| 摘要: | 傳統中藥，是常被用於治療乳癌患者的輔助另類療法之一，然而，傳統中藥對於乳癌病患的臨床作用，尤其是乳癌患者最關心的存活方面之影響，仍然缺乏大規模的臨床研究來驗證。
本研究使用臺灣全民健康保險研究資料庫，對於2001年至2010年間的晚期乳癌患者，進行的回溯性世代研究。研究對象分為傳統中藥使用者與非傳統中藥使用者兩組;並採用Cox regression model來分析使用傳統中藥與病患存活之間的相關性。此外，本研究也探討使用傳統中藥對於全身性感染、各項嚴重併發症、止痛藥物使用及醫療利用之影響。
本研究的對象包含729位接受Taxanes治療的晚期乳癌病患，這些患者的平均年齡為52.0歲，其中有115位是傳統中藥使用者，另614位則為非傳統中藥使用者。所有研究對象的平均追蹤時間為2.8年，在10年的追蹤期間當中，有277位患者死亡。多變項分析的結果顯示，與非傳統中藥使用者相比較，傳統中藥的使用與降低全死因死亡率(All-cause mortality)有顯著相關，使用傳統中藥30天至180天的患者之Adjusted hazard ratio是0.55 (95% CI, 0.33-0.90)，而使用傳統中藥大於180天患者的Adjusted hazard ratio是0.46 (95% CI, 0.27-0.78)。進一步分析，115位傳統中藥使用者所用的中藥處方，最常被乳癌患者使用的傳統中藥依序為加味逍遙散、蒲公英及白花蛇舌草。除了對於存活率的影響之外，本研究結果也顯示，使用傳統中藥有助於降低全身性感染率、止痛藥物使用量與病患住院天數。
本觀察性研究結果顯示，傳統中藥輔助治療，可能會降低晚期乳癌患者死亡與全身性感染的風險，並且減少止痛藥物的使用及住院天數。不過，仍需進一步的前瞻型臨床研究來驗證這項發現。
Traditional Chinese medicine (TCM) is one of the most common complementary and alternative medicines employed in the treatment of breast cancer patients. However, the clinical evidences of TCM in large scale studies on survival, which is the major concern for breast cancer patients are still lacking.
This study used the Taiwan National Health Insurance Research Database (NHIRD) to conduct a retrospective population-based cohort study of advanced breast cancer patients between 2001 and 2010. The patients were separated into TCM user and nonuser groups, and Cox regression models were applied to determine the association between the use of TCM and patient survival. In addition, this study investigated the effects on systemic infection, severe complications, analgesic usage, and health care utilization when using TCM in this specific population.
Total of 729 advanced breast cancer patients receiving taxanes were included in this study, 115 TCM users and 614 TCM nonusers with the mean age of 52.0 years. The mean time of follow-up was 2.8 years, with 277 deaths during the 10-year period. Multivariate analysis demonstrated that, compared with nonusers, the use of TCM was associated with a significantly decreased risk of all-cause mortality (adjusted hazard ratio [HR], 0.55 [95% CI, 0.33–0.90] for TCM use for 30-180 days; adjusted HR, 0.46 [95% CI, 0.27–0.78] for use more than 180 days). Further analysis in 115 TCM users, the most frequent TCMs used by breast cancer patients were Jia Wei Xiao Yao San, Pu Gong Ying, and Bai Hua She She Cao. In addition, the results showed that the use of TCM would reduce systemic infection, analgesic usage, and the length of hospitalization for these cancer patients.
Adjunctive TCM therapy with taxanes may lower the risk of death and systemic infection in advanced breast cancer patients. It could also reduce analgesic usage and the length of hospitalization among these patients. Future randomized controlled trials are still needed to validate these findings. |
