CAJ | 학술논문

背景与目的:胰腺癌是预后较差的恶性肿瘤之一,动脉灌注化疗/栓塞(hepatic artery infusion chemotherapy/transcatheter arterial chemoembolization,HAI/TACE)治疗胰腺癌取得了一定临床疗效.本研究通过中药清热化积法联合HAI/TACE治疗Ⅲ~Ⅳ期胰腺癌患者的随机对照Ⅱ期临床研究,探讨清热化积法的临床疗效以及血清CA199水平在胰腺癌预后中的价值.方法:选择2006年5月—2009年6月,在复旦大学附属肿瘤医院中西医结合科住院的Ⅲ~Ⅳ期胰腺癌患者70例,均接受HAI/TACE治疗.根据数字表法随机分为两组:清热化积中药治疗组(35例)和对照组(35例),比较清热化积中药与对照中药分别联合HAI/TACE治疗3、6、9和12个月生存情况,治疗前后的患者主要症状变化,采用RECIST标准评价治疗前后B超、CT或MRI等影像学中胰腺肿瘤大小的变化.结果:清热化积组中位生存期为6.94个月优于对照组的4.24个月(P<0.05).清热化积中药治疗前后肝肾功能的变化、骨髓抑制情况与对照组比较差异无统计学意义(P>0.05).清热化积组的患者中血清CA199<500 U/mL和CA199>500 U/mL的中位生存期分别为(9.40±2.28)个月和(4.07±0.53)个月,两者差异有统计学意义(P<0.05).清热化积中药能明显减低胰腺癌患者血清CA199水平,改善患者KPS和疼痛症状评分.结论:清热化积法联合HAI/TACE治疗中晚期胰腺癌,可降低胰腺癌患者血清CA199水平,改善患者KPS评分和生存质量,并缓解疼痛症状,延长生存期.
배경여목적:이선암시예후교차적악성종류지일,동맥관주화료/전새(hepatic artery infusion chemotherapy/transcatheter arterial chemoembolization,HAI/TACE)치료이선암취득료일정림상료효.본연구통과중약청열화적법연합HAI/TACE치료Ⅲ~Ⅳ기이선암환자적수궤대조Ⅱ기림상연구,탐토청열화적법적림상료효이급혈청CA199수평재이선암예후중적개치.방법:선택2006년5월—2009년6월,재복단대학부속종류의원중서의결합과주원적Ⅲ~Ⅳ기이선암환자70례,균접수HAI/TACE치료.근거수자표법수궤분위량조:청열화적중약치료조(35례)화대조조(35례),비교청열화적중약여대조중약분별연합HAI/TACE치료3、6、9화12개월생존정황,치료전후적환자주요증상변화,채용RECIST표준평개치료전후B초、CT혹MRI등영상학중이선종류대소적변화.결과:청열화적조중위생존기위6.94개월우우대조조적4.24개월(P<0.05).청열화적중약치료전후간신공능적변화、골수억제정황여대조조비교차이무통계학의의(P>0.05).청열화적조적환자중혈청CA199<500 U/mL화CA199>500 U/mL적중위생존기분별위(9.40±2.28)개월화(4.07±0.53)개월,량자차이유통계학의의(P<0.05).청열화적중약능명현감저이선암환자혈청CA199수평,개선환자KPS화동통증상평분.결론:청열화적법연합HAI/TACE치료중만기이선암,가강저이선암환자혈청CA199수평,개선환자KPS평분화생존질량,병완해동통증상,연장생존기.
@@@@Background and purpose: Pancreatic carcinoma has poor prognosis among most malignant tumors. The clinical efficacy has been made by hepatic arterial infusion chemotherapy and embolization (HAI/TACE) in the treatment of advanced pancreatic cancer. This study aimed to evaluate the therapeutic effects of Qing Re Hua Ji (QRHJ) decoction combined with HAI/TACE treating advanced pancreatic cancer patients and the importance of CA199 level. Methods: From May. 2006 to Jun. 2009, 70 pancreatic cancer patients with stage Ⅲ-Ⅳ hospitalized in the Department of Integrative Oncology, Fudan University Shanghai Cancer Center, were recruited. These patients were divided into two groups randomizedly, QRHJ group and control group. The 3, 6, 9 and 12 months of survival rate of the QRHJ group and control group combined HAI/TACE were calculated respectively. The improvement of symptoms was evaluated before and after treatment. The clinical effects were evaluated using RECIST criteria by B-mode ultrasound and CT or MRI imaging. Results: There was significant difference of objective response rate between the two groups. The QRHJ group had an advantage of survival rate over control group (1-year survival rate: 31.43% vs 5.71%, median @@@@survival: 6.94 months vs 4.24 months). Toxicity in QRHJ group was not very severe. QRHJ decoction combined with HAI/TACE treatment could prolong the survival rate of pancreatic cancer patient with serum CA199<500 U/mL, and it could reduce the level of serum CA199. QRHJ decoction also could increase the KPS core of the advanced pancreatic cancer patients and release the symptom of pain. Conclusion: It suggested that QRHJ decoction might benefit the advanced pancreatic cancer patients by stabilizing tumors and prolonging life expectancy, with less side effects and better quality of life. QRHJ decoction can reduce the level of serum CA199.