联合铂类化疗改善晚期胰腺癌预后

目的探讨治疗晚期胰腺癌的有效药物。方法选择病理诊断明确的Ⅲ～Ⅳ期胰腺癌患者,至少接受2周期以上吉西他滨、氟尿嘧啶及铂类化疗,电话回访生存期,分析不同药物治疗后生存期变化。结果 95例晚期胰腺癌患者中位生存期7.1月,1年生存率30.5%,2年生存率8.4%,3年生存率3.2%。Cox单因素生存模型分析显示,Ⅳ期患者较Ⅲ期患者生存期短（P=0.002,HR：2.09,95%CI：1.31～3.35）,联合铂类化疗方案治疗患者较未联合患者生存期长（P=0.011,HR：0.56,95%CI：0.35～0.88）,胰体尾癌较胰头颈部癌患者生存期有缩短趋势,但差异无统计学意义（P=0.062,HR：1.53,95%CI：0.98～2.38）。Cox多因素生存模型分析显示,Ⅳ期患者较Ⅲ期患者死亡风险增加（P=0.026,HR：1.83,95%CI：1.08～3.10）,联合铂类化疗能降低晚期胰腺癌死亡风险（P=0.026,HR：0.59,95%CI：0.38～0.94）。结论Ⅳ期胰腺癌患者较Ⅲ期患者预后差,联合铂类化疗可能延长晚期胰腺癌生存期。     

超声引导无水酒精注射术对肝癌患者乙醇代谢酶活性影响的临床研究

目的：探讨超声引导无水酒精注射（PEI）治疗对原发性肝癌患者乙醇代谢酶活性的影响。方法：原发性肝癌行PEI治疗30例为治疗组,以同期门诊体检30例健康成人为对照组,比较治疗前治疗组转氨酶及乙醇代谢酶水平与对照组的差异,观察比较PEI治疗前及治疗3、6、8次后转氨酶和乙醇代谢酶的变化。结果：治疗组PEI治疗前转氨酶及乙醇代谢酶活性明显高于对照组（P〈0.001）;治疗组治疗3、6、8次后均显著高于治疗前（P〈0.001）;第3次治疗后升高最明显,第6次后逐渐趋缓,第8次后下降但仍高于术前,两两比较有显著性差异（P〈0.001）。结论：原发性肝癌患者PEI治疗前就存在一定程度肝细胞损害,PEI治疗可造成癌旁肝细胞损害,致患者血清乙醇代谢酶活性升高,多次PEI治疗并未无限度地加重肝损害。检测乙醇代谢酶活性可作为临床评价PEI对癌旁肝组织损害程度的指标。     

肝癌与肝炎患者肝内人纤维介素的表达及意义

目的 探讨轻度、中度、重度慢性乙型肝炎及肝癌患者肝组织内人纤维介素（又称人纤维蛋白原样2凝血酶原酶,human fibrinogen-like protein 2 prothrombnase,h Fgl 2）的表达及其与患者血清转氨酶（ALT、AST）、胆红素（TBIL）、血浆凝血酶原时间（PT）等指标的相关性,并分析其意义。方法 对14例轻度慢性乙型肝炎、13例中度慢性乙型肝炎、8例重度慢性乙型肝炎及22例肝癌患者,应用免疫组化方法分别检测其肝炎组织及肝癌组织内h Fgl 2的表达,使用MIAS医学图像分析软件测定h Fgl 2的表达水平。结果 h Fgl 2在重度慢性乙型肝炎组及肝癌组的表达均高于轻度及中度慢性乙型肝炎组（P均〈0.05）。慢性乙型肝炎组患者肝组织内h Fgl 2蛋白的表达水平与患者血清ALT、AST的水平呈正相关（P〈0.001）,在肝癌组中h Fgl 2的表达水平与患者PT、ALT、AST、TBIL均无相关性（P均〉0.05）。结论 肝癌和重度慢性乙型肝炎患者肝内人纤维介素呈高表达,在慢性乙型肝炎中其水平与肝细胞破坏严重程度相关,而在肝癌中则无相关性,提示人纤维介素在肝癌中的作用可能不同于慢性乙型肝炎。     

凯西莱防治化疗药物性肝损害疗效观察

目的：观察硫普罗宁（凯西莱,tiopronin）对于恶性肿瘤患者接受化疗时并发的化疗药物性肝损害的预防和治疗作用。方法：采用前瞻性对照研究,将169例患者分为2组,预防组（89例）在化疗同时予以凯西莱;对照组80例单纯化疗,该组患者如出现肝损害则使用凯西莱治疗（30例）,观察比较两组患者在肝损害发生率及损害程度上的差异,并评价凯西莱治疗肝损害的疗效。结果：预防组及对照组在肝损害发生率上比较,有显著性差异（P〈0.01）;对照组中肝功能损害患者应用凯西莱治疗前后ALT,AST,TBIL及DBIL值的变化有显著性差异（P〈0.01）。结论：凯西莱用于预防和治疗恶性肿瘤患者化疗药物性肝损害疗效显著,值得推广使用。     

还原型谷胱甘肽防治化疗药物性肝损害效果观察

目的：观察双益健（还原型谷胱甘肽）对恶性肿瘤患者接受化疗时并发的化疗药物性肝损害的预防和治疗作用。方法：采用前瞻性对照研究,将148例患者分为2组,预防组74例在化疗同时予以还原型谷胱甘肽;对照组74例单纯化疗,该组患者如出现肝损害则使用还原型谷胱甘肽治疗（30例）,观察比较两组患者在肝损害发生率及损害程度上的差异,并评价还原型谷胱甘肽治疗肝损害的疗效。结果：预防组比对照组在损害发生率低,有显著性差异（P〈0．01）;对照组中肝功能损害患者应用还原型谷胱甘肽治疗前后ALT,AST,FBIL及DBIL值变化有显著性差异（P〈0．01）。结论：还原型谷胱甘肽预防和治疗恶性肿瘤患者化疗药物性肝损害治疗有效。     

化疗药物对胰腺癌患者血清GGT、ALP的影响

目的探讨胰腺癌患者抗肿瘤药物治疗前后血清γ-谷氨酰转移酶(GGT)和碱性磷酸酶(ALP)变化及其临床意义。方法胰腺癌患者81例化疗前后血清GGT、ALP检查结果及相关临床资料,并对其进行回顾性分析。结果化疗后GGT水平显著增高(t=2.17,P=0.0331)。接受单药方案化疗患者GGT、ALP水平高于联合化疗患者(P<0.05)。多次化疗前后GGT、ALP水平均较首次化疗者高,首次接受化疗患者化疗后GGT、ALP升高,而接受多次化疗患者化疗后GGT、ALP水平降低(P<0.05)。有肝转移患者化疗后GGT水平高于无肝转移者,Ⅳ期患者较Ⅱ、Ⅲ期患者ALP水平高(P<0.05)。结论化疗会引起胰腺癌患者的肝损害,主要发生在接受单药方案化疗患者,多药联合化疗能减轻化疗药的肝脏损害。肝转移者及临床分期较晚的患者化疗后易发生肝损害。     

HBV-DNA阳性肝癌患者术后动态观察ALT水平变化对病情发展的评估

目的动态观察HBV-DNA阳性肝癌患者术后ALT水平变化对并发症发生的评估及与防治的关系,以期寻找简便指标预测并发症的发生,指导临床实践。方法1998--2005年南通大学附属肿瘤医院收治HBV-DNA阳性HCC肝切除术患者46例,HBV-DNA阴性HCC肝切除术患者36例,所有病例术前进行肝功能评估。分别于术前、术后1d、7d、14d测定血清丙氨酸转氨酶（ALT）,PCR法检测HBV-DNA。生化指标均在日立7170A全自动生化分析仪测定。结果HBV—DNA阳性肝切除术后血清ALT水平明显升高,以后逐渐下降接近术前水平,术前后变化差异有统计学意义（P〈0．001）;并发症组各阶段值均高于无并发症组（P〈0．05）;HBV—DNA阴性肝切除术后血清ALT水平也明显升高,以后逐渐下降接近术前水平,术前后变化差异有统计学意义（P〈0．001）;并发症组HBV—DNA阳肝切除术患者与HBV—DNA阴性肝切除患者血清ALT水平显著增高（P〈0．05）,而无并发症组HBV-DNA阳性肝切除术患者与HBV-DNA阴性肝切除患者血清ALT水平无显著差异。结论HBV-DNA阳性与否与术后血清ALT增高水平与并发症发生率之间有一定的关系;HBV-DNA阳性肝癌患者术后动态观察ALT水平变化对预测病情发展尤其是并发症的发生有一定的临床价值。     

口服双环醇对奥沙利铂联合卡培他滨方案治疗胃癌患者引起肝损伤的防治研究

目的探讨口服双环醇对奥沙利铂联合卡培他滨方案治疗胃癌患者引起的肝损伤的治疗作用和预防作用.方法选取58例应用奥沙利铂联合卡培他滨方案治疗胃癌后出现肝损伤的患者,采用口服双环醇150mg/d治疗,待肝功能正常后再按原化疗方案治疗,同时服用双环醇片进行预防.比较2种化疗方式的ALT、AST、TBiL的差值.结果肝损害后口服双环醇片可以明显降低肝功能ALT、AST指标（t=10.076、4.043,P〈0.001）,患者在服用双环醇片后约9天（中位时间）后肝功能恢复正常.与单纯化疗相比,联合双环醇一起化疗可以使治疗前后ALT、AST的差值显著减小（t=6.423、2.960,P〈0.05）.结论口服双环醇可以治疗和预防奥沙利铂联合卡培他滨治疗胃癌引起的肝损伤.     

健脾活血中药联合苘三硫防治肝癌化疗栓塞术后肝功能损害的临床研究

目的探讨健脾活血中药联合茴三硫对防治肝癌化疗栓塞术（transcatheter arterial chemoembolization，TACE）后肝功能损害的疗效。方法64例中晚期肝癌患者随机分为治疗组和对照组，治疗组在TACE前、后均服用健脾活血为主的中药，根据TACE后出现的症状加用其他中药，并同时加服茴三硫。对照组于TACE前后给予肝泰乐和肌苷护肝。两组病例分别在第一次TACE治疗前和第一、第二次TACE治疗后1个月检查肝功能。结果治疗组第一、第二次TACE治疗后1个月血清谷丙转氨酶（ALT）、γ-谷氨酰转肽酶（GGTP）、总胆红素（TB）和直接胆红素（DB）均较第一次治疗前无明显改变或只有轻微升高（P〉0．05）；对照组则有明显变化，ALT、GGTP、TB和DB均较治疗前升高（P〈0．01）。结论健脾活血中药联合茴三硫可防治肝癌TACE后所引起的肝功能损害。     

肝细胞癌患者围手术期病毒载量及肝功能变化

目的:探讨肝细胞癌患者围手术期乙肝病毒DNA载量及肝功能的变化。方法:选取2013年4月-2015年4月本院收治的肝细胞癌患者78例作为研究对象。按照术前血清中HBV-DNA载量的不同,将其分为阴性组14例,低复制组48例,高复制组16例。三组患者均行手术治疗,记录三组患者手术前后7天静脉血清中HBV-DNA载量和术后1天肝功能［谷草转氨酶（AST）、谷丙转氨酶（ALT）、总胆红素（TBIL）以及白蛋白（ALB）］变化。结果:手术治疗7天后,阴性组和低复制组患者血清中HBV-DNA载量较治疗前7天有所下降,高复制组患者血清中HBV-DNA载量较治疗前7天有所上升,但无统计学意义（P>0.05）。三组患者手术后的ASL、ALT、TBIL指标较手术前均有明显上升（P＜0.05）,三组术后ALB指标较治疗前下降（P＜0.05）,且阴性组、低复制组、高复制组术后ASL、ALT、TBIL指标比较有递增变化,ALB指标比较有递减变化。结论:肝细胞癌患者行肝癌根除术后仍然存在HBV复制活跃的问题,HBV活跃程度和术前HBV-DNA载量高水平复制会影响到患者术后肝功能恢复。     

Pancreatic resection for metastatic tumors to the pancreas

We report 3 cases of resectable pancreatic metastasis. CASE 1: A 76-year-old woman was followed after nephrectomy for renal cell carcinoma for 13 years. CT examination demonstrated a high vascular lesion in the pancreatic body and tail. We conducted distal pancreatectomy and diagnosed with metastatic tumor from renal cell carcinoma. She died of liver metastasis 8 years after pancreatic resection. CASE 2: A 64-year-old man, who had undergone right lower lobectomy for lung cancer a year ago, was found to have a mass in the pancreatic tail. We performed distal pancreatectomy and diagnosed with metastatic tumor from lung cancer. He died of lung metastasis 12 months after pancreatic resection. CASE 3: A 62- year-old woman, who had undergone left nephrectomy for renal cell carcinoma 3 years ago, was found to have a mass in the pancreatic body. With a diagnosis of metastatic pancreatic tumor from renal cell carcinoma, distal pancreatectomy was done. She died of liver and lung metastases 15 months after pancreatic resection. Long-term survival can be achieved in patients undergoing a pancreatic standard resection including lymphadenectomy for isolated metastasis from nonpancreatic sites.     

含奥沙利铂联合方案引起肝功能异常的临床分析

 目的　观察含奥沙利铂联合化疗方案与非奥沙利铂方案对肿瘤患者肝功能的影响。方法　对2005年3月至2007年10月间42例出现化疗药物性肝功能异常的恶性肿瘤患者进行回顾性分析。所有患者均经组织学或细胞学确诊并接受单纯化疗,根据不同的肿瘤类型选择相应的化疗方案,化疗前肝功能均正常,同时排除伴有肝转移、乙肝和丙肝检测阳性、肝硬化等肝脏疾病的病例,其中22例接受含奥沙利铂联合化疗,均采用FOLFOX-4方案,其余20例采用不含奥沙利铂的联合化疗。观察止点为肝功能首次出现异常且在此之前化疗过程中未使用过保肝药物。观察指标包括ALT、AST、 TBIL、DBIL、IBIL、ALP、GGT,同时结合采用WHO不良反应分度标准进行评定。计量资料采用t检验,计数资料采用Wilcoxon秩和检验。结果　全组共接受90个疗程化疗,平均每例接受2.14个周期化疗后出现不同程度的肝损伤。化疗后有13例出现0度肝脏毒性、21例为Ⅰ度、7例为Ⅱ度、1例为Ⅲ度;化疗后以ALT和AST增高更显著（P＜0.05）,其中含奥沙利铂的化疗方案较不含奥沙利铂方案对ALT和AST增高的影响更显著（P＜0.05）,化疗对胆红素无显著影响。两亚组首次出现肝功能异常之前累计化疗疗程数以及不良反应分度的总体分布相似。结论　在保肝药干预之前,含奥沙利铂组较其他化疗方案更易引起肝功能损伤,主要表现为转氨酶的升高。     

A case of pancreatic acinar cell carcinoma with a giant liver metastasis successfully treated with combination of gemcitabine and peroral S-1

Pancreatic acinar cell carcinoma is rare, and its incidence is less than 1% of all the malignant pancreatic tumors. Little is reported on effectiveness of chemotherapy. We report a 64-year-old male patient with pancreatic acinar cell carcinoma and a giant metastatic liver tumor, which responded to combination chemotherapy with gemcitabine(GEM)and peroral S-1 administration. The patient had upper abdominal pain and hypervascular tumors in liver(15 cm in diameter)and pancreas tail (3 cm in diameter), which were detected by an enhanced abdominal computed tomography(CT)scan, and was admitted for further examination. Abdominal angiography, FDG-positron emission tomography(PET), and liver tumor biopsy led to a diagnosis of pancreatic acinar cell carcinoma in the pancreas tail with liver metastasis. The patient was then treated with combination chemotherapy, which consisted of intravenous infusion of GEM and peroral administration of S-1, and the metastatic liver tumor was markedly reduced(partial response in RECIST). Although the prognosis of patients with unresectable pancreatic acinar cell cancers is generally unfavorable, it is suggested that the GEM/S- 1 combination chemotherapy is effective for these patients' treatment.     

109例成人软组织肉瘤化疗的疗效分析

背景与目的:成人软组织肉瘤(soft tissue sarcoma,STS)发病率低,化疗效果不肯定.本研究通过分析成人软组织肉瘤病例的临床特征,探讨化疗在成人软组织肉瘤综合治疗中的意义.方法:回顾性分析2000年1月至2005年12月在中山大学肿瘤防治中心诊断为软组织肉瘤,并接受化疗的109例患者的临床资料和化疗情况,统计各一线化疗方案的有效率及患者的生存资料.结果:109例患者中有66例行姑息化疗,40例行辅助化疗,3例行新辅助化疗.姑息化疗患者一线化疗方案的总有效率为22.7%,中位生存期16.9个月,1年和2年生存率分别为63.6%和33.3%,中位无进展生存期为3.4个月.仅发生肺转移的患者中位生存期为25.1个月,仅发生肝转移的患者中位生存期为11.8个月,两者比较差异有统计学意义(P＜0.05).MAID方案是最常用的一线化疗方案,其次是CYVADIC方案,有效率(完全缓解 部分缓解)分别为28.0%和22.2%.确诊后半年内发生转移的患者比半年后转移的患者中位生存期短(11.8个月vs.42.9个月),两者之间差异有统计学意义(P=0.04).结论:MAID和CYVADIC均为有效的化疗方案,既往使用过常规剂量的阿霉素±异环磷酰胺后进展的患者仍可能从大剂量异环磷酰胺化疗中获益.肝转移患者比肺转移患者对化疗更不敏感,确诊后半年内出现转移的患者预后较确诊半年后转移者差.     

老年肿瘤患者化疗后肝损害的临床分析

目的分析老年肿瘤患者化疗后肝损害的特点及易感因素。方法回顾性分析2008年1月～12月在北京协和医院肿瘤内科住院化疗的所有老年患者化疗后肝损害的特点。结果共收治老年患者（≥65岁）134例,占所有患者的31．2％。其中49例在2008年化疗期间出现过肝损害,发生率为36．6％。年龄范围65～84岁,中位年龄70岁。出现肝损害与未出现肝损害的老年患者在性别比和年龄结构比方面无明显差异。出现肝损害的患者中10．2％合并慢性病毒性肝炎。21例（42．9％）伴有肝脏转移,发生率明显高于无肝损害患者的14．1％。肝功能损害出现在不同的化疗周期,大多出现在化疗前2个周期（占37．8％）。肝损害表现为丙氨酸转移酶（ALT）升高41例,天冬氨酸转移酶（AST）升高28例,碱性磷酸酶（ALP）升高27例,白蛋白（ALB）降低10例,总胆红素（TBIL）升高9例。多为1～2度,有4例（占全部老年患者3．0％）出现3度肝功能损害。出现肝功能损害后,其中19例患者未予特殊治疗,30例接受积极的保肝治疗。45例肝功恢复正常,2例肝功恶化,2例肝功无改善。结论肝功能损害与年龄／分期无明显相关,但出现肝脏转移可能是肝损害的易感因素;老年患者化疗后的肝损害一般预后较好,无需减量或延迟化疗。     

Advanced pancreatic carcinoma showing a complete response to arterial infusion chemotherapy

We report a patient with advanced carcinoma of the pancreatic body and tail with multiple liver metastases who showed a complete response to hepatic and splenic arterial infusion chemotherapy (HSAIC) with gemcitabine and 5-fluorouracil, following transcatheter peripancreatic arterial embolization (TPPAE) and partial splenic embolization (PSE). Nonresectable advanced pancreatic carcinoma tends to have a low response to medical treatment, with the median survival time being 6 months or less for stage IV cases. We disclose herein that the median survival time of patients receiving HSAIC after TPPAE is more than three times longer than the survival time attained with conventional treatments. However, in patients with advanced carcinoma of the pancreatic tail, for which TTPAE is not applicable, survival times remain low. Thus, in the patient described here, we also performed embolization of the left gastric and short gastric arteries as well as PSE to increase the flow within the great pancreatic and caudal pancreatic arteries via the splenic artery, and gemcitabine and 5-fluorouracil were administered via the splenic artery. As a result of these procedures, marked reduction in the advanced carcinoma of the pancreatic body and tail and of liver metastases was attained.     

A case of pancreatic metastasis from breast cancer during multimodality therapy

We report a case of pancreatic metastasis from breast cancer during multimodality therapy. A 53-year-old woman received right breast-conserving surgery for invasive ductal carcinoma and then chemo-radiotherapy for liver, brain, bone, neck and axillary lymphnodes, mediastinum, pleural, and spinal cord metastasis. Although she then survived in a tumor-free condition, a blood examination performed 4 years after the surgery showed an elevated serum amylase level. Abdominal CT and US revealed swelling of the pancreas head and body with main pancreatic duct dilatation of the pancreatic tail. ERCP showed diffuse stenosis of the extrahepatic bile duct and the main pancreatic duct of the pancreatic head and body. Immunohistochemical staining of the biopsy specimen from the pancreatic head confirmed pancreatic metastasis from breast cancer. Despite the intensive chemotherapy including trastuzumab, she died 2 years after the onset of pancreatic metastasis. Metastatic breast cancer to the pancreas is very rare. However, considering the recent advances of multimodality therapy for breast cancer, this clinical state may become more common.     

Comparison of the chemosensitivity of the primary lesion and a pancreatic metastasis of colon cancer: a case report

Pancreatic metastasis from colorectal cancer is rare, and accounts for less than 2% of all pancreatic metastases. There have been no studies that have reported the differences in the sensitivity to chemotherapy between the primary lesion and the pancreatic metastasis in colorectal cancer. We experienced a rare example of pancreatic metastasis from colorectal cancer, and report here the difference in the sensitivity to the antitumor drug. A 68-year-old female underwent colectomy for rectal carcinoma with a mass in the pancreatic tail and the liver. The patient also underwent a distal pancreatectomy and a segmental liver resection at the same time. v-Ki-ras2 Kirsten rat sarcoma viral oncogene homolog (KRAS) and tumor protein 53 (TP53) gene mutation analyses, in addition to the histopathological examinations, revealed tumors of the liver and the pancreatic tail as being metastases from the primary carcinoma. We employed a collagen gel droplet-embedded culture drug sensitivity test for both the primary lesion and the pancreatic metastasis. The sensitivity to oxaliplatin and FOLFOX (5-flurouracil, folinic acid and oxaliplatin) were lower in the pancreatic metastasis compared to the primary lesion. In conclusion, pancreatic metastasis from colorectal malignancy is rare, and the present results suggest that there are potential differences in the sensitivity to chemotherapy between the primary colorectal tumor and its pancreatic metastasis.     

Is resection of periampullary or pancreatic adenocarcinoma with synchronous hepatic metastasis justified?

BACKGROUND: To date, no consensus has been reached regarding which primary tumor subtypes are managed appropriately with hepatic metastectomy. Specifically, the role of hepatic resection for metastatic periampullary or pancreatic adenocarcinoma remains controversial. METHODS: Between 1995 and 2005, 1563 patients underwent surgical resection for periampullary carcinoma (n=608 patients) or pancreatic adenocarcinoma (head, n=905 patients; tail, n=50 patients). Data on demographics, operative details, primary tumor status, and-when indicated-extent of hepatic metastasis were collected. RESULTS: Of the 1563 patients who underwent resection of periampullary or pancreatic adenocarcinoma, 22 patients (1.4%) underwent simultaneous hepatic resection for synchronous liver metastasis. The primary tumor site was ampullary (n=1 patient ), duodenal (n=2 patients), distal bile duct (n=2 patients), or pancreas (head, n=10 patients; tail, n=7 patients). The majority of patients (86.4%) had a solitary hepatic metastasis, and the median size of the largest lesion was 0.6 cm. Hepatic metastectomy included wedge resection (n=20 patients), segmentectomy (n=1 patient), and hemihepatectomy (n=1 patient). After matching patients on primary tumor histology and location, the median survival of patients who underwent hepatic resection of synchronous metastasis was 5.9 months compared with 5.6 months for patients who underwent palliative bypass alone (P=.46) and 14.2 months for patients with no metastatic disease who underwent primary tumor resection only (P<.001). Pancreatic (median, 5.9 months) versus nonpancreatic (median, 9.9 months) primary tumor histology was not associated with a difference in survival in patients who underwent resection of synchronous liver metastasis (P=.43). CONCLUSIONS: Even in well selected patients with low-volume metastatic liver disease, simultaneous resection of periampullary or pancreatic carcinoma with synchronous liver metastases did not result in long-term survival in the overwhelming majority of patients.     

Clinical significance of P-glycoprotein expression in metastatic breast carcinoma

Multidrug resistance(MDR)is one of the importantfactors,limiting the chemotherapeutic efficacy[l].Thereare various resistance related-proteins overexpression inthe tissue of breast carcinoma[2].MDR phenotype isassociated with overexpression of mdr-1gene andP-glycoprotein,encoding product of mdr-1,which is oneof the major mechanisms of MDR in breast carcinoma[3].We have had partly understanding about the mechanismof breast carcinoma associated with P-gp expression bystudying the mdr-1gene,t…