72例乳腺癌患者化疗失败后个体化治疗的远期疗效及预后影响因素  

Long-term results of personalized treatment in 72 breast cancer patients who failed chemotherapy

作　　者：聂冬[1] 尤庆山[1] 栾谨微[1] 李洋[1] 李香兰[1] 郭汝涛[1] 张莉萍[1] 吴静[1] 

机构地区：[1]哈尔滨医科大学附属肿瘤医院放疗科,150081

出　　处：《中华肿瘤杂志》2013年第12期941-945,共5页Chinese Journal of Oncology

摘　　要：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，非浸滑I生导管癌、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t〉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。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 muhidisciplinary 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 I〉 gO, 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 I〉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.

关 键 词：乳腺肿瘤 治疗失败 中草药 预后 

分 类 号：R737.9[医药卫生—肿瘤]