A Clinical Research On Integrated Traditional Chinese And Western Medicine For The Treatment Of Pancreatic Cancer With Liver Metastasis

IntroductionPancreatic cancer is one of the malignant cancers with poor prognosis,with the overall 5 year survival no more than 5%and there has been a increasing trend in the incidence of pancreatic cancer.The overall 5 year survival is no more than 2%with the median survival time of 3～4 months for metastasis pancreatic cancer.Liver metastasis is the major reason leading to poor prognosis of pancreatic cancer and it was reported that about 50%pancreatic cancer had liver metastasis on diagnosis. Pancreatic cancer with liver metastasis can not be treated by radical surgical resection. Resistance of pancreatic caner with liver metastasis to conventional chemotherapy and radiation leads to a very dismal prognosis.Former researches indicated that traditional Chinese medicine(TCM) was of some advantages in treating pancreatic cancer with liver metastasis patients.Our former researches also indicated that TCM could improve quanlity of life and prolong survival,So our researches attracted the intresting at home and abroad.Therefore integrated traditional Chinese and western medicine(ITCWM) in treating pancreatic cancer with liver metastasis is being emphasized by clinical oncologist and it warrants the further investigation.ObjectivesWe aimed to understand the affections to the treatment and prognosis of integrated traditional Chinese and western medicine(ITCWM) in treating pancreatic cancer with liver metastasis through retrospective clinical studies,and to define the clinical value of transcatheter arterial chemoembolization(TACE) mainly in ITCWM for the management of pancreatic cancer with liver metastasis.Materials and Methods1.Kaplan-Meier method was used to calculate the survival and Log-rank test was used to compare the differences between groups.A multifactorial Cox proportional hazard model analysis was introduced to examine the prognostic factors in 127 pancreatic cancer with liver metastasis patients treated by ITCWM.According to these prognostic factors which had statistics significance,we established prognostic PI index equation.2.Kaplan-Meier method was used to calculate the survival and Log-rank test was used to compare the differences between groups.A multifactorial Cox proportional hazard model analysis was introduced to examine the prognostic factors of 110 pancreatic cancer with liver metastasis patients treated mainly by TACE of ITCWM.Results1.The retrospective study on 127 pancreatic cancer with liver metastasis patients who received ITCWM showed an median survival time of 4.7 months and overall half, 1,3 and 5 year survival of 35.43%,14.96%,5.15%and 3.43%.Multivariate analysis disclosed the correlation of survival with KPS＜80,serum CA199＞1000 U/ml, chemotherapy(include by artiry and vein) and QYHJ decoction(P＜0.05).Prognostic index PI=0.666X₁+0.488X₄-0.866X₈-0.879X9 was established according these factors.With the increasing of PI,the survival time showed a tendency of decline (P＜0.05).The median survival time and overall 1,3 year survival of 46 patients treated by TACE and radiotherapy for pancreatic lesions and QYHJ decoction were 5.4 months and 26.09%,9.78%.While the median survival time and overall 1,3 year survival of 81 patients treated by other modalities were 4.4 months and 8.64%,0%(P =0.005).And the median survival time and overall 1,3 year survival of 21 patients treated by no less than four kinds of modalities were 7.3 months and 33.33%,17.14%, which obviously better than patients treated by less than four kinds of modalities.The survival time became longer when the kinds of modality increased(P=0.000).2.The retrospective study on 110 pancreatic cancer with liver metastasis patients who received TACE mianly of ITCWM showed the median survival time of 5.0 months and overall half,1,3 and 5 year survival of 37.27%,15.45%,5.31%and 3.54%.Multivariate analysis disclosed the correlation of survival with KPS＜80 and CA199≥1000 U/ml,radiotherapy for pancreatic lesions,QYHJ decoction treatment (P＜0.05).The median survival time and overall 1,3 year survival of 10 patients treated by no less than 3 times of TACE were 11.8 months and 50.00%,40.00%,and which were 6.2 months and 17.24%,0%of 29 patients treated by 2 times of TACE and 4.3 months and 9.86%,0%of 71 patients treated by 1 times of TACE.The survival of patients treated by TACE for no less than 3 times is better than for 2 times, 1 times(P＜0.05). Conclusions1.KPS＜80 and tumor marker CA199＞1000 U/ml may be negative prognostic factors for patients with pancreatic cancer with liver metastasis after treatment. While application of chemotherapy and QYHJ herbal decoction may be the important protective factors to achieve a good survival.2.TACE and radiotherapy for pancreatic lesions and QYHJ decoction treatment may be an important integrated traditional chinese and western medicine treatment mode to prolong the survival of pancreatic cancer with liver metastasis patients.The survival became longer when the kinds of modality increased.3.Radiotherapy for pancreatic lesions or QYHJ decoction treatment may be the important protective factors to achieve a good survival for pancreatic cancer with liver metastasis patients treated by TACE.KPS＜80 and tumor marker CA199＞1000 U/ml may be negative prognostic factors for patients treated by TACE.4.The survival of pancreatic cancer with liver metastasis patients in ITCWM treated by TACE for no less than 3 times is better than for 2 times,1 times,which indicated that patients fit for TACE could be treated by TACE more times and would have better effect.