早期应用双膦酸盐在晚期恶性肿瘤治疗中的作用

目的]探讨早期静脉应用双膦酸盐在晚期恶性肿瘤治疗中的作用。方法]128例晚期恶性肿瘤患者分为两组：早期应用双膦酸盐（确诊骨转移之前应用）患者64例为治疗组;未早期应用者64例为对照组。比较双膦酸盐治疗前后VAS疼痛评分和Karnofsky评分以及两组骨转移发生率及确诊时间。结果]双膦酸盐治疗前后VAS疼痛评分为8.10±1.13,3.10±1.27（t=24.96,P〈0.01）;Karnofsky评分为57.00±7.80,69.00±8.60（t=8.77,P〈0.05）。治疗组骨转移发生率26.56%（17/64）,对照组59.37%（38/64）,差异有统计学意义（χ2=14.06,P〈0.01）;治疗组中位骨转移发生时间较对照组延迟3个月（7个月vs 4个月）,差异有统计学意义（P=0.038）。结论]早期应用双膦酸盐治疗晚期恶性肿瘤,能够明显改善生活质量、减轻疼痛;可以减少骨转移发生率,并推迟骨转移发生时间。

The Role of Early Application of Bisphosphonates in the Treatment for Advanced Cancer

Purpose ] To investigate the role of early intravenous bisphosphonate in the treatment for advanced cancer. Methods ] One hundred and twenty-eight cases with advanced cancer were divided into two groups：64 patients as treatment group,with application of bisphosphonate before the diagnosis of bone metastases ,which was defined as early use ;64 patients as control group ,without early use of bisphosphonate. VAS pain score, Karnofsky score and bone mineral density were compared before and after bisphosphonate treatment;bone metastasis incidence and time to diagnosis were compared in the two groups. Results] VAS pain score before and after bisphosphonate treatment was 8.10±1.13 and 3.10±1.27 respectively （t=24.96,P〈0.01）; Karnofsky score,57.00±7.80 and 69.00±8.60 respectively （t=8.77,P〈0.05）. The incidence of bone metastasis was 26.56%（17/64） in treatment group,and 59.37%（38/64） in the control group （X2=14.06,P〈0.01）;the median time to diagnosis of bone metastases was delayed for 3 months compared that to control group （7m vs 4m）,with significant difference （P=0.038）. Conclusion] Early application of bisphosphonate in the treatment for advanced cancer may significantly improve the quality of life ,reduce pain, reduce the incidence of bone metastases and postpone the occurrence of bone metastasis