The presence of estrogen receptors in breast cancers is now accepted as a predictor of extended disease-free survival, but the relative value of progesterone receptors for this purpose has not been established. We have examined both receptors along with other risk factors in 189 patients receiving adjuvant therapy for Stage II breast cancer. The presence of either estrogen receptors or progesterone receptors was positively correlated with disease-free survival when analyzed separately, whether or not the adjuvant regimen included an endocrine component. However, when estrogen receptors and progesterone receptors were analyzed together in multivariate models, the presence of progesterone receptors was more significant than that of estrogen receptors for predicting time to recurrence, regardless of what other variables were included in the model. These data suggest that determination of the progesterone-receptor concentration is of equal or greater value than determination of the estrogen-receptor concentration for predicting the disease-free survival of patients with breast cancer. Future trials should include measurement of progesterone receptors.
During normal spontaneous inspiration pulmonary blood flow increases in spite of an increase in resistance to flow in the pulmonary bed. The enhancement of pulmonary flow is caused by an augmentation of venous return due to thoracic aspiration. The right heart acts as a moderator for the pulmonary flow by temporarily storing part of the large influx of venous blood during inspiration and ejecting the stored part during expiration and the expiratory pause.O N E of the oldest controversies in the field of pulmonary circulation concerns the effect of spontaneous respiration on blood flow in the pulmonary artery. According to pulmonary vascular bed perfusion experiments pulmonary flow diminishes due to an increase in resistance when the lungs are expanded by negative pressure in the closed chest, such as would occur during spontaneous inspiration.1 ' s On the other hand, Baxter and Pearse* found that, in the intact animal, pulmonary flow was augmented during inspiration. These contradictory findings could be explained only if one assumes that during inspiration venous return increases to such an extent that it augments right heart output in spite of the higher pulmonary bed resistance. Recently it has been demonstrated that venous return actually can increase with inspiration. 4 ' 6 The correlation of such flow augmentation with changes in pulmonary flow has not been established, however, and it was the purpose of this investigation to study this problem. METHODIn acute experiments on dogs, blood flow was simultaneously measured in both the main pulmonary artery and the superior vena eava with two 5734 vacuum tube bristle flowmeters. The superior caval flow was taken as representative of venous return since it has been found in former experiments' that superior and inferior caval flows show the same From the Departments of Physiology and Surgery, School of Medicine, Western Reserve University and University Hospitals of Cleveland.Aided by grants from the Life Insurance Medical Research Fund and the Cleveland Area Heart Society.Received for publication December 6, 1954.directional changes during the respiratory and cardiac cycle. Flow in the superior cava was recorded with a bristle flowmeter of a design described previously. 7 ' 8 The cross-sectional area of the vein was fixed for volume flow determination by the ringlike head of the flow cannula inserted into the vessel at the entrance of the right atrium. The internal diameter of the cannula head was 12 mm. Right heart output was recorded by a modified bristle flowmeter inserted into the main pulmonary artery.' The bristle wasintroducedintothetrunk of the pulmonary artery through a buttonhole incision without blood loss, and the cross sectional area of the vessel was kept constant by passing a suitable metal band around it.Nine dogs, ranging from IS to 34 Kg. in weight, were anesthetized with 1.5 mg/kg morphine sulfate and 15 mg/Kg. sodium pentobarbital. The animals were fixed in the right lateral position and the chest was entered on the left side between th...
The prognostic value of estrogen receptor determination was studied for 510 stage I (axillary node negative) breast cancer patients treated by mastectomy alone. Results at 60 months after mastectomy indicate that stage I patients whose tumors lack estrogen receptors fall into a significantly poorer prognostic group for both recurrence and survival than those whose tumors contain estrogen receptors. Within the postmenopausal group, estrogen receptor negative (ER -) patients are recurring more rapidly than estrogen receptor positive (ER +) patients. Within the premenopausal group, ER + patients have a recurrence rate identical to ER - patients, which is apparent only after prolonged follow-up. In contrast to postmenopausal ER + patients, premenopausal ER + patients appear to have no prognostic advantage over the ER - patients, and thus constitute a high risk group for which adjuvant endocrine therapy might prove beneficial.
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