阳和汤对乳腺癌新辅助化疗患者的临床疗效及炎症因子的影响

胡旻昊; 毛若瑜; 张馨月; 李思雨; 沙珊焱; 高超; 王洁琼; 杨雨涵; 林天依; 季亚婕; 薛晓红

doi:10.16306/j.1008-861x.2023.04.001

您当前的位置：

首页 >

文章列表页 >

阳和汤对乳腺癌新辅助化疗患者的临床疗效及炎症因子的影响

临床研究 | 更新时间：2023-08-04

- 阳和汤对乳腺癌新辅助化疗患者的临床疗效及炎症因子的影响
- Clinical efficacy of Yanghe Decoction in patients with breast cancer receiving neo⁃adjuvant chemotherapy and its impact on inflammatory factors
- 上海中医药大学学报 2023年37卷第4期页码：1-8
- 作者机构：
  
  1.上海中医药大学附属岳阳中西医结合医院乳腺病科（上海　200437）
- 作者简介：
  
  胡旻昊，男，硕士，住院医师，主要从事中西医结合治疗乳腺疾病的临床研究
  薛晓红，主任医师、教授，博士生导师；E-mail：xiaohong_xue@126.com
- 基金信息：
  
  国家自然科学基金资助项目(82004446);上海市科委“科技创新行动计划”医学创新研究专项项目(22Y11923000;20Y21901100);上海市申康发展中心促进市级医院临床技能与临床创新能力三年行动计划项目(SHDC2020CR4057);上海中医药大学附属岳阳中西医结合医院薛晓红名医工作室建设项目
- DOI：10.16306/j.1008-861x.2023.04.001
  中图分类号：
扫描看全文
胡旻昊,毛若瑜,张馨月等.阳和汤对乳腺癌新辅助化疗患者的临床疗效及炎症因子的影响[J].上海中医药大学学报,2023,37(04):1-8.

HU Minhao,MAO Ruoyu,ZHANG Xinyue,et al.Clinical efficacy of Yanghe Decoction in patients with breast cancer receiving neo⁃adjuvant chemotherapy and its impact on inflammatory factors[J].Academic Journal of Shanghai University of Traditional Chinese Medicine,2023,37(04):1-8.
胡旻昊,毛若瑜,张馨月等.阳和汤对乳腺癌新辅助化疗患者的临床疗效及炎症因子的影响[J].上海中医药大学学报,2023,37(04):1-8. DOI： 10.16306/j.1008-861x.2023.04.001.

HU Minhao,MAO Ruoyu,ZHANG Xinyue,et al.Clinical efficacy of Yanghe Decoction in patients with breast cancer receiving neo⁃adjuvant chemotherapy and its impact on inflammatory factors[J].Academic Journal of Shanghai University of Traditional Chinese Medicine,2023,37(04):1-8. DOI： 10.16306/j.1008-861x.2023.04.001.

摘要

目的,2,评价阳和汤对乳腺癌新辅助化疗（NAC）患者的临床疗效及对患者炎症因子水平的影响。,方法,2,选择62例经穿刺病理明确为乳腺癌、拟行术前NAC的初治乳腺癌女性患者，随机分为研究组和对照组，每组各31例。研究组患者在常规NAC基础上加用阳和汤口服，对照组患者在常规NAC基础上加用安慰剂口服，中药服用周期跟随NAC周期，治疗时间覆盖患者治疗全周期。评价两组患者的临床疗效及病理化疗反应疗效［包括Miller-Payne（MP）分级和残余肿瘤负荷系统（RCB）等级］；于NAC前、中期及NAC后，检测患者的血清炎症因子水平，包括白介素（IL）-2R、IL-6、IL-8及肿瘤坏死因子-α（TNF-α）；记录NAC期间患者发生的安全性事件及化疗常见不良反应，评价阳和汤应用于NAC的安全性。,结果,2,①研究组患者的客观缓解率（ORR）为90.3%，对照组患者的ORR为87.1%，组间比较差异无统计学意义（,P,>,0.05）；在治疗应答时间（TTR）方面，在NAC前4周期临床疗效达到完全缓解或部分缓解的患者比例研究组为67.7%、对照组为41.9%，组间比较差异有统计学意义（,P,<,0.05）。②治疗后，研究组中MP等级达到G4、G5级者21例（占67.7%），对照组中达到G4、G5级者13例（占41.9%），组间比较差异有统计学意义（,P,<,0.05）。③NAC中及NAC后，研究组患者的IL-6、IL-8水平低于对照组（,P,<,0.05）；NAC后，研究组患者的TNF-α水平低于对照组（,P,<,0.05）。④NAC期间，两组患者均未出现严重安全性事件，两组患者的安全性事件发生率比较，差异无统计学意义（,P,>,0.05）；在不良反应发生情况方面，研究组患者的乏力发生率显著低于对照组（,P,<,0.05）。,结论,2,阳和汤可提高乳腺癌患者NAC期间的肿瘤退缩速度，改善病理化疗反应疗效，降低患者的血清炎症因子水平，改善NAC期间的不良反应，且用药安全。

Abstract

Objective： To evaluate the clinical efficacy of Yanghe Decoction in patients with breast cancer receiving neo-adjuvant chemotherapy （NAC） and its impact on inflammatory factors of the patients.,Methods,2,Sixty-two female patients with breast cancer， confirmed by biopsy， who were scheduled to undergo preoperative NAC for the first time were selected and randomly divided into the study group and control group， 31 cases in each group. The patients in the study group were treated with Yanghe Decoction orally based on routine NAC， and the patients in the control group were treated with placebo orally based on routine NAC. The administration of Chinese medicine followed the NAC cycles， and the treatment duration covered the entire NAC period of the patients. The clinical efficacy and pathological chemotherapy response ［including Miller-Payne （MP） grade and residual cancer burden （RCB） grade） of the two groups were evaluated. Before and after NAC and in the middle of NAC， the levels of serum inflammatory factors including interleukin （IL）-2R， IL-6， IL-8 and tumor necrosis factor-α （TNF-α） were detected. Meanwhile， safety events and common adverse reactions during NAC were recorded in order to evaluate the safety of Yanghe Decoction applied in NAC.,Results,2,①The objective response rate （ORR） was 90.3% in the study group and 87.1% in the control group， with no statistically significant difference between the two groups （,P,>,0.05）. In the aspect of time to response （TTR）， the proportion of patients who achieved complete or partial response in the first 4 cycles of NAC was 67.7% in the study group and was 41.9% in the control group， with statistically significant difference between the two groups （,P,<,0.05）. ②After treatment， 21 patients （67.7%） in the study group reached MP grade 4 or grade 5， and 13 patients （41.9%） in the control group reached MP grade 4 or grade 5， with statistically significant difference between the two groups （,P,<,0.05）. ③In the middle of NAC and after NAC， the levels of IL-6 and IL-8 in the study group were lower than those in the control group （,P,<,0.05）. After NAC， the level of TNF-α in the study group was lower than that in the control group （,P,<,0.05）. ④During NAC， no serious safety events occurred in both groups， and there was no statistically significant difference in the incidence of safety events between the two groups （,P,>,0.05）. In the aspect of the incidence of adverse reactions， the incidence of fatigue in the study group was significantly lower than that in the control group （,P,<,0.05）.,Conclusion,2,Yanghe Decoction can enhance the tumor regression rate during NAC in patients with breast cancer， improve the efficacy of pathological chemotherapy response， reduce the levels of serum inflammatory factors， and improve the adverse reactions during NAC， which was safety.

关键词

乳腺癌阳和汤新辅助化疗炎症因子临床疗效安全性不良反应

Keywords

breast cancerYanghe Decoctionneo-adjuvant chemotherapyinflammatory factorsclinical efficacysafetyadverse reactions

references

CORTAZAR P， ZHANG L， UNTCH M， et al. Pathological complete response and long-term clinical benefit in breast cancer： the CTNeoBC pooled analysis ［J］. Lancet， 2014， 384（9938）： 164-172.

李康乐，彭湃，张欣萌，等. 阳和汤对人乳腺癌MDA-MB-231细胞凋亡的影响［J］. 四川中医，2018， 36（12）： 40-42.

LI K L， PENG P， ZHANG X M，et al. The effect of Yanghe Decoction on apoptosis of MDA-MB-231 breast cancer cells［J］. Sichuan Traditional Chinese Medicine， 2018， 36（12）： 40-42.

叶凯，何芬莉，杨小娟，等. 阳和汤含药血清对乳腺癌干细胞增殖的影响［J］. 国际中医中药杂志，2019， 41（1）： 49-52.

YE K，HE F L， YANG X J， et al. Effect of Yanghe decoction serum on the proliferation of breast cancer stem cells［J］. International Journal of Traditional Chinese Medicine， 2019， 41（1）： 49-52.

李康乐，杨小蒨，张愉，等. 阳和汤对三阴性乳腺癌细胞MDA-MB-231凋亡Egr1/p21信号通路的影响［J］. 中国实验方剂学杂志，2020， 26（8）： 62-67.

LI K L， YANG X Q， ZHANG Y， et al. Effect of Yanghetang on Apoptosis of Triple Negative Breast Cancer Cell Line MDA-MB-231 Based on Egr1/p21 Signaling Pathway［J］. Chinese Journal of Experimental Traditional Medical Formulae， 2020， 26（8）： 62-67.

杨硕，李康乐，朱中博，等. 阳和汤含药血清通过p38/STAT3信号通路对乳腺癌MCF-7细胞凋亡的影响［J］. 中国实验方剂学杂志，2020， 26（5）： 6-10.

YANG S，LI K L，ZHU Z B，et al. Effect of Serum Containing Yanghetang on Apoptosis of MCF-7 Cells in Breast Cancer Through p38/STAT3 Signaling Pathway［J］. Chinese Journal of Experimental Traditional Medical Formulae， 2020， 26（5）： 6-10.

黄芊，张扶莉，李雪莲，等. 阳和汤对人乳腺癌MDA-MB-231细胞增殖、凋亡及其Akt/mTOR信号通路的影响［J］. 陕西中医，2018， 39（11）： 1497-1500.

HUANG Q， ZHANG F L， LI X L， et al. Effect of Yanghe decoction on proliferation， apoptosis and Akt/mTOR signaling pathway in human breast cancer MDA-MB-231 cells［J］. Shaanxi Journal of Traditional Chinese Medicine， 2018， 39（11）： 1497-1500.

黄芊，张扶莉，李雪莲，等. 阳和汤对人乳腺癌MCF-7细胞及其PI3K/Akt信号通路的影响［J］. 四川中医，2019， 37（2）： 47-50.

HUANG Q， ZHANG F L， LI X L， et al. Effect of Yanghe Decoction on Human Breast Cancer MCF-7 Cells and Its PI3K/Akt Signaling Pathway［J］. Sichuan Traditional Chinese Medicine， 2019， 37（2）： 47-50.

黄芊，杨小娟，叶凯，等. 阳和汤对三阴性乳腺癌化疗患者生活质量的影响［J］. 中医临床研究，2019， 11（15）： 80-81.

HUANG Q，YANG X J，YE K，et al. Effect of Yanghe Decoction on Quality of Life in Patients with Triple Negative Breast Cancer Chemotherapy ［J］. Clinical Journal of Chinese Medicine， 2019， 11（15）： 80-81.

黄芊，杨小娟，叶凯，等. 阳和汤对乳腺癌化疗患者免疫功能指标水平的影响［J］. 中医临床研究，2019， 11（6）： 88-90.

HUANG Q， YANG X J， YE K， et al. Effect of Yanghe Decoction on the level of immune function index in patients with breast cancer chemotherapy［J］. Clinical Journal of Chinese Medicine，2019， 11（6）： 88-90.

邵志敏，沈镇宙，徐兵河. 乳腺肿瘤学［M］. 上海：复旦大学出版社，2013.

SHAO Z M， SHEN Z Z， XU B H. Breast Tumorology［M］. Shanghai： Fudan University Press， 2013.

TAN P H，ELLIS I，ALLISON K，et al. The 2019 WHO classification of tumours of the breast［J］. Histopathology， 2020， 77（2）： 181-185.

AMIN M B， EDGE S， GREENE F， et al. AJCC Cancer Staging Manual［M］. 8th ed. NewYork： Springer， 2017.

陆德铭，陆金根. 实用中医外科学［M］. 2版. 上海：上海科学技术出版社，2010.

LU D M， LU J G. Practical Traditional Chinese Medicine Surgery［M］. 2nd ed. Shanghai：Shanghai Scientific & Technical Publishers， 2010.

JIANG Z，SONG E，WANG X，et al. Guidelines of Chinese Society of Clinical Oncology （CSCO） on Diagnosis and Treatment of Breast Cancer （2020 version）［J］. Chin J Cancer Res， 2020， 33（1）： 117-134.

EISENHAUER E A， THERASSE P， BOGAERTS J，et al. New response evaluation criteria in solid tumours： revised RECIST guideline （version 1.1）［J］. Eur J Cancer， 2009， 45（2）： 228-247.

OGSTON K N，MILLER I D，PAYNE S，et al. A new histological grading system to assess response of breast cancers to primary chemotherapy： prognostic significance and survival［J］. Breast，2003， 12（5）： 320-327.

SYMMANS W F，PEINTINGER F，HATZIS C，et al. Measurement of residual breast cancer burden to predict survival after neoadjuvant chemotherapy［J］. J Clin Oncol， 2007， 25（28）： 4414-4422.

MILLER T P， FISHER B T， GETZ K D， et al. Unintended consequences of evolution of the Common Terminology Criteria for Adverse Events［J］. Pediatr Blood Cancer， 2019， 66（7）： e27747.

RASTOGI P， ANDERSON S J， BEAR H D， et al. Preoperative chemotherapy： updates of National Surgical Adjuvant Breast and Bowel Project Protocols B-18 and B-27［J］. J Clin Oncol， 2008， 26（5）： 778-785.

MAMOUNAS E P， CORTAZAR P，ZHANG L，et al. Locoregional recurrence （LRR） after neoadjuvant chemotherapy （NAC）： Pooled-analysis results from the Collaborative Trials in Neoadjuvant Breast Cancer （CTNeoBC）［C］. San Antonio：Breast Cancer Symposium， 2014.

张敏璐，彭鹏，吴春晓，等. 2008—2012年中国肿瘤登记地区女性乳腺癌发病和死亡分析［J］. 中华肿瘤杂志，2019， 41（4）： 315-320.

ZHANG M L， PENG P， WU C X， et al. Report of breast cancer incidence and mortality in China registry regions， 2008-2012［J］. Chinese Journal of Oncology， 2019， 41（4）： 315-320.

窦建卫，黄芊，赵天一，等. 阳和汤对三阴性乳腺癌裸鼠移植瘤生长及IL-6、MMP-9表达的影响［J］.中国现代医药杂志，2016， 18（12）： 1-4.

DOU J W， HUANG Q， ZHAO T Y， et al. Yanghe Decoction's growth inhibition of transplanted tumor in nude mice with triple negative breast cancer and influence on expression of IL-6 and MMP-9［J］. Modern Medicine Journal of China， 2016， 18（12）： 1-4.

SORIA G， OFRI-SHAHAK M， HAAS I， et al. Inflammatory mediators in breast cancer： Coordinated expression of TNF-α & IL-1β with CCL2 & CCL5 and effects on epithelial-to-mesenchymal transition［J］. BMC Cancer， 2011， 11： 130.

WARREN M A ， SHOEMAKER S F， SHEALY D J， et al. Tumor necrosis factor deficiency inhibits mammary tumorigenesis and a tumor necrosis factor neutralizing antibody decreases mammary tumor growth in neu/erbB2 transgenic mice［J］. Mol Cancer Ther，2009， 8（9）： 2655-2663.

YIN Y， CHEN X， SHU Y. Gene expression of the invasive phenotype of TNF-α-treated MCF-7 cells［J］. Biomed Pharmaco-ther， 2009， 63（6）： 421-428.

BURGER R A，GROSEN E A，IOLI G R，et al. Spontaneous release of interleukin-6 by primary cultures of lymphoid and tumor cell populations purified from human ovarian carcinoma［J］. J Interferon Cytokine Res， 1995， 15（3）： 255-260.

SCHROEDER A，HERRMANN A，CHERRYHOLMES G，et al. Loss of androgen receptor expression promotes a stem-like cell phenotype in prostate cancer through STAT3 signaling［J］.Cancer Res， 2014， 74（4）： 1227-1237.

KNÜPFER H， PREISS R. Significance of interleukin-6 （IL-6） in breast cancer［J］. Breast Cancer Res Treat， 2007， 102（2）： 129-135.

ALFARO C， SANMAMED M F， RODRÍGUEZ-RUIZ M E， et al. Interleukin-8 in cancer pathogenesis， treatment and follow-up［J］.Cancer Treat Rev， 2017， 60： 24-31.

DAVID J M， DOMINGUEZ C， HAMILTON D H， et al. The IL-8/IL-8R axis： a double agent in tumor immune resistance［J］.Vaccines （Basel）， 2016， 4（3）： 22.

SANMAMED M F，CARRANZA-RUA O，ALFARO C，et al. Serum interleukin-8 reflects tumor burden and treatment response across malignancies of multiple tissue origins［J］. Clin Cancer Res， 2014， 20（22）： 5697-5707.

KIM H M，AN C S，JUNG K Y，et al. Rehmannia glutinosa inhibits tumour necrosis factor-α and interleukin-1 secretion from mouse astrocytes［J］. Pharmacol Res， 1999， 40（2）： 171-176.

LEE B J，KIM Y J，CHO D H，et al. Immunomodulatory effect of water extract of cinnamon on anti-CD3-induced cytokine responses and p38， JNK， ERK1/2， and STAT4 activation［J］. Immunopharmacol Immunotoxicol， 2011， 33（4）： 714-722.

吴圣曦，吴国欣，何珊，等. 白芥子挥发油对小鼠肝癌H22移植性肿瘤的抑制作用及其机制研究［J］.中草药，2013， 44（21）： 3024-3029.

WU S X， WU G X， HE S，et al. Antitumor effect of volatile oil from Sinapis Albae Semen on H22-bearing mice and its mechanism［J］. Chinese Traditional and Herbal Drugs， 2013， 44（21）： 3024-3029.

浏览量

下载量

CSCD

CNKI被引量

文章被引用时，请邮件提醒。

提交

工具集

关联资源

鹿角壮督汤治疗强直性脊柱炎的临床观察

肾衰乙方治疗慢性肾脏病4期合并慢性心力衰竭的临床观察

基于CiteSpace的针刺疗法在乳腺癌中应用的可视化分析

从乳腺癌不同分子分型谈中医药研究策略

括约肌间引流术治疗肛周脓肿的临床观察