中西医结合治疗转移性乳腺癌的临床研究
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摘要
本论文包括文献综述和临床研究两部分。
文献综述两篇：综述一主要总结了中医在转移性乳腺癌中的应用及作用优势,首先认为转移性乳腺癌以正虚为本并详细分析了正虚的病因病机和治疗,应以扶正培本为基础,佐以解毒抗瘤作为治疗原则。其次,是从辨转移部位治疗的方面进行了论述,主要包括骨转移、肺转移、肝转移等的选方用药经验。第三是从提高晚期乳腺癌生活质量的方面,主要从改善失眠、抑郁、疼痛、厌食等症状方面进行论述。综述二主要回顾了国内外治疗晚期乳腺癌的化疗概况。主要介绍了化疗的适应症,即复发转移性乳腺癌,ER、PR阴性者,或有症状的内脏转移,或ER、PR阳性但对内分泌治疗无效者。化疗药物的选用方法和原则,MBC治疗决策的制定包括(1)既往的治疗药物及其疗效(2)无病间隔(3)内分泌治疗疗效(4)HER2状态(5)肿瘤负荷(定义为转移灶数目和部位)绝经情况、年龄、合并症(包括器官功能障碍)、PS(6)快速控制疾病／症状的需要、社会经济和心理因素(7)患者本人意愿以及患者所在地区能进行的治疗。优先考虑使用的药物与方案有蒽环类、紫杉类、抗代谢药和其他微管抑制剂。单药和联合化疗方案的选择,对于疾病进展快、一般情况好、肿瘤负荷大、年轻的患者可以选择联合化疗,而疾病进展缓慢、肿瘤负荷小、一般情况差、老年患者考虑单药化疗。以及靶向药物的应用。
临床研究：目的：观察中西医结合治疗晚期乳腺癌的临床疗效。方法：收集2005年1月～2011年5月中日友好医院中西医结合肿瘤内科住院治疗的转移性乳腺癌患者共68例,主要观察指标为生存期(0S),次要观察指标为肿瘤进展时间(TTP)。结果：中西医结合组共59人,中位生存期为38.5个月(8-108个月),中位TTP为15个月(4到65个月)。西医组9例,0S最短2个月,最长9个月,中位总生存期5个月。与文献相比,中西医结合组的中位OS和中位TTP均明显延长。且中西医结合组和西医组0S比较有明显差异(P<0.05)。结论：中西医结合治疗晚期乳腺癌可以延长总生存期,延长TTP。
This essay consists of two parts:Two literature reviews and clinical research.
Two literature review:the first review discusses applications to metastatic breast cancer. First, The characteristic of metastatic breast cancer is that heathy-qi deficient is the foundation, should treated with strengthening healthy-qi. Then represent treating with Chinese medicine by differentiation of metastatic parts, mainly include bone metastasis, lung metastasis, liver metastasis and so on. The third, Mainly discuss how to improve the life quality of advanced breast cancer, in terms of improving insomnion, depression, pain, anorexia and so on. The second literature review retrospect the chemotherapy of advanced breast cancer, mainly introduce the indications of chemotherapy, the choose methods and principles to chemotherapy, The common use and the latest new chemotherapy regimens include sigle and combination regimens,and target drugs and their new trails passed by FDA.
Clinical reseach:Objective:To investigate that combination of Chinese and westen medicine can prolong the RR and TTP. Method:We collect the metastatic breast cancer patients who are hospitalized in the oncology, of China-Japan friendship hospital.We investigate the median overall survival of Chinese-west medicine combination group(died group) is 38.5 months(from 8 to 108 months), chinese-west medicine group (include died and not died) has 59 patients, median TTP is 15 months (4 to 65 months). The west medicine group (died group) has 9 patients, the shortest OS is 2 months, the longest is 9 months, the median overall surviaval is 5 months. Compare to literature,The Chinese-west medicine combination group have a longer OS and TTP. OS of Chinese-west, medicine group and west medicine group have obvious differentiation(P<0.05). Conclusion: Combination of Chinese and west medicine can prolong the OS and TTP.
文献综述两篇：综述一主要总结了中医在转移性乳腺癌中的应用及作用优势,首先认为转移性乳腺癌以正虚为本并详细分析了正虚的病因病机和治疗,应以扶正培本为基础,佐以解毒抗瘤作为治疗原则。其次,是从辨转移部位治疗的方面进行了论述,主要包括骨转移、肺转移、肝转移等的选方用药经验。第三是从提高晚期乳腺癌生活质量的方面,主要从改善失眠、抑郁、疼痛、厌食等症状方面进行论述。综述二主要回顾了国内外治疗晚期乳腺癌的化疗概况。主要介绍了化疗的适应症,即复发转移性乳腺癌,ER、PR阴性者,或有症状的内脏转移,或ER、PR阳性但对内分泌治疗无效者。化疗药物的选用方法和原则,MBC治疗决策的制定包括(1)既往的治疗药物及其疗效(2)无病间隔(3)内分泌治疗疗效(4)HER2状态(5)肿瘤负荷(定义为转移灶数目和部位)绝经情况、年龄、合并症(包括器官功能障碍)、PS(6)快速控制疾病／症状的需要、社会经济和心理因素(7)患者本人意愿以及患者所在地区能进行的治疗。优先考虑使用的药物与方案有蒽环类、紫杉类、抗代谢药和其他微管抑制剂。单药和联合化疗方案的选择,对于疾病进展快、一般情况好、肿瘤负荷大、年轻的患者可以选择联合化疗,而疾病进展缓慢、肿瘤负荷小、一般情况差、老年患者考虑单药化疗。以及靶向药物的应用。
临床研究：目的：观察中西医结合治疗晚期乳腺癌的临床疗效。方法：收集2005年1月～2011年5月中日友好医院中西医结合肿瘤内科住院治疗的转移性乳腺癌患者共68例,主要观察指标为生存期(0S),次要观察指标为肿瘤进展时间(TTP)。结果：中西医结合组共59人,中位生存期为38.5个月(8-108个月),中位TTP为15个月(4到65个月)。西医组9例,0S最短2个月,最长9个月,中位总生存期5个月。与文献相比,中西医结合组的中位OS和中位TTP均明显延长。且中西医结合组和西医组0S比较有明显差异(P<0.05)。结论：中西医结合治疗晚期乳腺癌可以延长总生存期,延长TTP。
This essay consists of two parts:Two literature reviews and clinical research.
Two literature review:the first review discusses applications to metastatic breast cancer. First, The characteristic of metastatic breast cancer is that heathy-qi deficient is the foundation, should treated with strengthening healthy-qi. Then represent treating with Chinese medicine by differentiation of metastatic parts, mainly include bone metastasis, lung metastasis, liver metastasis and so on. The third, Mainly discuss how to improve the life quality of advanced breast cancer, in terms of improving insomnion, depression, pain, anorexia and so on. The second literature review retrospect the chemotherapy of advanced breast cancer, mainly introduce the indications of chemotherapy, the choose methods and principles to chemotherapy, The common use and the latest new chemotherapy regimens include sigle and combination regimens,and target drugs and their new trails passed by FDA.
Clinical reseach:Objective:To investigate that combination of Chinese and westen medicine can prolong the RR and TTP. Method:We collect the metastatic breast cancer patients who are hospitalized in the oncology, of China-Japan friendship hospital.We investigate the median overall survival of Chinese-west medicine combination group(died group) is 38.5 months(from 8 to 108 months), chinese-west medicine group (include died and not died) has 59 patients, median TTP is 15 months (4 to 65 months). The west medicine group (died group) has 9 patients, the shortest OS is 2 months, the longest is 9 months, the median overall surviaval is 5 months. Compare to literature,The Chinese-west medicine combination group have a longer OS and TTP. OS of Chinese-west, medicine group and west medicine group have obvious differentiation(P<0.05). Conclusion: Combination of Chinese and west medicine can prolong the OS and TTP.
引文
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