RESUMO
BACKGROUND: This study investigated the differences in clinicopathologic features and surgical treatment between an Italian and a Chinese cohort of premenopausal women with breast cancer, and highlighted the potential advantages of international medical exchange projects. METHODS: Premenopausal women who underwent surgical treatment between 2012 and 2016 at one Italian and one Chinese institution participating in a medical exchange program were compared. Factors associated with the probability to receive mastectomy were determined via logistic analysis. Changes in surgical management at the Chinese institution in the period 2018-2019, after the exchange program, were also evaluated. RESULTS: A total of 505 patients, 318 from Italy and 187 from China, were evaluated. The Chinese patients had more frequently advanced-stage tumours, large tumour size (30.9 vs. 18.1 mm, p < 0.01), invasive carcinoma (92.5 vs. 83.3%, p < 0.01), positive axillary lymph nodes (54.5 vs. 27.4%, p < 0.01), Her-2 positivity (36.4 vs. 22.0%, p < 0.01), and high proliferative index (55.1 vs. 30.2%, p < 0.01). Positive oestrogen receptor status and rates of triple-negative breast cancer did not differ (77.0 vs. 69.5%, p = 0.09 and 14.2 vs. 16%, p = 0.56, respectively). Mastectomy rates were higher among Chinese women (85 vs. 41%, p < 0.001), whereas use of sentinel node biopsy was more frequent among Italian women (77 vs. 33%, p < 0.001). Chinese women had more than 4-fold higher risk of receiving mastectomy. In the last 2 years, the rates of breast-conserving surgery and sentinel node biopsy at the Chinese institution increased from 15 to 23%, and from 33 to 42%, respectively. CONCLUSIONS: Tumour features and surgical strategies for premenopausal breast cancer may differ signiï¬cantly between Italy and China. Since the international exchange program, patients from the Chinese institution have been offered more frequently less invasive surgery. International exchange programs can help in designing epidemiological studies which may be useful for strategies to improve breast cancer management and control.
RESUMO
This study was aimed to detect the expression of CD4(+)CD25(+) regulatory T cells (Treg), sFas and sFasL in patients with autoimmune thrombocytopenic purpura (AITP), and to explore their roles in the pathogenesis of AITP and clinical significance, so as to provide a theoretical basis for effective treatment for AITP. The expressions of CD4(+)T, Treg, CD4(+)CD25(-)T, Treg/CD4(+)T in peripheral blood of 30 the patients with AITP and 18 controls were detected by flow cytometry, and enzyme-linked immunosorbent assay (ELISA) was used to detect the levels of sFas and sFasL in peripheral blood of controls and the patients with AITP before and after treatment. The results indicated that the expression rate of CD4(+)T in AITP patients was lower than that in the control (p < 0.05), and the expression rates of Treg and Treg/CD4(+)T were significantly lower than those of control (p < 0.01), but the expression rate of Treg between the two group had no difference (p > 0.05). The levels of sFas and sFasL in the peripheral blood of the patients before treatment were significantly higher than that after treatment and control group (p < 0.01), and no difference between the patients after treatment and the control group (p > 0.05) was found. The expression rates of Treg, Treg/CD4(+)T were positively related with the platelet count and the level of sFas was positively related with the level of sFasL in the peripheral blood of AITP before treatment. There were no significant correlation between the levels of CD4(+)T, Treg, sFas, sFasL and the platelet count. No correlation was seen between the expression of Treg and sFas, sFasL. It is concluded that CD4(+)CD25(+) Treg play a role in the pathogenesis of AITP; the expression rate of Treg is associated with the severity of AITP; the abnormal levels of sFas and sFasL participate in the immune pathogenesis of AITP.