE and Cochrane library, meeting presentations and abstracts were searched. Eligible studies were randomized controlled trials (RCTs) which evaluated first-line chemotherapy with or without bevacizumab in mCRC. The extracting data were included and examined in the meta-analysis according to the type of chemotherapy regimen. Results. Seven trials, totaling 3436 patients, were analyzed. Compared with first-line chemothery alone, the adding of bevacizumab did not show clinical benefit for OS both in first-line therapy and the most used combination chemotherapy (HR = 0.89; 95% CI = 0.78-1.02; P = 0.08; HR = 0.93; 95% CI = 0.83-1.05; P = 0.24). In contrast with OS, the addition of bevacizumab resulted in significant improvement for PFS (HR = 0.68; 95% CI = 0.59-0.78; P < 0.00001). Moreover, it also demonstrated statistical benefit for PFS in the most used combination first-line chemotherapy (HR = 0.84; 95% CI = 0.75-0.94; P = 0.002). And the subgroup analysis indicated only capacitabine-based regimens were beneficial. Conclusions. This meta-analysis shows that the addition of bevacizumab to FOLFOX/FOLFIRI/XELOX regimens might not be beneficial in terms of OS. Benefit has been seen when PFS has been taken into account. In subgroup analysis, benefit adding bevacizumab has been seen when capecitabine-based regimens are used. Further studies are warranted to explore the combination with bevacizumab.

[Indirect comparison of different adjuvant chemotherapies for stage II-III gastric cancer after D2 gastrectomy in Asian patients].

OBJECTIVE: To compare efficacy of different adjuvant chemotherapy regimens for stage II-III gastric cancer after D2 gastrectomy in Asian patients. METHODS: Associated literatures were searched through electronic databases and hand-searching. Prospective randomized clinical trials (RCTs) comparing adjuvant chemotherapy after D2 gastrectomy with surgery alone were included in the study. Overall survival and disease-free survival were chosen as the endpoints. Relative hazard was analyzed by Bucher adjusted indirect comparison. RESULTS: Two RCTs were selected, including comparison between S-1 versus surgery alone and comparison between XELOX versus surgery alone. There was no statistical difference in overall survival between the two regimens (HR=0.94, 95%CI:0.62-1.44, P=0.79). The recurrence risk of S-1 was slightly higher as compared to XELOX, but no statistical difference was found (HR=1.11, 95%CI:0.80-1.53, P=0.54). CONCLUSION: The adjuvant chemotherapy with S-1 is similar to XELOX for stage II-III gastric cancer after D2 gastrectomy in Asian patients.

Indirect comparison showed survival benefit from adjuvant chemoradiotherapy in completely resected gastric cancer with d2 lymphadenectomy.

Background. Little data on directly comparing chemoradiotherapy with observation has yet been published in the setting of adjuvant therapy for resected gastric cancer who underwent D2 lymphadenectomy. The present indirect comparison aims to provide more evidence on comparing the two approaches. Methods. We conducted a systematic review of randomized controlled trials, extracted time-to-event data using Tierney methods (when not reported), and performed indirect comparison to obtain the relative hazards of adjuvant chemoradiotherapy to observation on overall and disease-free survival. Results. seven randomized controlled trials were identified. Three trials compared adjuvant chemoradiotherapy with adjuvant chemotherapy, and 4 trials compared adjuvant chemotherapy with observation. Using indirect comparison, the relative hazards of adjuvant chemoradiotherapy to observation were 0.43 (95% CI: 0.33-0.55) in disease-free survival and 0.52 (95% CI: 0.38-0.71) in overall survival for completely resected gastric cancer with D2 lymphadenectomy. Conclusions. Postoperative chemoradiotherapy can prolong survival and decrease recurrence in patients with resected gastric cancer who underwent D2 gastrectomy. Molecular biomarker might be a promising direction in the prediction of clinical outcome to postoperative chemoradiotherapy, which warranted further study.

No survival benefit from adding cetuximab or panitumumab to oxaliplatin-based chemotherapy in the first-line treatment of metastatic colorectal cancer in KRAS wild type patients: a meta-analysis.

BACKGROUND: The efficacy of combined therapies of oxaliplatin-based chemotherapy and anti-epidermal growth factor receptor (anti-EGFR) monoclonal antibodies (MAbs) remains controversial in colorectal cancer (CRC). The aim of this study is to estimate the efficacy and safety of adding cetuximab or panitumumab to oxaliplatin-based chemotherapy in the first line treatment in KRAS wild type patients with metastatic colorectal cancer (mCRC) through meta-analysis. METHODS: Medline, EMBASE, and Cochrane library, American Society of Clinical Oncology (ASCO) and European Society for Medical Oncology (ESMO) were searched. Eligible studies were randomized controlled trials (RCTs) which evaluated oxaliplatin-based chemotherapy with or without anti-EGFR drugs (cetuximab or panitumumab) in untreated KRAS wild type patients with mCRC. The outcomes included overall survival (OS), progression-free survival (PFS), overall response rate (ORR) and toxicities. Hazard ratios (HR) and risk ratio (RR) were used for the meta-analysis and were expressed with 95% confidence intervals. RESULTS: This meta-analysis included four RCTs with 1270 patients, and all of the patients were administered oxaliplatin-based chemotherapy regimens with or without anti-EGFR MAbs. The result of heterogeneity of OS was not significant. Compared with chemotherapy alone, the addition of cetuximab or panitumumab didn't result in significant improvement in OS (HR = 1.00, 95%CI [0.88, 1.13], P = 0.95) or PFS (HR = 0.86, 95%CI [0.71, 1.04], P = 0.13). The subgroup analysis of cetuximab also revealed no significant benefit in OS (HR = 1.02, 95%CI [0.89, 1.18], P = 0.75) or in PFS (HR = 0.87, 95%CI [0.65, 1.17], P = 0.36). Patients who received combined therapy didn't have a higher ORR (Risk Ratio = 1.08, 95%CI [0.86, 1.36]). Toxicities slightly increased in anti-EGFR drugs group. CONCLUSIONS: The addition of cetuximab or panitumumab to oxaliplatin-based chemotherapy in first-line treatment of mCRC in wild type KRAS population did not improve efficacy in survival benefit and response rate. More RCTs are warranted to evaluate the combination of chemotherapy and targeted therapy.

Efficacy and adverse effects of transdermal fentanyl and sustained-release oral morphine in treating moderate-severe cancer pain in Chinese population: a systematic review and meta-analysis.

BACKGROUND: Previous meta-analysis suggested that transdermal fentanyl was not inferior to sustained-release oral morphine in treating moderate-severe cancer pain with less adverse effects. Now, we updated the data and performed a systematic review. METHODS: Updated cohort studies on transdermal fentanyl and oral morphine in the treatment of cancer pain were searched in electronic databases including CBMdisc, CNKI, VIP, Medline, EMBASE and Cochrane Library. Primary end points assessed by meta-analysis were remission rate of pain and incidence of adverse effects. Quality of life was assessed by systematic review, which was the second end point. RESULTS: 32 cohort studies, which included 2651 patients, were included in present study. The remission rate in transdermal fentanyl group and sustained-release oral morphine group were 86.60% and 88.31% respectively, there was no significant difference [RR = 1.13, 95% CI (0.92, 1.38), P = 0.23]. Compared with oral morphine group, there were less adverse effects in terms of constipation [RR = 0.35, 95% CI (0.27, 0.45), P < 0.00001], nausea/vomiting [RR = 0.57, 95% CI (0.49, 0.67), P < 0.00001], and vertigo/somnolence [RR = 0.59, 95% CI (0.51, 0.68), P < 0.00001] in transdermal fentanyl group. Six of selected trials supported either transdermal fentanyl or sustained-release oral morphine improved QOL of cancer patients and one of them showed more patients got better QOL after sustained-release oral morphine transferred to transdermal fentanyl. CONCLUSIONS: Our study showed again that both transdermal fentanyl and oral morphine had the same efficacy in the treatment of moderate-severe cancer pain in Chinese population, but the former might have less adverse effects and better quality of life.

Silencing Fas-associated phosphatase 1 expression enhances efficiency of chemotherapy for colon carcinoma with oxaliplatin.

AIM: To investigate whether silencing Fas-associated phosphatase 1 (FAP-1) expression enhances the efficiency of chemotherapy for colon carcinoma with oxaliplatin. METHODS: Expression of FAP-1 in mRNA and protein was detected by reverse transcription polymerase chain reaction (RT-PCR) and flow cytometry. Small interfering RNA (siRNA) was designed according to the FAP-1 mRNA sequence. Cell proliferation was evaluated by methyl thiazolyl tetrazolium (MTT) assay. Anenxin V- and propidine iodine (PI) were assayed by flow cytometry for the detection of apoptosis. RESULTS: The expression of FAP-1 was increased in SW480 cells after chemotherapy with oxaliplatin. Transfection of FAP-1 siRNA into SW480 cells silenced the expression of FAP-1 and consequently abolished the inhibitory function of Fas/FasL-mediated apoptosis pathway, thus increasing the efficacy of chemotherapy for colon carcinoma with oxaliplatin. CONCLUSION: RNA interference combined with conventional chemotherapy is more effective against colon cancer.

[Meta-analysis on gemcitabine of fixed-dose rate infusion plus oxaliplatin as first-line therapy for advanced pancreatic cancer].

BACKGROUND & OBJECTIVE: Recent clinical trials showed that gemcitabine (GEM) of fixed-dose rate infusion has certain effect on advanced pancreatic cancer. Some meta-analyses suggest that GEM plus cisplatin (DDP) or its analogues is better than GEM alone in treating advanced pancreatic cancer. This study was to evaluate the efficacy of GEM of fixed-dose rate infusion plus oxaliplatin (GEMOX regimen) as first-line therapy for advanced pancreatic cancer by meta-analysis. METHODS: Two reviewers performed the meta-analysis of all relative studies through searching the international literature, including MEDLINE, EMBASE, ASCO abstracts. This meta-analysis included all randomized evidences to compare GEMOX regimen with GEM alone with respect to overall survival rate and adverse events in patients with advanced pancreatic cancer. RESULTS: Two randomized controlled trials (including 869 patients) were screened from 182 reports. GEMOX regimen was better than GEM alone in terms of 6-month survival rate [risk difference (RD)=0.09, 95% confidence interval (CI)=0.03-0.16, P=0.005], 1-year survival rate (RD=0.05, 95% CI=-0.01-0.11, P=0.08), and objective remission rate (RD=0.06, 95% CI=0.02-0.10, P=0.006). WHO grade 3-4 adverse events analysis revealed that GEMOX was associated with a reduction in anemia (RD=-0.05, 95% CI=-0.08 - -0.01, P=0.01); the addition of oxaliplatin, however, significantly increased neuropathy (RD= 0.14, 95% CI=0.04-0.24, P=0.009) and nausea/vomiting (RD=0.13, 95% CI=0.08-0.18, P<0.001). The occurrence rates of neutropenia and thrombocytopenia were similar in the 2 groups. CONCLUSION: Analyses of the available evidences suggest GEMOX regimen is promising as the first-line therapy for advanced pancreatic cancer, which encourages further clinical trials.

[Expression and significance of survivin in colon cancer].

BACKGROUND & OBJECTIVE: Survivin is a newly identified apoptosis inhibitor. Studies indicated that Survivin over-expressed in malignant tumors. This study was designed to evaluate the expression of Survivin in colon cancer,and the correlation of its expression to clinical characteristics and prognosis of patients with colon cancer. METHODS: Expression of Survivin protein was investigated by immunohistochemistry in 12 cases of normal colon tissues,and 79 cases of colon cancer tissues without the history of radiotherapy or chemotherapy. RESULTS: Expression of Survivin was detected in 78.5%(62/79) of colon cancer tissues,higher than that in tumor nests adjacent tissues, which was 32.9% (26/79). In contrast, normal colon tissues did not express Survivin. There was no relationship between the expression of Survivin and age, sex, blood type, serum CEA level, lymph node metastasis, histological grade, infiltration degree, and Dukes' stage(P >0.05). When 25% was used as the cut-off point between high and low expression of Survivin, 3-year overall survival rate of low expression group (63.56%) was much higher than that of high expression group (39.96%) (P=0.04). Cox proportional hazards model analysis showed that Dukes' stage, and high expression of Survivin were the only 2 prognosis factors influenced the survival times (Wald values were 24.225, and 5.504, respectively, P values were 0.000, and 0.019, respectively). CONCLUSIONS: There is a high expression level of Survivin in colon cancer, it may play an important role in tumorgenesis and development of colon cancer. Over-expression of Survivin was related with poor prognosis, it may be a potential prognostic index.

[Clinical study of comparison of CAF regimen and TP regimen in treatment of advanced breast cancer].

BACKGROUND & OBJECTIVE: CAF regimen [Cytoxan+ Adriamycin+5-fluorouracil (5-FU)] and TP regimen (paclitaxel+cisplatin) were effective to advanced breast cancer (ABC). But TP regimen was expensive and the administration was complicated. So the authors evaluated the clinical results of CAF and TP regimens. METHODS: A total of 117 ABC patients proved pathologically were divided into CAF and TP groups. Patients in both groups were well matched with baseline disease characteristics (P >0.05). CAF group (66 cases):received Cytoxan 600 mg/m(2), i.v. drip d(1), Adriamycin 60 mg/m(2) i.v. drip d(1) and 5-FU 600 mg/m(2), i.v. drip d(1,8); TP group (51 cases): received paclitaxel 135 mg/m(2) by i.v. drip for 3 hours and cisplatin 60 mg/m(2), i.v. drip d(2-3) The treatments were repeated every 3 weeks. All patients received two cycles of the treatment at least. RESULTS: In CAF group, the response rates (RR) of the initial treatment cases, the retreatment cases, and the whole cases were 54.8% (17/31), 31.4% (11/35), and 42.4% (28/66), respectively. The median time to progression (TTP) was 7.8 months (95%CI:5.3-10.8 months) and the median survival was 17.8 months (95%CI:13.3-22.5%). Whereas in TP group, the RR of the initial treatment cases, the retreatment cases, and the whole cases were 62.5%(15/24), 59.3%(16/27), and 60.8%(31/51), respectively. The median TTP and the median survival were 8.6 months (95%CI:6.5-12 months) and 19 months (95%CI:15-25.5 months), respectively. There were significant differences between two groups in the RR of retreatment cases and the whole cases (P< 0.05, Chi-square test). However, there was no significant difference in the RR of the initial treatment cases, the median TTP and median survival (for RR, P >0.05, Chi-square test; for median TTP and median survival, P >0.05, Log-rank test). Diarrhea was more serious in CAF group than in TP group; however, myodynia, peripheral neuropathy,and skin exanthem were more serious in TP group than in CAF group(P< 0.05,Wilcoxon rank sum test). There was no significant difference in the other side effects between the two groups. All side effects were tolerable. CONCLUSION: CAF regimen was still a firstly selected regimen for the patients with ABC.