CAJ | 학술논문

目的：通过临床回顾性研究对以清胰化积方为主的中西医综合治疗老年胰腺癌进行疗效评估，探讨可行性治疗模式。方法采用Kaplan-Meier方法计算生存期，Log-rank检验进行组间比较，并通过应用Cox比例风险模型对2002年1月至2008年12月期间接受中西医结合治疗的190例老年胰腺癌患者进行多因素分析。结果本组190例老年胰腺癌患者：1年生存率28．42％；3年生存率6．32％；5年生存率2．11％。中位生存期为7．1个月。其中清胰化积组102例，中位生存期8．7个月；非清胰化积方88例，中位生存期4．7个月，差异有统计学意义（P＜0.05）。KPS评分＜80、CA19-9≥500 U/ml、消瘦（体重在6个月内减轻≥10％）、肝转移、手术方式、全身化疗和清胰化积中药是影响该治疗模式预后的独立影响因子。结论根治手术、全身化疗和清胰化积中药是老年胰腺癌长期生存保护因素。老年胰腺癌Ⅲ期患者可化疗结合清胰化积方中药治疗，Ⅳ期老年胰腺癌患者则应以中药及最佳对症支持治疗为主。
목적：통과림상회고성연구대이청이화적방위주적중서의종합치료노년이선암진행료효평고，탐토가행성치료모식。방법채용Kaplan-Meier방법계산생존기，Log-rank검험진행조간비교，병통과응용Cox비례풍험모형대2002년1월지2008년12월기간접수중서의결합치료적190례노년이선암환자진행다인소분석。결과본조190례노년이선암환자：1년생존솔28．42％；3년생존솔6．32％；5년생존솔2．11％。중위생존기위7．1개월。기중청이화적조102례，중위생존기8．7개월；비청이화적방88례，중위생존기4．7개월，차이유통계학의의（P＜0.05）。KPS평분＜80、CA19-9≥500 U/ml、소수（체중재6개월내감경≥10％）、간전이、수술방식、전신화료화청이화적중약시영향해치료모식예후적독립영향인자。결론근치수술、전신화료화청이화적중약시노년이선암장기생존보호인소。노년이선암Ⅲ기환자가화료결합청이화적방중약치료，Ⅳ기노년이선암환자칙응이중약급최가대증지지치료위주。
Objective To evaluate the clinical effect of integrated traditional Chinese and Western medicine therapy based on Qingyi Huaji (QYHJ)formula (for clearing the pancreas and dissolving the stasis)in the elderly patients with pancreatic cancer by a retrospective study and to explore a feasible treatment modality for this disease.Methods The data of 190 elderly pancreatic cancer patients (≥60 years),who re-ceived integrated traditional Chinese and Western medicine therapy from January 2002 to December 2008,were retrospectively reviewed.These patients were assigned to receive QYHJ formula or non-QYHJ formula.The Kaplan-Meier method was used for calculating survival rates, and the log-rank test was used for survival difference analysis;multivariate analysis was performed using the Cox proportional hazards model. Results The 1 -,3-,and 5-year survival rates of the 190 patients were 28.42%,6.32%,and 2.11%,respectively,and the median sur-vival was 6.7 months.The QYHJ group (n=102)had a significantly longer median survival than the non-QYHJ group (n=88)(8.7 months vs 4.7 months,P<0.05).For the elderly patients with pancreatic cancer,KPS<80,CA19-9≥500 U/ml,weight loss (≥10%within six months),and liver metastasis were poor prognostic factors,while radical surgery,systemic chemotherapy,and QYHJ formula were favorable prognostic factors.Conclusion Radical surgery,systemic chemotherapy,and QYHJ formula are protective factors for long-term survival in elderly patients with pancreatic cancer.Combination therapy with chemotherapy and QYHJ formula is suitable for elderly patients with stageⅢpancreatic cancer,while herbal formula combined with the optimal symptomatic and supportive treatment are suitable for those with stage Ⅳpancreatic cancer.