中醫(yī)藥治療胰腺癌長期帶瘤生存的作用及機制(復旦大學腫瘤醫(yī)院劉魯明20160523)

QYHJFormula-basedIntegratedHerbsandWesternmedicineTherapyinElderlyPatients

with

PancreaticCancerLumingLiu

DepartmentofIntegrativeOncology

FudanUniversityCancerHospitalShanghaiChinaStagedistributionatdiagnosisand5-yearrelativesurvivalrateamongpatientswithpancreaticcancerUS,1996-20035-yearrelativesurvivalrateStagedistributionatdiagnosisFromJemal,A.etal.CACancerJClin2008;58:71-96.The4thleadingcauseofcancer-relatedmortalityinU.S.A.EdwardsBKetal.Annualreporttothenationonthestatusofcancer,1973–1999,featuringimplicationsofageandagingonU.S.cancerburden.

Cancer,200241％pancreaticcanceroccursover75yearsold71％pancreaticcanceroccursover65yearsoldStandardizedIncidenceofcancerinShanghaiCity

Incidenceofpancreaticcancerfrom1972-1999increased72.2％inmaleand56.2％infemale，2％orsoincreaseeveryyear.ArapidlyincreasingtrendintheincidenceforPC:the8thand9thformenandwomeninShanghaiLIUJusi,etal.Tumor2004,24(1)11-15caCharacteristics

in

ElderlyPatientswithCancersAgeingandsickly;Cancerprogressionrelativelyslow;Cancermetastasisprobablyless;Multipleprimarycarcinomaincreasing;PoortolerancetoChem&RT（becauseofitslosingphysiologicalfunctionin

elderlypatients）Aretrospectivestudyon

advancedpancreaticcancertreatedbyTCMHerbs---Ananalysisof56cases

LiuLM,WuLC,LinSY,etal.

TherapeuticEvaluationonAdvancedPancreaticCancerTreatedbyIntegrativeChineseandWesternMedicine-ClinicalAnalysisof56Cases.

ChinJIntegrativeMed,2003,9(1):39-43.

56caseswithadvancedpancreaticcancertreatedbychemotherapyaloneorchemotherapycombinedwithTCMdecoctionTheTCM+CHEMOgrouphadabettersurvivalovertheCHEMOgroup（P＝0.04）TherewasasuperiorityofchemotherapycombinedwithTCMtochemotherapyinobjectiveresponse(p=0.049)andinimprovementofsymptoms(P＝0.002）

Survivalrate(%)Mediansurvival(month)1year2year3year5yearTCM+CHEMO(31)55.37±3.2434.61±16.3125.96±24.6425.96±24.6416.3CHEMO(25)21.95±27.547.31±27.54007.5Case167y,F.

Symptomsbeforeoperation:Jaundice,upperabdominalpain;

Tumorsize:89cm

Operationtime:Oct.8,1997,Tumorunresected1999FENGErbao

Nov2004

7-yearbirthdayFollowup

inxinhua（新華）HospitalHangzhou

inMarch18，2006111232casesfromMay1,2002-Dec.31,2005werereviewed, and134caseswithadvancedpancreaticcancerhadpathologicaldiagnosiswereincludedinthisanalysis(94nopriortreatment,40hadtreatment).Weexcluded98cases(nopathology64,not-provenbypathology16,neuroendocrinecarcinoma2，nomassafterpancreaticoperation7；clinicaldataincomplete4；herbstreatment<1month5,stageII10例、stageIII15、stageIV109

withremoteM).ARetrospectiveStudyonAdvancedPancreaticCancerTreatedwithIntegratedWesternMedicineandTraditionalChineseherbs:Analysisof134Cases2002-2005

ShenYe-hua,LiuLu-ming,MengZhi-qiang,ChenZhen,LinJun-hua,ZhouZhen-hua,ChenHao,WangKun,FuJie,YuEr-xin

DepartmentofIntegratedOncology，F(xiàn)udanUniversityCancerHospitalSurvivalMedianSurvival5.7monsHalfyrsurvival47.0％1-yrsurvival17.5％2-yrsurvival8.7%3-yrsurvival

7.2%QYHJHerbsP<0.001monsQYHJHerbsOthersHerbs20062004200520072008Case2BeforeTreatment

2002-7-25AfterTreatment2003-6-6Case3Xingxx;18/07/2002Admission,2010.1.1.Follow-upCase32011Case4

WuJianpingxxF，44yrs,JiangsunativeDiagnoseddata:May2003CT：PCMass10cm，twoloberlivermultimasses，biggestoneis9cm;Case4Liverbiopsy：metastasispoordifferentiatedadenocarcinoma;Treatment

:May28,2003:Gemcitabine(1.4g/m2),Oxalipatin(150mg/m2),THP60mg+Lipiodol

13mlin1stcycleTAIforlivermetastasis；June25,2003～July23,2003

3DCRT6MVX-ray3160cGy/20FxforPC;Aug11,2003:Gemcitabine1.4g，Oxalipatin200mg，THP60mg+LP10mlin2ndcycleTAI;

HerbstreatmentJuly31,2003-7-31Aftertreatment——intrahepaticmetastasismassesregression，andmassnotclearMay22,2003BeforeTreatment

May2003PCMassBeforetreatmentOct.2003PCmassnotclearJuly2003aftertreatmentPCmassregressionCase5Yangxx

longsurvivalwithcancerbefore(13/10/2004)after(17/04/2008)F，43y，ShanghainativeDiagnoseddata:31/08/2004Diagnosis：PancreaticCawithLM(09/2004),bothlungM(09/2004),post-peritoneumLNm(09/2004),multi-bone(11/2006);Cytology：denocarcinomaFollow-up:31/12/2009Survives86monsCase5MultimodalityTreatmentofPancreaticCancerWithLiverMetastasesUsingChemotherapy,RadiationTherapy,and/orChineseHerbalMedicine

---Analysisof164Cases

Huaqiang

Ouyang,PengWang,MD,Zhiqiang

Meng,MD,ZhenChen,Er’xinYu,HuanJin,DavidZ.Chang,ZhongxingLiao,LorenzoCohen,PhD,andLumingLiuPancreas,2011;40(1):120~126,IF:2.607RESULTSFrom2002to2007,164casesofpancreaticcancerpatientswithlivermetastasisdiagnosedbypathologyQYHJFormulaisindependentprognosticfactors

YESNOmOS5.4m3.9m1yearsurvival21.9%4.8%QingyihuajiFormula（QYHJ）AmorphophallusrivieriDurieu蛇六谷

Oldenlandiadiffusa(Willd)

Roxb白花蛇舌草ScutellariabarbataD.Don半支蓮清熱解毒、利濕消腫、活血止痛為臣AmomumcardamomumL.白豆蔻化濕和胃、行氣寬中為使Gynostemmapentaphyllum(Thunb.)Mak.絞股蘭扶助正氣、清熱解毒為佐Liuetal.ChinJIntegrMed.2005Shenetal.TraditChinMed.2006Shenetal.CJBMTCM.2006Shenetal.ChinaOncology.2006Clinical&experimentalstudyshowedthat:QYHJisoftheeffectsonanti-pancreaticcancer.

Aprospectiverandomizedcontrolled

PhaseIIclinicaltrial

IntegrativetherapyofQYHJ+Gemcitabine-

basedchemotherapyorwith3DCRTforadvancedpancreaticcancer

ShenYehua,LiuLuming,ChenZhen,MengZhiqiang,

LinJunhua,ZhouZhenhua,ChengWenwu,YuErxin,JiangGuoliang.

IntegrativeMedicineProgramofLiver，GallbladderandPancreaticCancer,FudanUniversityCancerHospital

JournalofTraditionalChineseMedicine

2010，51(12)

:1093-1097StudyDesign

PrimaryObjective：Response,MedianSurvival,OverallSurvivalSecondaryobjective：ClinicalBenefits,AdverseEffectsRGEMd1+3DCRTd15+QYHJherbsfor4monsGEMd1+3DCRTd15+Placebofor4monsTAI:Gem1.0g/m2,Oxaplatin135mg/m2orCisplatin40mg/m23DCRT：6MVXray，36～40Gy/1.8～2GyAdvancedPCResearchsubjects(participants)83caseswereenrolledintothisstudyduringMarch,2004~2009;1pathologicdiagnosischanged;2notreatment: 1(QYHJ)obstructivejaundice; 1(Control)bowelobstruction;80receivedtreatmentandincludedinthestudy:QYHJ41cases，control39.ComparisonofControlandQYHJGroupControl(n=39)QYHJ(n=41)PvalueSexM21290.119F1812Age59[42～74]60[41～78]0.950Massofpancreasminus8160.090body,tail3125TumorSize(cm)4.6[1.5～9.0]4.7[1.5～10.0]0.304stageLocaladvanced7120.234metastasis3229KPS＜8015150.863≥802426ComparisonofControlandQYHJGroupTreatControl(n=39)QYHJ(n=41)PvalueGEM-based129290.391TAItimes2109302401ChemodrugsCDDP990.904Oxaplatin3032TACEYes21170.268No1824ERTYes27330.245No128CompletedERTYes20280.121No1913ResponseCRPRSDPDPvalueQYXJ(n=36)0512190.067Control(n=36)001323

Of80,72isvaluableassesment. 5casesarePRinQYHJgroup，noCRorPRincontrol.

Survival

1y%3y%

OS(mo)

QYHJControl5.104.3Lastestfollow-up:nolostonDec.1,2009;3cases(allinQYHJ)stillsurvive.P=0.046GroupControlQYHJAdverseEffectsP>0.05GIbleedingVomitNorsea

3-4.Thrompenia

3-4.LeucopeniaALPAKPControlPrognosticanalysisof190elderlypatientswithPancreaticcancertreatedbyintegratedHerbsandWesternmedicine

PanY,LiuLM,ChenZ,MengZQ,LinJH,ChenH,

WangK,ShenYH,ZhuXY

ChineseJ.Clin

Hepatol.2014,(30)4:330~333190elderlypancreaticcancerpatientstreatedbyintegratedHerbsandWesternmedicineduringJan.,2002~Dec.,2008.

Provedbyhistopathology63;cytology127;

Female:126，male:64，averageage:67.93±5.54（60～83ys);

UICC

stageⅢ:52(27.4%)，stageⅣ138(72.6%)。

distantmetastasis132(69.5%)

survivaltimeofQYHJformulatoTNM-IIIPancreaticcancerinelderlypatientswithnon-surgery

survivaltimeofQYHJformulatoTNM-IVPancreaticcancerinelderlypatientswithnon-surgeryConclusion

Forelderlypatientswithadvancepancreaticcancer,itisbesttochooseQYHJ-basedformulawithoutothers.F，41y，Anhui和縣native;Diagnosisdata:01/04/2005;Diagnosis:PancCa(CT:02/2005)withlivermetastasis(liverboispy:04/2005);Cytology:Adenocarcinoma6Case6Treatment

21/02/2005CT：CancerinpancreatictailwithliverM;11/03/2005CT：Cancerinpancreatictailwithlivermulti-M;04/04/2005Liverboipsy:Adenocarcinoma;05/04/20051thliverTACE;28/04/2005PCERT+QYHJ;03/08/2005MRI：Nomassinpancreas；livermulti-M;10/08/20052thliverTACE;14/11/20063thTACE;07/07/2007CT：PRinlivermulti-M.31/12/2009Survives59mons.MRI——MRaftertreatmentBeforeAfterTreatmentCase7ChenxxM，62y，Helongjiang大慶native.Diagnosisdata：21/03/2003Diagnosis：Pancreaticcancerresected（09/1999),Pathology:AdenocarcinomawithliverMLiverbiopsy（12/2002）：metastaticpoordifferentiatedAdenocarcinomaStomachCaresected（09/1999),Pathology:AdenocarcinomaTreatment09/1999:Pancreaticcancerresected&StomachCaresected;12/2002:liverM;12/2002:Liverbiopsy：metastaticpoordifferentiatedAdenocarcinoma;03/2003:TACE;04/2003:Oxplatin+5-Fu+CF;04/2003;TACE;05/2003:LiverERT;12/31/2009:Survives6-yearmore.2003.4.15

Case8LinM，53y，Zhejiang瑞安RuiAnnativeDiagnosisdata：

21/03/2005Diagnosis

：PancCa(CT:03/2005)withlivermetastasis(liverboispy:05/2005);Cytology:Liverbiopsy(28/03/2005)poordifferentiatedcarcinomalongsurvivalwithcancer(March,2005~now).Dec.30,2009:

Survives58monsTreatment

31