榄香烯在老年复发、转移性乳腺癌铂类联合化疗中的应用

Elemene combined with platinum-containing chemotherapy in elderly patients with recurrent and metastatic breast cancer

目的对比含铂方案足量化疗与减量化疗联合榄香烯在老年复发、转移性乳腺癌患者中的疗效及不良反应。方法回顾性分析2009年12月至2015年6月在大连医科大学附属第一、第二医院诊治具有完整随访资料的72例老年复发、转移性乳腺浸润性导管癌患者的临床资料。按治疗方法分为常规组(37例):顺铂75 mg/m^2,分2~3 d静脉滴注,联合吉西他滨1 000 mg/m^2或长春瑞滨25 mg/m^2,第1、8天静脉滴注,每3周重复;联合组(35例):顺铂60~75 mg/m^2,分2~3 d静脉滴注,联合吉西他滨800 mg/m^2或长春瑞滨20 mg/m^2,第1、8天静脉滴注,每3周重复,同时注射榄香烯400 mg/d,2周为1个疗程。分析2组患者的近期及远期疗效、不良反应及生活质量差异。组间例数比较用χ~2检验,等级资料比较采用秩和检验,生存分析采用Kaplan-Meier和Log-rank法。结果常规组患者完全缓解(CR)率为10.81%(4/37)、部分缓解(PR)率为37.84%(14/37)、病情稳定(SD)率为24.32%(9/37)、病情进展(PD)率为27.03%(10/37),联合组CR率为11.43%(4/35)、PR率为34.28%(12/35)、SD率为22.86%(8/35)、PD率为31.43%(11/35),2组差异无统计学意义(Z=-0.289,P=0.773)。联合组白细胞减少的发生率低于常规组[45.71%(16/35)比70.27%(26/37),Z=-2.025,P=0.043]。消化道不良反应主要是恶心、呕吐,常规组和联合组发生率分别为97.30%(36/37)和80.00%(28/35),差异有统计学意义(Z=-2.080,P=0.038)。其他不良反应的发生率,常规组与联合组比较,差异均无统计学意义(血小板减少:35.14%比20.00%,Z=-1.425,P=0.154;贫血:35.14%比37.14%,Z=-0.066,P=0.947;肝功能损害:29.73%比25.71%,Z=-0.265,P=0.791)。2组患者生活质量差异无统计学意义(Z=-1.760,P=0.078)。常规组、联合组中位无进展生存时间分别为8.9、6.5个月,差异无统计学意义(χ~2=0.226,P=0.634)。结论老年复发、转移性乳腺癌患者减量化疗联合榄香烯治疗,与常规足量化疗疗效相近,安全性更佳。

Objective To compare the therapeutic effect and adverse effect between the platinumcontainingadequate dose chemotherapy and reduced dose chemotherapy combined with elemene in elderlypatients with recurrent and metastatic breast cancer. Methods The 72 elderly patients with recurrent andmetastatic breast invasive ductal carcinoma in the First and Second Affiliated Hospitals of Dalian Medical University from December 2009 to June 2015 were involved in a retrospective study. All the cases had completefollow-up data. They were divided into conventional chemotherapy group （ n = 37） and combined chemotherapygroup （ n = 35）. Patients in conventional chemotherapy group were treated with cisplatin 75 mg/m2 applied in 23days and gemcitabine 1000 mg/m2 or vinorelbine 25 mg/m2 applied on days 1 and 8 , one cycle every3 weeks. Patients in combined chemotherapy group were treated with cisplatin 60-75 m ^ m2 applied in 2 3days and gemcitabine 800 mg/m2 or vinorelbine 20 mg/m2 on days 1 and 8 , one cycle every 3 weeks.Patients in combined chemotherapy group were also injected with elemene 400 m g/d, 2 weeks as a course oftreatment. The short-term and long-term efficacy, adverse reaction and quality of life in two groups wereanalyzed. 字 test was used for group comparison and rank sum test was used for rank data comparison. Survivalanalysis was conducted using Kaplan-Meier and Log-rank methods. Results The proportions of patients withcomplete response （C R ）, partial response （ P R ） , stable disease （SD） and progressive disease （PD ） were10. 81% （4/37 ） ,37. 84% （14/37 ） ,24. 32% （9/37 ） and 27. 03 % （10/37 ） in conventional chemotherapygroup,11. 43% （ 4/35 ） , 34. 28% （ 12/35 ） , 22. 86% （ 8/35 ） and 31. 43% （ 11/35 ） in combinedchemotherapy group, respectively, indicating no significant difference （ Z = - 0. 289, P = 0.773 ）. Theincidence of leukopenia in combined chemotherapy group was significantly lower than that in conventionalchemotherapy group [45. 71% （16/35 ） vs 70. 27% （26/37 ） ,Z = -2. 025, P = 0. 043 ]. Adverse reactions indigestive system were mainly nausea and vomiting, observed in 36 cases （ 97.30% ） of conventionalchemotherapy group and 28 cases （80.00% ） of combined chemotherapy group, indicating a significantdifference （ Z = -2. 080,P = 0. 038 ） . There were no significant differences in the incidence of other adversereaction between conventional chemotherapy group and combined chemotherapy group （thrombocytopenia：35. 14% vs 20. 00% ,Z = -1. 425,P = 0. 154; anemia： 35. 14% vs 37. 14% ,Z = -0. 066,P = 0. 947; liverfunction impairment： 29. 73% vs 25. 71% ,Z = -0. 265,P = 0. 791 ） . There was no significant difference inquality of life between two groups （ Z = - 1.760,P = 0. 078 ）. The median survival of conventionalchemotherapy group and combined chemotherapy group was 8.9 and 6.5 months respectively, indicating nosignificant difference （ 字2 =0. 226,P = 0. 634） . Conclusion For elderly patients with recurrent and metastaticbreast cancer, platinum-containing reduced dose chemotherapy combined with elemene has beneficialtherapeutic effect similar to adequate dose chemotherapy, with higher safety.