CAJ | 학술논문

目的评价乳腺癌患者化疗失败后个体化治疗的疗效及预后影响因素.方法回顾性分析72例乳腺癌化疗失败患者的临床资料,全部患者均为Ⅳ期,其中术后辅助化疗失败42例,辅助化疗失败后解救化疗进展30例.在对局部正常组织和机体免疫功能不损伤或少损伤方法的原则指导下,采取以精确放疗同步中药、生物等综合治疗.结果全组患者的中位生存时间为20个月.单因素分析显示,非浸润性导管癌、转移器官数目少、无脑转移、无肝转移、无肺转移、卡氏评分≥80分、同期未配合化疗、接受多疗程中药生物巩固治疗的患者预后较好(均P＜0.05).多因素分析显示,无脑转移、病理类型为非浸润性导管癌、中药生物巩固治疗疗程≥7个和同期未接受化疗是影响乳腺癌患者化疗失败后个体化治疗疗效的保护因素(均P＜0.05).全组患者3、4级血液学反应的发生率分别为8.3％ (6/72)和5.6％ (4/72),出现4级血液学反应的患者均为入院时3级患者.全组无3、4级肝、肺急性放射损伤病例.结论乳腺癌化疗失败后患者经中药、生物等综合治疗获得了较长的生存时间,中药、生物等综合治疗为乳腺癌化疗失败后患者提供了一种可选择的治疗模式.
목적 평개유선암환자화료실패후개체화치료적료효급예후영향인소.방법 회고성분석72례유선암화료실패환자적림상자료,전부환자균위Ⅳ기,기중술후보조화료실패42례,보조화료실패후해구화료진전30례.재대국부정상조직화궤체면역공능불손상혹소손상방법적원칙지도하,채취이정학방료동보중약、생물등종합치료.결과 전조환자적중위생존시간위20개월.단인소분석현시,비침윤성도관암、전이기관수목소、무뇌전이、무간전이、무폐전이、잡씨평분≥80분、동기미배합화료、접수다료정중약생물공고치료적환자예후교호(균P＜0.05).다인소분석현시,무뇌전이、병리류형위비침윤성도관암、중약생물공고치료료정≥7개화동기미접수화료시영향유선암환자화료실패후개체화치료료효적보호인소(균P＜0.05).전조환자3、4급혈액학반응적발생솔분별위8.3％ (6/72)화5.6％ (4/72),출현4급혈액학반응적환자균위입원시3급환자.전조무3、4급간、폐급성방사손상병례.결론 유선암화료실패후환자경중약、생물등종합치료획득료교장적생존시간,중약、생물등종합치료위유선암화료실패후환자제공료일충가선택적치료모식.
Objective To evaluate the efficacy and prognostic factors of personalized treatment for breast cancer patients who failed chemotherapy.Methods Seventy-two patients with breast cancer who failed chemotherapy were treated at the Tumor Hospital of Harbin Medical University from January 2001 to January 2012.Among them,42 cases received 5.6 cycles (range,4-8 cycles) of postoperative adjuvant chemotherapy,and 30 cases received 12.2 cycles (range,6-22 cycles),both postoperative adjuvant and salvage chemotherapy.All of the 72 patients of stage Ⅳ were given personalized treatment.Under guidance of the principle that multidisciplinary treatment improves control rate but does not or less damage the normal tissues and host immune function,precise radiotherapy combined with Chinese herbal medicine (CHM),biological agent and others were chosen for the patients.Results The median survival time was 20 months.Univariate analysis showed that non-invasive ductal carcinoma,less metastasized organs,without brain,liver and lung metastasis,Karnofsky performance scores ≥ 80,not combined with chemotherapy,and multiple courses of Chinese herbal medicine and biolojical agent treatment had significant impact on survival (P ＜0.05).Multivariate analysis showed that no brain metastasis,non-invasive ductal carcinoma,and Chinese herbal medicine and biological agent treatment ≥7 courses and not combined with chemotherapy had obvious significance (P ＜ 0.05).The rate of grade 3 and 4 treatment-related hematological toxicity was 8.3％(6/72) and 5.6％ (4/72),respectively.All the patients with grade 4 hematological toxicity were the cases of grade 3 at hospital admission.No grade 3 and 4 acute radiation damages of the lung and liver were noticed.Conclusion Chinese herbal medicine combined with biological agents and others prolongs survival time in breast cancer patients who failed chemotherapy,and provides an alternative treatment modality for them.