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。

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/m²，分2～3 d静脉滴注，联合吉西他滨1 000 mg/m²或长春瑞滨25 mg/m²，第1、8天静脉滴注，每3周重复；联合组(35例)：顺铂60～75 mg/m²，分2～3 d静脉滴注，联合吉西他滨800 mg/m²或长春瑞滨20 mg/m²，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χ²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。

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(χ²＝0.226，P＝0.634)。

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。

To compare the therapeutic effect and adverse effect between the platinum-containing adequate dose chemotherapy and reduced dose chemotherapy combined with elemene in elderly patients with recurrent and metastatic breast cancer.

The 72 elderly patients with recurrent and metastatic 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 complete follow-up data. They were divided into conventional chemotherapy group (n=37) and combined chemotherapy group (n=35). Patients in conventional chemotherapy group were treated with cisplatin 75 mg/m² applied in 2-3 days and gemcitabine 1000 mg/m² or vinorelbine 25 mg/m² applied on days 1 and 8, one cycle every 3 weeks. Patients in combined chemotherapy group were treated with cisplatin 60-75 mg/ m² applied in 2-3 days 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 mg/d, 2 weeks as a course of treatment. The short-term and long-term efficacy, adverse reaction and quality of life in two groups were analyzed. χ² test was used for group comparison and rank sum test was used for rank data comparison. Survival analysis was conducted using Kaplan-Meier and Log-rank methods.

The proportions of patients with complete response (CR), partial response (PR), stable disease (SD) and progressive disease (PD) were 10.81% (4/37), 37.84% (14/37), 24.32% (9/37) and 27.03 % (10/37) in conventional chemotherapy group, 11.43% (4/35), 34.28% (12/35), 22.86% (8/35) and 31.43% (11/35) in combined chemotherapy group, respectively, indicating no significant difference (Z=-0.289, P=0.773). The incidence of leukopenia in combined chemotherapy group was significantly lower than that in conventional chemotherapy group [45.71%(16/35) vs 70.27%(26/37), Z=-2.025, P=0.043]. Adverse reactions in digestive system were mainly nausea and vomiting, observed in 36 cases (97.30%) of conventional chemotherapy group and 28 cases (80.00%) of combined chemotherapy group, indicating a significant difference (Z=-2.080, P=0.038). There were no significant differences in the incidence of other adverse reaction 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; liver function impairment: 29.73% vs 25.71%, Z=-0.265, P=0.791). There was no significant difference in quality of life between two groups (Z=-1.760, P=0.078). The median survival of conventional chemotherapy group and combined chemotherapy group was 8.9 and 6.5 months respectively, indicating no significant difference (χ²=0.226, P=0.634).

For elderly patients with recurrent and metastatic breast cancer, platinum-containing reduced dose chemotherapy combined with elemene has beneficial therapeutic effect similar to adequate dose chemotherapy, with higher safety.