臺灣博碩士論文加值系統

肥大細胞瘤為犬隻中最常見的皮膚腫瘤，約佔所有犬隻皮膚腫瘤16到21%，現今大部份的治療方法為使用合併多種治療方法。在內科治療中，其中一個已被文獻證實有效對抗犬隻肥大細胞瘤的常用藥物為prednisolone，然而，目前尚未有文獻完整評估使用單一prednisolone治療犬隻肥大細胞瘤的臨床療效。本篇研究主要目的即為評估使用單一prednisolone治療犬隻肥大細胞瘤的治療效果，包括整體反應率、中位數反應持續時間、無疾病間隔時間以及治療無效時間。本實驗從2001到2010年總共有67隻狗，整體反應率為65% (38/67)，其中部份消退為25隻、維持穩定疾病為11隻以及完全消退和疾病進展各為1隻，此反應率較先前的化學治療文獻研究(包括單一治療或合併治療藥物)皆為高。在38隻外觀可摸到腫瘤的犬隻中，中位數反應持續時間為39.5天，而中位數治療無效時間為66天；其他27外觀無明顯腫瘤的犬隻中，中位數無疾病間隔時間為54天，而中位數治療無效時間為67天，無論中位數反應持續時間或中位數無疾病間隔時間皆比先前文獻較為短。大致上而言，所有病畜對單一prednisolone治療的副作用皆能良好承受。腫瘤鄰近淋巴結狀態(p=0.04)和治療反應(p=0.013)為影響反應持續時間的重要因子；犬隻品種(p=0.043)為影響無疾病間隔時間的重要因子；至於外觀可摸到腫瘤的犬隻中，無統計上明顯差異的因子影響治療無效時間；但在外觀無明顯腫瘤的犬隻中，犬種(p=0.031)和治療反應(p=0.013)為影響治療無效時間的重要因子。另外在使用單一prednisolone治療與使用合併治療(prednisolone加cyclophosphamide和prednisolone加vinblastine)的治療效果比較中，在反應持續時間和治療無效時間皆無統計上差異性。由於使用單一prednisolone的治療效果為高整體反應率、短暫的反應持續時間和無疾病間隔時間，我們推論在進行大範圍手術切除犬隻肥大細胞瘤之前，為了達到足夠的手術範圍而使用單一prednisolone治療進行縮小腫瘤體積是一個有效的治療方法。然而，如果肥大細胞瘤的犬隻選擇使用化學治療作為長遠的治療方法，使用多重藥物合併治療則較使用單一prednisolone為較建議的治療方法選擇。

Mast cell tumors (MCTs) are the most common cutaneous tumor in dogs, comprising 16-21 % of all cutaneous tumors. The treatment options of canine MCTs nowadays are mostly managed by combination protocols. Among internal medicine management, one commonly used drug is prednisolone, which is proven to have efficacy in treating canine MCTs in previous studies. However, no report to date has completely evaluated the response of single agent regimen of prednisolone as the choice of canine MCTs treatment. The aim of this study is to evaluate clinical response using single agent prednisolone in the treatment of canine MCTs, including overall response rate (ORR), median response duration (MRD), disease free interval (DFI), and time to treatment failure (TFF). 67 cases were collected into this study through 2001 to 2010.ORR was 65%. Of these cases (38/67), 25 was partial remission, 11 was stable disease, and other 2 were complete remission and progressive disease, respectively. It was higher than most previous clinical trials including single and combinational agent therapies. 38 cases had measurable disease, and the MRD was 39.5 days. Median TTF was 66 days. 27 cases (42%) had no measurable disease, and the median DFI was 54 days. Median TTF was 67 days. The MRD and median DFI were obvious shorter than others clinical reports. In general, the side effects of prednisolone treatment were well tolerated in present study. Regional lymph node status (p=0.04) and treatment response (p=0.013) were significant factors of response duration (RD). And breed of dogs was significant predictor of DFI (p=0.043). There were no significant factors for TTF of group that dogs with gross obvious tumors. But breed of dogs (p=0.031) and treatment response (p=0.013) were significant predictors of TTF of group that dogs without gross obvious tumors. There was no statistical difference of RD and TTF neither between the group that dogs treat with single agent prednisolone and the group that dogs treat with combinational prednisolone and cyclophosphamide or the group that dogs treat with single agent prednisolone and the group that dogs treat with combinational prednisolone and vinblastine. Owing to the characteristic of high response rate and short-term response duration and disease free interval in single agent prednisolone protocol, we conclude that it was an effective single regimen used in treat canine MCTs before wide-margin surgery in order to obtain adequate surgical margin. However, if patients of canine MCTs were treated with chemotherapy alone for long time, it had better choose multiple combinational protocols rather than single regimen of prednisolone.

口試委員會審定書 #
誌謝 i
中文摘要 ii
Abstract iv
Contents vi
List of figures viii
List of tables x
Chapter 1 Introduction 1
Chapter 2 Literatures review 3
2.1 The background of the prednisolone 3
2.2 The mechanism of prednisolone acts on canine mast cell tumors 4
2.3 The clinical usefulness of the prednisolone on canine mast cell tumors 6
Chapter 3 Aims 13
Chapter 4 Material and Methods 14
4.1 Patient selection 14
4.2 Initial evaluation 14
4.3 Treatment protocol 15
4.4 Assessment of response 16
4.5 Statistical analysis 18
Chapter 5 Result 20
5.1 Patient characteristics 20
5.2 Tumor details 21
5.3 Response to treatment 22
5.4 Factors evaluation 24
5.5 Compared with other treatment protocol groups 25
Chapter 6 Discussion 27
6.1 Treatment efficacy and side effects of single agent prednisolone 28
6.2 Influenced factors evaluation 31
6.3 Compared of treatment efficacy with other treatment groups 35
6.4 Limitations of this study 37
Chapter 7 Conclusion 40
Figures 42
Tables 57
References 69

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