中医药治疗中晚期肝癌的临床研究
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摘要
目的:观察并比较莪术油(CAO)介入治疗与TACE治疗中晚期原发
    性肝癌(PLC)的近期疗效以及对PLC患者生存质量的影响。
     方法:将70例次(41例)中晚期PLC病人随机分为CAO组(n=36)、
    TACE组(n=34)。CAO组予CAO或CAO+Lip介入治疗,TACE组用化
    疗药或化疗药+Lip介入治疗。在介入前1~3天及介入后2周分别用“肝
    癌患者生存质量量表”测计生存质量积分。比较生存质量、AFP、肝功能、
    肾功能、骨髓造血功能、出凝血功能等的变化。
     结果:CAO组与TACE组的有效率(CR+PR)分别为0%、14.71%,
    稳定率(CR+PR+SD)为100%、85.29%,组间均无显著性差异(P=0.0541)。
    治疗后CAO组生存质量提高,TACE组则降低,有显著性差异(P<0.01)。
    介入后AFP、ALP、γ-GT、TBIL、RBC等变化,组间比较无显著性差异
    (P>0.05);而ALT、AST、WBC、PLT、PT、FIB、Cr、BuN等变化TACE
    组较大(P<0.05)。通过二值多元Logistic回归分析,与生存质量提高5%
    以上正相关的有:治疗前的Karnofsky分、生存总积分、γ-GT、WBC、
    RBC、PLT、Cr,治疗后的γ-GT、WBC、 RBC、PLT、Cr等因子;负相
    关的有:治疗前的AFP、ALT、AST、ALP、TBIL、PT、FIB、BuN,治
    疗后的生存总积分、AFP、ALT、AST、ALP、TBIL、PT、FIB、BuN等
    因子。
     结论:莪术油有较好的抗肿瘤作用,其介入治疗PLC的近期疗效与
    TACE相似;莪术油介入较TACE能更好地改善PLC患者的生存质量;莪
    
    
    术油对肝功能/肾功能、骨髓造血功能以及凝血功能等的损害较小,安全
    性更高;获术油能更好地改善PLC患者生存质量,可能与其具有抗肿瘤
    作用的同时,对机体的毒副作用较小有关。
     关键词;获术油 介入治疗 原发性肝癌 生存质量
     第二部分 中晚期肝癌综合抬疗的疗效及预后因子分析
     目的:观察比较中晚期肝癌综合治疗的疗效并分析预后相关因子。
     方法;回顾性调查肿瘤内科近5年收治的3℃例中晚期肝癌病人。将
    本组病例归纳为TACE、TAI、中药介入栓塞、全身化疗、中医辨证中药
    治疗、对症治疗6个治疗因子,通过卡卜兰-迈尔(KaplanMeie*法统计
    分析不同治疗因子的远期疗效;选定25个预后因子,用叼X回归分析作
    多因素统计分析,筛选危险因子及保护因子;为今后临床治疗PLC提供
    参考。
     结果;半年和 1年的累计生存率的比较,中医辨证中药治疗侣7.76
    %vs45。25%,42,12%vsZ.39%,P<0刀5。施加与未施加比较,下同*、
    TACE(89.33% vs 80.95%,64*9% vs 0.31%,P<0.05)、中药介入栓塞
    治疗0入43% VS 55.90%;57、*%VS 31.52%,P<0.0引后相应的累计生
    存率均提高。而TAI(55.56% vs89.76%,18.43% vs44*8%,P<0.05)
    和全身化疗O0.59%。84.28%,0%VS 43.27o,P<0.0幻未能有效提高
    0.5年和1年的累计生存率。
     预后因于经X叫回归分析,中医辨证分型、瘤灶数目、包膜、血清
    AF P水平、肝功能*hMb分级、腹水、远处转移、介入栓塞等因子对累
    计生存率的影响有统计学意义O功刀5人 其中包膜、介入栓塞为保护因
    子,其余为危险因子。介入次数、手术、局部放疗、中医辨证中药治疗亦
     4
    
    为预后保护因子,但无统计学意义0邓刀5人
     结论:TACE、中药介入栓塞及中医辨证中药治疗可提高中晚期PLC
    的累计生存率;TAI和全身化疗并不能提高中晚期PLC累计生存率;合
    理选择多种有效方法可望提高中晚期PLC远期疗效。中医分型、肝功能
    Childb分级、远处转移、腹水、AFP、瘤灶数目均为PLC预后危险因子;
    栓塞治疗、肿瘤包膜、介入次数、手术、局部放疗以及中医辨证中药治疗
    等均为PLC预后保护因子。对于不能手术切除的中晚期PLC病例,选择
    中西药物多次介入栓塞+中医辨证中药治疗,可能是提高远期疗效最好的
    途径之一。
ABSTRACT
    PAR I: 1MPROVED QUALITY-OF-LIFE OF MEDIUM OR LATE
    STAGE LIVER CANCER PATIENTS BY CURCUMA AROMATICA
    OIL (CAO) INTERWNT1ONALTHERAPY
    Objectivc: To study recent therapeutic effects of CAO interventonal therap
    fOr medium or late stage of PLC as well as Quality-of life(QOL) ialluence of
    Primary Liver Cancer (PLC) patients compared with transcatheter ederial
    chemoembolization (TACE).
    Method:70 PLC cases (41 patients) of medium or late Stage were edmly
    divided into CAO grouP (n==36) and TACE grouP(n=34).The CAO grouP wer
    treated with CAO or CAO+Lip iboonal theraPy While the TACE grouP
    were treated with cheInotheraPelltics or chemotheraPeutcs+Lip interventional
    theraPy. The points of QOL wee respectvely measured l-3 days before and 2
    weeks after interventional theraPy according to "Quality of life Scale for
    patiellts of liver cancer .. QOL, AFP, liver fullotion, lddney function,
    hematoPOietic function of marrow and cruor fimction were observed and
    comPared.
    Results: The effective ratCs of the CAO grouP and the TACE grouP are
    respeCtively o% and l4.7l%, and the StCady ndes are resPectively l00% and
    85.29%. There is no statistical diffeence between the two grouPs re=0.054l).
    The alterationS of AFP,ALP, Y -GT,TBIL and RBC are no statistical
    difference bforeen the tWo grouPs after the tfeatInent, While the alterations of
    ALT, AST, WBC, PLT, PT, FIB, Cr and BuN of TACE grOuP are grCater than
    the CAO grouP(P<0.05). According to Binny Logistic Regression, Which
    have positive relation with imProved QOL more than 5% are the Kamofsky
    poinis, the totai QOL poinis, Y -GT, WBC, RBC, PLT and Cr before
    trCdriellt, Y -GT, WBC, RBC, PLT, and Cr after tretheellt: Which have
    negative relation are: AFP, ALT, AST, ALP, rsIL, PT, FIB and BuN before
    trCthellt, the total poinis of QOL, AFP, ALT, AST, ALP, TBIL, PT, FIB and
    BuN after trCtheent.
    ConcIusion: CAO has good antinoplastic effects. The recent therapeotic
    effects of CAO interVenona therapy Wth PLC are similar to TACE. CAO
    does less lesion to liver function, lddney fhaction, hematpoietic function of
    marrow and cruor funCtion, and is safer than TACE. The probable mechanisms
    of CAO imPrving QOL of PLC pati0lls are the anineoplastic effeets and less
    6
    
    
    side-effect tO orgbosm of CAO.
    Kepoords: Cureuma Aromatica Oil(CAO), InterVentional TheraPy, Primary
    Liver Cancer(PLC), Quality of lif0(QOL)
    PART ll: THE OBSERVAION OF THERAPEUTIC EFFECTS AND
    hoYSES OF PsoGNOSIS FACTOas FOR THE
    COMPREHENSIVE TasATMwiT OF MEDIUM OR LATE STAGE
    OF LIrsRCANCca
    ObjeCtive:TO observe and comPare the thprapeutic effects of the
    cHsive trCbe of Meditnn-stage or late-Stage PLC, and analyse the
    prognO5is hars.
    MethOds: 322 PLC cases of mediwn or late stage treated by Medicai
    DePartInent of oncology of Traditional Chinese Medical HosPital of
    GUangdon Provipoe were rthespectivly researched. It 6
    theraPeutic faCtors: TACE, TAI, chemotheraPy, Traditionsl Chinese Medicine
    (TCM) intervene embolism and the diaieGtical Of TCM. The cumulative
    Proportion sUrViving of each theraPeutic factOr was analysed by the
    KaPlan-Meier statistical method. 25 prognosis factors were selected, and were
    analysed by the cox regression method. Then doperous factors and protCctive
    faCtors were screened out, which may offer referece for clinical trCtheent of
    PLC in the for.
    Result: 0.5 and 1 yCar cumulative PropOrtion surviving were rased by the
    dialecticaltreaAnentofTCM (87.76% vs 45.25%, 42.l2% vs 2.39%,
    P<0.05 ), TACE (89.33 % vs 80.95%, 64.09 % vs 0.3l%, P<0.05 ), and TCM
    intervene embolism (95.43 % vs 55.90%, 57.l4% vs 3l.52%, P<0.05 ), but
    nduced byTAI (55.56% vs 89.76%, l8.43% vs44.08%, P<0.05) and
    chemotheraP (70.59% vs 84.28%, 0% vs43.27%, P<0.05).
    25 prognosis faCtrs were analysed by the cox regression method, the
    result shows: the dialectical tyPe TCM, tUmour focus number,theour enveloPe,
    AFP level in serum, the Child's ghe of 1iver boion, ascites, forane
    mbois and lnttwe emboIism effect the curnulative Prop
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