乳腺癌术后高危人群复发转移影响因素及中医治疗评价

Influencing Factors of Recurrence and Metastasis for Postoperative Breast Cancer High-risk Population and Evaluation on TCM Therapy

目的观察乳腺癌术后高危人群复发转移的影响因素,并应用中医辨证论治方案干预,观察其降低复发转移率的有效性。方法对178例激素受体阳性乳腺癌术后高危人群复发转移影响因素进行分析,比较中西医结合队列(中医辨证论治+内分泌治疗)与西医队列(内分泌治疗)的复发转移、无病生存情况及中医症状积分。结果淋巴结转移情况、肿瘤分期、是否接受中医辨证治疗3个因素对乳腺癌术后高危患者的无病生存率有影响,是否服用中药是影响无病生存期的独立预后因素。与西医队列比较,中西医结合队列3年复发转移率明显减少,差异有统计学意义(P=0.03)。两队列的中医临床症状总积分在治疗3个月及6个月时均明显下降,接受中医辨证治疗的队列改善程度更大。中医治疗对于心烦易怒及烘热汗出的疗效显著,自汗及失眠的疗效次之,口干口苦及神疲乏力的改善情况欠佳。结论淋巴结转移情况、肿瘤分期、是否接受中医辨证治疗是影响乳腺癌术后复发转移的主要因素。中医辨证治疗可降低3年复发转移率,明显改善中医症状,尤其对心烦易怒及烘热汗出的疗效更为显著。

Objective To observe the influencing factors of recurrence and metastasis for postoperative breast cancer high-risk population, and TCM regimen of syndrome differentiation and treatment was used to validate its significance for the prevention of recurrence and metastasis. Methods The influencing factors of recurrence and metastasis of 178 postoperative breast cancer high-risk cases with positive hormone receptor were studied. The recurrence and metastasis, disease-free survival and accumulative points of TCM symptoms of integrated group （with TCM syndrome differentiation and endocrine therapy） and western medicine group （with endocrine therapy） were compared. Results Lymph node metastasis, cancer staging and TCM therapy had influence on the disease-free survival rate of postoperative breast cancer high-risk patients. TCM therapy was the independent prognostic factor for disease-flee survival. 3-year recurrence and metastasis rate was lower in integrated group than that in western medicine group, with statistical difference （P=0.03）. The total accumulative points of TCM symptoms in both two groups decreased after treated for 3 and 6 months, integrated group showed greater significance. TCM therapy was better for the treatment of irritability, hot flash and perspiration, good for spontaneous perspiration and insomnia, but poor in dry mouth, bitter taste in mouth and fatigue. Conclusion Lymph node metastasis, cancer staging and TCM therapy are main influencing factors for recurrence and metastasis. TCM therapy with regimen of syndrome differentiation and treatment can reduce 3-year recurrence and metastasis rate, improve TCM symptoms, especially is significant for the improvement of irritability, hot flash and perspiration.