基于生存分析的清胰化积方干预晚期胰腺癌预后相关因素研究  

Research on prognostic factors in advanced pancreatic cancer treated by “Qingyi Huaji Formula”based on survival analysis

作　　者：高惠峰[1,2] 陈颢[1,2] 冯兰云[1,2] 王鹏[1,2] 王琨[1,2] 林钧华[1,2] 陈震[1,2] 孟志强[1,2] 刘鲁明[1,2] 

机构地区：[1]复旦大学附属肿瘤医院中西医结合科,上海200032 [2]复旦大学上海医学院肿瘤学系,上海200032

出　　处：《上海中医药杂志》2014年第6期28-33,共6页Shanghai Journal of Traditional Chinese Medicine

摘　　要：目的分析接受以清胰化积方等中西医综合治疗的晚期胰腺癌患者的预后相关因素,为晚期胰腺癌综合治疗方案的制定提供参考依据。方法采用历史性前瞻研究方法,纳入454例晚期胰腺癌患者的临床资料,进行回顾性信息采集。运用SPSS16.0统计软件建立数据库,并采用寿命表法统计患者的1、2、3、5年生存率;采用Kaplan-Meier法计算中位生存期,并进行单因素分析,差异经Log-rank检验进行组间比较;经单因素分析有意义的因素纳入COX回归模型进行多因素分析,筛选出晚期胰腺癌的预后相关因素。结果①454例晚期胰腺癌患者的总中位生存期为6.7个月,其中清胰化积组的中位生存期为7.6个月,非清胰化积组的中位生存期为5.4个月,两组比较差异有统计学意义(P<0.05)。清胰化积组1、2、3、5年生存率分别为29.60%、12.46%、9.35%、5.92%,非清胰化积组1、2、3、5年生存率分别为13.53%、5.26%、3.01%、0.00%,两组生存率比较差异有统计学意义(P<0.05)。②单因素分析结果显示,肝转移、治疗前KPS评分、治疗前CA19-9、治疗前GGT、血糖异常、腹水、疼痛、消瘦、清胰化积中药、胰腺局部放疗为预后相关因素(P<0.05)。③多因素分析结果显示,肝转移、治疗前KPS<80、CA19-9≥500 mg/L、GGT≥110 U/L、血糖异常、腹水、疼痛和消瘦(体重减轻≥10%)为影响晚期胰腺癌患者生存时间的危险因素,而清胰化积中药和胰腺局部放疗是影响晚期胰腺癌预后的独立保护因素。结论①清胰化积方在延长晚期胰腺癌患者的生存期方面明显优于非清胰化积中药;②清胰化积方、胰腺局部放疗可降低晚期胰腺癌患者的死亡风险,使患者生存获益;③以清胰化积方为基础的中西医综合治疗模式在晚期胰腺癌治疗中切实有效,值得进一步推广。Objective To analyze the prognostic factors in patients with advanced pancreatic cancer treated by integrated Chinese and western medicine mainly with ＂Qingyi Huaji Formula＂, and to provide references for the treatment. Methods By historical prospective study method, we collected 454 advanced pancreatic cancer patients＇ clinical data retrospectively. SPSS 16.0 was used to build database and life table method was used to calculate the survival rate of 1,2, 3, and 5 years. Kaplan-Meier method was used to calculate the survival and Log-rank test was used to compare the differences between two groups. A multifactorial Cox proportional hazard model analysis was introduced to examine the prognostic factor in patients with advanced pancreatic cancer. Results ①The median survival time of 454 patients with advanced pancreatic cancer was 6.7 months. In ＂Qingyi Huaji Formula＂ group, the median survival time was 7.6 months and was 5.4 months in non- ＂Qingyi Huaji Formula＂ group, with significant differences between the two groups （P 〈 0.05 ）. In ＂Qingyi Huaji Formula＂ group, the survival rate of 1, 2, 3, and 5 years.was 29.60%, 12.46%, 9.35% and 5.92% respectively. In the control group, the survival rate of 1, 2, 3, and 5 years was 13.53 %, 5.26%, 3.01% and 0.00% respectively, with significant differences between the two groups （ P 〈 0.05 ）. ②Single-factor analysis showed that liver metastases, KPS, CA19-9, GGT, glucose abnormal, ascites, pain, weight loss, QYHJ formula and pancreatic radiotherapy were prognostic factors （P 〈 0.20）. ③ Multi-factor analysis showed that liver metastases, KPS 〈 80, CA19-9 I〉500 mg/L, GGT≥110 U/L, glucose abnormal, ascites, pain and weight loss≥10% were risk factors and QYHJ formula and pancreatic radiotherapy were independent protective factors. Conclusion ①Comparing with non-QYHJ formula, QYi4J formula has an advantage in prolonging survival of patients with advanced pancreatic cancer. ②QYHJ formula and pancreatic radiotherapy reduce the de

关 键 词：胰腺癌 晚期 清胰化积方 胰腺局部放疗 生存分析 预后因素 

分 类 号：R735.9[医药卫生—肿瘤]