中医药治疗胰腺癌长期带瘤生存的作用及机制 (复旦大学肿瘤医院 刘鲁明20160523)

FUDANUNIVERSITYCANCERHOSPITALQYHJFormula-basedIntegratedHerbsandWesternmedicineTherapyinElderlyPatientswithPancreaticCancerLumingLiuDepartmentofIntegrativeOncologyFudanUniversityCancerHospitalShanghaiChinaFUDANUNIVERISTYCANCERHOSPITALStagedistributionatdiagnosisand5-yearrelativesurvivalrateamongpatientswithpancreaticcancerUS,1996-20032021158872225550510152025LocalizedRegionalDistantAllStagesAllracesWhiteAfricanAmerican778262624525254010203040506070LocalizedRegionalDistantAllracesWhiteAfricanAmerican5-yearrelativesurvivalrateStagedistributionatdiagnosisFromJemal,A.etal.CACancerJClin2008;58:71-96.The4thleadingcauseofcancer-relatedmortalityinU.S.A.FUDANUNIVERISTYCANCERHOSPITALEdwardsBKetal.Annualreporttothenationonthestatusofcancer,1973–1999,featuringimplicationsofageandagingonU.S.cancerburden.Cancer,200241％pancreaticcanceroccursover75yearsold71％pancreaticcanceroccursover65yearsoldFUDANUNIVERISTYCANCERHOSPITALStandardizedIncidenceofcancerinShanghaiCityIncidenceofpancreaticcancerfrom1972-1999increased72.2％inmaleand56.2％infemale，2％orsoincreaseeveryyear.ArapidlyincreasingtrendintheincidenceforPC:the8thand9thformenandwomeninShanghaiLIUJusi,etal.Tumor2004,24(1)11-15caFUDANUNIVERISTYCANCERHOSPITALCharacteristicsinElderlyPatientswithCancers1.Ageingandsickly;2.Cancerprogressionrelativelyslow;3.Cancermetastasisprobablyless;4.Multipleprimarycarcinomaincreasing;5.PoortolerancetoChem&RT（becauseofitslosingphysiologicalfunctioninelderlypatients）FUDANUNIVERISTYCANCERHOSPITALAretrospectivestudyonadvancedpancreaticcancertreatedbyTCMHerbs---Ananalysisof56casesLiuLM,WuLC,LinSY,etal.TherapeuticEvaluationonAdvancedPancreaticCancerTreatedbyIntegrativeChineseandWesternMedicine-ClinicalAnalysisof56Cases.ChinJIntegrativeMed,2003,9(1):39-43.FUDANUNIVERISTYCANCERHOSPITAL56caseswithadvancedpancreaticcancertreatedbychemotherapyaloneorchemotherapycombinedwithTCMdecoctionTheTCM+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±27.54007.5FUDANUNIVERISTYCANCERHOSPITALCase167y,F.Symptomsbeforeoperation:Jaundice,upperabdominalpain;Tumorsize:89cmOperationtime:Oct.8,1997,Tumorunresected1999FENGErbaoNov20047-yearbirthdayFollowupinxinhua（新华）HospitalHangzhouinMarch18，2006111FUDANUNIVERISTYCANCERHOSPITAL232casesfromMay1,2002-Dec.31,2005werereviewed,and134caseswithadvancedpancreaticcancerhadpathologicaldiagnosiswereincludedinthisanalysis(94nopriortreatment,40hadtreatment).Weexcluded98cases(nopathology64,not-provenbypathology16,neuroendocrinecarcinoma2，nomassafterpancreaticoperation7；clinicaldataincomplete4；herbstreatment1month5,stageII10例、stageIII15、stageIV109withremoteM).ARetrospectiveStudyonAdvancedPancreaticCancerTreatedwithIntegratedWesternMedicineandTraditionalChineseherbs:Analysisof134Cases2002-2005ShenYe-hua,LiuLu-ming,MengZhi-qiang,ChenZhen,LinJun-hua,ZhouZhen-hua,ChenHao,WangKun,FuJie,YuEr-xinDepartmentofIntegratedOncology，FudanUniversityCancerHospitalmonth60544842363024181260Survival1.0.8.6.4.20.0SurvivalMedianSurvival5.7monsHalfyrsurvival47.0％1-yrsurvival17.5％2-yrsurvival8.7%3-yrsurvival7.2%FUDANUNIVERISTYCANCERHOSPITAL生存月数60544842363024181260Survival1.0.8.6.4.20.0清胰化积中药非清胰化积中药QYHJHerbsP0.001monsQYHJHerbsOthersHerbsFUDANUNIVERISTYCANCERHOSPITAL20062004200520072008Case2BeforeTreatment2002-7-25AfterTreatment2003-6-6Case3Xingxx;18/07/2002Admission,2010.1.1.Follow-upCase32011FUDANUNIVERISTYCANCERHOSPITALCase4WuJianpingxxF，44yrs,JiangsunativeDiagnoseddata:May2003CT：PCMass10cm，twoloberlivermultimasses，biggestoneis9cm;Case4Liverbiopsy：metastasispoordifferentiatedadenocarcinoma;Treatment:May28,2003:Gemcitabine(1.4g/m2),Oxalipatin(150mg/m2),THP60mg+Lipiodol13mlin1stcycleTAIforlivermetastasis；June25,2003～July23,20033DCRT6MVX-ray3160cGy/20FxforPC;Aug11,2003:Gemcitabine1.4g，Oxalipatin200mg，THP60mg+LP10mlin2ndcycleTAI;HerbstreatmentFUDANUNIVERISTYCANCERHOSPITALJuly31,2003-7-31Aftertreatment——intrahepaticmetastasismassesregression，andmassnotclearMay22,2003BeforeTreatmentFUDANUNIVERISTYCANCERHOSPITALMay2003PCMassBeforetreatmentOct.2003PCmassnotclearJuly2003aftertreatmentPCmassregressionFUDANUNIVERISTYCANCERHOSPITALCase5Yangxxlongsurvivalwithcancerbefore(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:31/12/2009Survives86monsCase5FUDANUNIVERISTYCANCERHOSPITALMultimodalityTreatmentofPancreaticCancerWithLiverMetastasesUsingChemotherapy,RadiationTherapy,and/orChineseHerbalMedicine---Analysisof164CasesHuaqiangOuyang,PengWang,MD,ZhiqiangMeng,MD,ZhenChen,Er’xinYu,HuanJin,DavidZ.Chang,ZhongxingLiao,LorenzoCohen,PhD,andLumingLiuPancreas,2011;40(1):120~126,IF:2.607FUDANUNIVERISTYCANCERHOSPITALRESULTSFUDANUNIVERISTYCANCERHOSPITALFrom200