2016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课件

FUDAN UNIVERSITY CANCER HOSPITAL QYHJ Formula-based Integrated Herbs and Western medicine Therapy in Elderly Elderly PatientsPatients w with ith Pancreatic CancerPancreatic Cancer Luming LiuLuming Liu Department of Integrative Oncology Fudan University Cancer Hospital Shanghai China FUDAN UNIVERISTY CANCER HOSPITAL Stage distribution at diagnosis and 5-year relative survival rate Stage distribution at diagnosis and 5-year relative survival rate among patients with pancreatic cancer US,1996-2003among patients with pancreatic cancer US,1996-2003 5-year relative survival rateStage distribution at diagnosis From Jemal, A. et al. CA Cancer J Clin 2008;58:71-96. The 4th leading cause of cancer-related mortality in U.S.A. FUDAN UNIVERISTY CANCER HOSPITAL Edwards BK et al. Annual report to the nation on the status of Edwards BK et al. Annual report to the nation on the status of cancer, 19731999, featuring implications of age and aging on cancer, 19731999, featuring implications of age and aging on U.S. cancer burden.U.S. cancer burden. Cancer, 2002Cancer, 2002 41pancreatic cancer occurs over 75 years old 71pancreatic cancer occurs over 65 years old FUDAN UNIVERISTY CANCER HOSPITAL StandarStandard dized Incidence of cancer in Shanghai Cityized Incidence of cancer in Shanghai City Incidence of pancreatic cancerIncidence of pancreatic cancer from from1972-1999 increased 72.2 in male and 56.2 in female，2 or so increase every year. A rapidly increasing trend in the incidence for PC: the 8th and 9th for men and women in Shanghai LIU Jusi,et al. Tumor 2004,24(1)11-15 ca FUDAN UNIVERISTY CANCER HOSPITAL Characteristics in Elderly Patients with CancersCharacteristics in Elderly Patients with Cancers 1.Ageing and sickly; 2.Cancer progression relatively slow; 3.Cancer metastasis probably less; 4.Multiple primary carcinoma increasing; 5.Poor tolerance to Chem Symptoms before operation: Jaundice, upper abdominal pain; Tumor size: 8Tumor size: 89cm9cm Operation time: Oct.8,1997 ,Tumor unresectedOperation time: Oct.8,1997 ,Tumor unresected 1999 FENG Erbao Nov 2004 7-year birthday Follow up in xinhua（新华 ） Hospital Hangzhou in March 18，2006 1 1 1 FUDAN UNIVERISTY CANCER HOSPITAL l232 cases from May 1, 2002-Dec. 31, 2005 were reviewed, and 134 cases with advanced pancreatic cancer had pathological diagnosis were included in this analysis (94 no prior treatment, 40 had treatment). lWe excluded 98 cases (no pathology 64, not-proven by pathology 16, neuroendocrine carcinoma 2，no mass after pancreatic operation 7；clinical data incomplete 4； herbs treatment 0.05 GI bleeding Vomit Norsea 3-4. Thrompenia 3-4. Leucopenia ALP AKP Control FUDAN UNIVERISTY CANCER HOSPITAL Prognostic analysis of 190 elderly Prognostic analysis of 190 elderly patients with Pancreatic cancer treated by patients with Pancreatic cancer treated by integrated Herbs and Western medicineintegrated Herbs and Western medicine Pan Y, Liu LM, Chen Z, Meng ZQ, Lin JH, Chen H, Wang K, Shen YH, Zhu XY Chinese J. Clin Hepatol. 2014, (30)4: 330333 FUDAN UNIVERISTY CANCER HOSPITAL 190 elderly pancreatic cancer patients treated 190 elderly pancreatic cancer patients treated by integrated Herbs and Western medicine by integrated Herbs and Western medicine during Jan. ,2002Dec., 2008 .during Jan. ,2002Dec., 2008 . Proved by histopathology 63; cytology 127; Female:126，male:64，average age: 67.935.54（ 6083ys); UICC stage : 52(27.4%)， stage 138 (72.6%) 。 distant metastasis 132 ( 69.5%) FUDAN UNIVERISTY CANCER HOSPITAL survival time of QYHJ formula to TNM-III Pancreatic cancer in elderly patientswith non-surgery FUDAN UNIVERISTY CANCER HOSPITAL survival time of QYHJ formula to TNM-IV Pancreatic cancer in elderly patients with non-surgery FUDAN UNIVERISTY CANCER HOSPITAL ConclusionConclusion For elderly patients with advance pancreatic cancer, it is best to choose QYHJ-based formula without others. FUDAN UNIVERISTY CANCER HOSPITAL lF，41y，Anhui 和县 native; lDiagnosis data: 01/04/2005; lDiagnosis: Panc Ca(CT:02/2005) with liver metastasis(liver boispy:04/2005); lCytology: Adenocarcinoma 6 6 Case 6Case 6 TreatmentTreatment 21/02/2005 CT：Cancer in pancreatic tail with liver M; 11/03/2005 CT：Cancer in pancreatic tail with liver multi-M; 04/04/2005 Liver boipsy:Adenocarcinoma; 05/04/2005 1th liver TACE; 28/04/2005 PC ERT+QYHJ; 03/08/2005 MRI： No mass in pancreas； liver multi-M; 10/08/2005 2th liver TACE; 14/11/2006 3th TACE; 07/07/2007 CT： PR in liver multi-M. 31/12/2009 Survives 59 mons. FUDAN UNIVERISTY CANCER HOSPITAL MRIMR after treatment BeforeBeforeAfter TreatmentAfter Treatment FUDAN UNIVERISTY CANCER HOSPITAL Case 7 Chen xx lM，62y，Helongjiang大 庆 native. lDiagnosis data： 21/03/2003 lDiagnosis：Pancreatic cancer resected（ 09/1999), Pathology: Adenocarcinoma with liver M Liver biopsy（12/2002）： metastatic poor differentiated Adenocarcinoma Stomach Ca resected（ 09/1999), Pathology: Adenocarcinoma FUDAN UNIVERISTY CANCER HOSPITAL TreatmentTreatment 09/1999: Pancreatic cancer resected 12/2002: liver M; 12/2002: Liver biopsy： metastatic poor differentiated Adenocarcinoma; 03/2003: TACE; 04/2003: Oxplatin+5-Fu+CF; 04/2003; TACE; 05/2003: Liver ERT; 12/31/2009: Survives 6- year more. 2003.4.15 FUDAN UNIVERISTY CANCER HOSPITAL Case 8 LinCase 8 Lin lM，53y，Zhejiang 瑞安 RuiAn native lDiagnosis data： 21/03/2005 lDiagnosis ： Panc Ca(CT:03/2005) with liver metastasis(liver boispy:05/2005); lCytology: Liver biopsy (28/03/2005) poor differentiated carcinoma long survival with cancer (March, 2005 now). Dec. 30, 2009: Survives 58 mons Treatment 31/03/2005 1th liver TACE 19/07/2005 3th liver TACE; 28/07/2005 HIFU for pancreatic mass; 12/06/2008 11th liver TACE; 8 8 FUDAN UNIVERISTY CANCER HOSPITAL Case 10 Zhang xxCase 10 Zhang xx lF，51y，Shanghai Native l1st Diagnosis：08/10/2004 lCT：mass in pancreatic head with liver metastasis lLiver biopsy：Adenocarcinoma lFollow up: 16/01/2010. lSurvival time:63 mons. Jan.,2010Jan.,2010 08/10/200416/01/2010 1010 FUDAN UNIVERISTY CANCER HOSPITAL vFewer side-effects and toxicity than western medicine; vTolerated well for extended periods of time; vInexpensive. It is a suitable therapy for Elderly Pancreatic Cancer patients. Summary Advanta