清胰化积方为主综合治疗晚期胰腺癌64例生存分析-沈晔华

:(02DZ19106):,[e-mail],(021)64175590130864沈晔华　刘鲁明　孟志强　陈　震　林钧华　周振华　陈　颢　王　琨　于尔辛(复旦大学附属肿瘤医院中西医结合科,复旦大学上海医学院肿瘤学系,上海市徐汇区东安路270号,200032)[](64),(70),13525.0%14.1%8.4%,7.6,(P0.05)CA19-9500U/mlKPS80(P0.05),(P0.05),(P0.05)[];;;SurvivalAnalysison64CasesofAdvancedPancreaticCancerTreatedbyIntegratedWesternandTraditionalChineseMedicineMainlywithQingyiHuajiFormulaSHENYehua,LIULuming,MENGZhiqiang,etal.(CancerHospitalAffiliatedtoFudanUniversity,Shanghai200032)ABSTRACTObjectiveToobservethesurvivalstateofpatientswithadvancedpancreaticcancertreatedbyintegratedwesternandtraditionalChinesemedicinemainlywithQingyiHuajiFormula(formulaforclearingthepancreasanddissolvingthestasis),andtheinfluencefactorsofthetreatment.MethodsAreviewedanalysiswasmadeonthepatientswithadvancedpancreaticcancerwhoweretreatedbyQingyiHuajiFormula,theintegratedwesternandtraditionalChineseMedicine.Thesurvivalrateoftreatmentgroup,64cases,wascomparedwiththatofthecontrolgroup,70cases,treatedbynon-QingyiHuajiFormula,andtheinfluenceofvariousclinicalfactors,chemicaltherapy,radiotherapyonthesurvivalratewasanalyzed.ResultsInthetreatmentgroup,thesurvivalrateof1,3,and5yearswas25.0%,14.1%and8.4%respectively,andthemediansurvivalwas7.6months,obviouslylongerthanthoseofthecontrolgroup(P0.05).ThosewhowiththeserumCA19-9500U/mlandKPS80beforetreatmentwererelatedwithpoorersurvival(P0.05).Inthetreatmentgroup,thesurvivalrateofdifferentTCMsyndromeswasnotsignificantlydifferent(P0.05).Thesurvivalrateofradiotherapyandchemotherapywasbetterthanthatofchemotherapyalone(P0.05).ConclusionQingyiHuajiFormulaisimportantinprolongingsurvivalofpatientswithadvancedpancreaticcancer.KeyWordsPancreaticcancer;ComprehensivetreatmentwithintegratedwesternandtraditionalChinesemedicine;QingyiHuajiFormula(formularforclearingthepancreasanddissolvingthestasis);Survivalanalysis,206[1]110%,34[2],56[3],,[4]6411.1　诊断标准:(CTMRIPET),,,,CA19-9CA242;:[5]1.2　纳入标准;:,2002UICCTNM;,11cm;1.3　排除标准1();3920091501JournalofTraditionalChineseMedicine,2008,Vol.50,No.11.4　一般资料20025120051231232134(64,70)6418,46:45(70.3%)39(60.9%)35(54.7%)13(20.3%)10(15.6%)8(12.5%)7(10.9%)(10.9%):21,23,207015,55:52(74.3%)43(61.4%)43(61.4%)17(24.3%)11(15.7%)10(14.3%)9(12.9%)11(15.7%):29,15,9,11122.1　治疗方法2.1.1　治疗组:641,1,3.8,:15g,30g,30g,15g,20g,6g,20g:¹(21):,,,,,,,,:(:20g,15g,10g,10g,15g,20g,20g,15g)º(23):,,,,,,,,,:(:30g,3g,10g)»(20):,,,,,,,,:(:10g,6g,15g,1(64)(70)P36450.380282559.211.558.510.00.70630330.975343718160.5534654KPS8026250.906803835(g/L)39.34.238.05.00.168CA19-9(U/ml)50036300.16650028401130.08369535245490.969192110200.265134352171333241470.720232325380.0863932(Gy)38.66.536.38.10.19010g,10g):¹:19(1g/m218,,3,,:FF4BP9B)(100mg/m2,,3,,:04082512)(30mg/m213,,3,,:20030713)54,(1g/m2)(130mg/m2)(40mg/m2),(),()46º:39,1.82Gy,1,5,3054Gy,38.6Gy»:52.1.2　对照组:701,1,3.2(29):4020091501JournalofTraditionalChineseMedicine,2008,Vol.50,No.1:20g,10g,10g,3g(15)::15g,15g,30g,12g,15g(9)::10g,30g,12g,10g,10g11:¹:º:,36.3Gy»:3,(P0.05),12.2　观察指标和方法,,20071231,39.0(26.266.4):2.3　统计学方法SPSS15.0t;KaplanMeier,,Cox,P0.0533.1　治疗组及对照组生存情况比较64,60.9%,25.0%,14.1%,8.4%,7.67(53,342,232),66.470,35.7%,10.0%,2.9%,,4.2,(P0.001)3.2　各种临床因素对治疗组生存情况的影响,(P0.05)KPS80(5.5)KPS80(8.0);CA19-9500U/ml(4.5)CA19-9500U/ml(9.3),(P0.05),2,KPS80CA19-9500U/ml(P=0.011,P=0.003),2.0652.3362(x-s)()(%)(%)(%)P367.216.75.65.60.097288.635.725.08.360336.424.218.26.10.89260318.225.89.79.7309.326.713.36.70.568/347.223.514.79.8189.944.422.214.80.104467.217.410.95.4457.425.614.09.30.952199.323.814.37.1396.427.512.500.287258.620.816.716.7137.818.2000.434517.626.417.010.280265.515.43.83.80.047KPS80388.031.621.112.6CA500369.336.818.49.20.01119-9(U/ml)500284.57.77.77.739267.419.211.500.460(g/L)39387.628.915.811.83.3　治疗组不同中医辨证分型的生存情况比较,13519.0%9.5%0,7.4;13534.8%13.0%13.0%,7.2;13520.0%10.0%10.0%,7.8,(P0.05)3.4　治疗组接受不同西医治疗者的生存情况比较,(25)(4)+(35),,13512.0%4.0%0,7.2;13525.0%00,7.5;+13534.3%22.9%13.7%,8.6+,(P0.05),(P0.05)4120091501JournalofTraditionalChineseMedicine,2008,Vol.50,No.14,,,,,,,,,,,,,,,;;;,,,,,56,18%,[3]2[6],,7.6,,,,,,643,,,,,,(35),,,,KPSCA19-9KPS[7],,CA19-9[8],CA19-9500U/ml500U/ml,CA19-9,1.5,[2],,,1.4,,,,,,,,KPSCA19-9[1].[J].,1997,36(7):435.[2]JemalA,TiwariRC,MurrayT,etal.Cancerstatistics,2004[J].CACancerJClin,2004,54(1):8-29.[3]OkusakaT,KosugeT.Systemicchemotherapyforpancreaticcancer[J].Pancreas,2004,28(3):301-304.[4]LiuLuming.Comprehensivetherapyofpancreaticcancerbyintegrativetraditionalandwesternmedicine[J].ChineseJIntegrativeMedicine,2004,10(3):236-237.[5].[M].:,1994:253.[6]MooreMJ,GoldsteinD,HammJ,etal.Erlotinibplusgemcitabinecomparedwithgemcitabinealoneinpatientswithadvancedpancreaticcancer:aphasetrialoftheNationalCancerInstituteofCanadaClinicalTrialsGroup[J].JClinOncol,2007,25(15):1960-1966.[7]MickeO,BrunsF,KurowskiR,etal.Predictivevalueofcarbohydrateantigen19-9inpancreaticcancertreatedwithradiochemotherapy[J].IntJRadiatOncolBiolPhys,2003,57(1):90-97.[8]FerroneCR,FinkelsteinDM,ThayerSP,etal.PerioperativeCA19-9levelscanpredictstageandsurvivalinpatientswithresectablepancreaticaden