中医药治疗晚期非小细胞肺癌的回顾性研究

目的:评价中医药治疗对晚期非小细胞肺癌(NSCLC)生存率的疗效,探索影响晚期NSCLC预后的相关因素,为中西医结合个体化治疗晚期NSCLC的诊疗方案提供参考依据。方法:采用回顾性研究方法,整理连续性住院的609例晚期NSCLC患者的临床资料,分别从人口学资料、肿瘤特征、治疗方法三个方面进行影响因素的采集。运用寿命表法统计患者的1年、2年及3年生存率及中位生存期(MST);运用Kaplan-Meier计算进行单因素分析,经Log-rank法检验将有意义的因素纳入Cox回归模型进行多因素分析,筛选出晚期NSCLC的预后相关因素。结果:609例晚期NSCLC患者的中位生存期为25.1个月,1年、2年、3年生存率分别为71.7%、50.0%及32.8%。单因素分析结果显示,性别、年龄、吸烟指数、病理类型、中医辨证分型、PS评分、艾灸治疗、中药静脉疗程、靶向治疗时机、综合治疗方式为预后相关因素(P0.05);多因素分析结果显示,吸烟指数、病理类型、PS评分、中药静脉疗程、综合治疗方式是预后的独立因素。结论:长期辨证中医药治疗能有效延长晚期NSCLC的生存期;多疗程的中药静脉制剂、艾灸治疗能使患者获益,延长生存期;晚期NSCLC的最佳治疗模式是以中医药贯穿始终的多学科综合治疗;晚期NSCLC患者中不吸烟是预后的保护因素;晚期NSCLC病理类型中以腺癌预后较好。

Retrospectively Study of Traditional Chinese Medicine in the Treatment of Advanced Non-small Cell Lung Cancer

  Objective:To evaluate the efficacy of traditional Chinese medicine therapy on the survival rate of advanced non-small cell lung cancer(NSCLC)and explore the prognostic factors of advanced NSCLC,and provide reference for the individualized diagnosis and treatment plan of integrated Chinese and western medicine in the treatment of advanced NSCLC.   Methods: By retrospectively study,the clinical data of 609 patients with advanced NSCLC who were continuously hospitalized were sorted out,and the influencing factors were collected from demographic data,tumor characteristics and treatment methods respectively. The 1-year,2-year and 3-year survival rates and median survival time (MST) were calculated by life table method. The single factor analysis was performed by Kaplan-Meier calculation,and after Log-rank test the significant factors were included into the Cox regression model for multivariate analysis,and then the prognostic factors of advanced NSCLC were screened out.   Results: The median survival time of 609 patients with advanced NSCLC was 25.1 months,the 1-year,2-year and 3-year survival rates were 71.7%,50.0% and 32.8%,respectively.The results of single factor analysis showed that,the prognostic factors included gender,age,smoking index,pathological types,TCM syndrome differentiation,performance status(PS)score,moxibustion therapy,intravenous treatment course of Chinese medicine,target treatment timing and comprehensive treatment methods(P<0.05). The results of multivariate analysis showed that,the smoking index,pathological types,PS score,intravenous treatment course of Chinese medicine and comprehensive treatment methods were independent prognostic factors.   Conclusion: Long-term syndrome differentiation and treatment of traditional Chinese medicine can effectively prolong the survival of patients with advanced NSCLC. The multi-courses therapy of Chinese medicine intravenous preparation and moxibustion can benefit the patients and prolong the survival time. The best treatment mode for advanced NSCLC is multidisciplinary comprehensive treatment based on traditional Chinese medicine throughout the whole course.Non-smoking is the prognostic protective factor in advanced NSCLC patients,and the adenocarcinoma in pathological type of advanced NSCLC shows the better prognosis.