中医辨证施治结合化疗对中晚期非小细胞肺癌预后因子的影响

目的：观察中医辨证施治结合化疗对中晚期非小细胞肺癌预后因子的影响。方法：将120例中晚期非小细胞肺癌患者随机分为3组。中医组予以中医辨证施治(抗肿瘤中药静脉制剂、消积饮、辨证中药汤剂)、一般支持治疗及对症处理；西医组予以化疗、一般支持治疗及对症处理；中西医组予以中医辨证施治结合化疗、一般支持治疗及对症处理。并通过卡卜兰-迈尔(Kaplan-Meier)法统计分析各组的远期疗效，用COX回归模型多因素分析影响生存率的24个预后因子，筛选危险因素及保护因素。结果：中位生存期中医组为(285．00±17．92)天，西医组为(265．00±1．80)天，两组比较差异无显著性(P>0．05)，中西医组为(359．00±7．00)天，与中医组及西医组比较，差异有显著性(P<0．05)。0．5、1年生存率(％)中医组分别为84．4、18．1；西医组为82．5、20．6；中西医组为92．5、42．7。中西医组与中医组、西医组1年生存率比较，差异均有显著性(P<0．05)。24个预后因子经COX回归模型多因素分析，临床分期、淋巴结受累、并发症、中医证候分类、治疗前Kamofsky评分、乳酸脱氢酶、癌胚抗原、CA199、治疗方式、治疗后生存量表总积分、治疗稳定、CD3^+等因素对生存率的影响，差异均有显著性(P<0．05)；临床分期、淋巴结受累、并发症、中医证候分类、乳酸脱氢酶、癌胚抗原、CA199为中晚期非小细胞肺癌预后危险因子；治疗前Kamofsky评分、治疗方式、治疗后生存量表总积分、治疗稳定、CD3^+为中晚期非小细胞肺癌预后保护因子。结论：中西医结合治疗能延长生存期，提高远期生存率，可作为不宜手术切除的中晚期非小细胞肺癌最佳治疗方法之一。

Effect of Combination of Syndrome Differentiation Depending Treatment and Chemotherapy on Prognostic Factors in Treating Mid-late Patients with Non-small Call Lung Cancer

OBJECTIVE: To observe the effect of combination of Syndrome Differentiation (SD) depending treatment and chemotherapy on prognostic factors in patients with non-small cell lung cancer (NSCLC). METHODS: One hundred and twenty patients with NSCLC were randomly divided into the TCM group, the western medicine (WM) group and the combined TCM and WM (TCM-WM) group. Besides the conventional supporting and symptomatic treatment given to all the 3 groups, to the TCM group, Chinese drug medication according to patients' SD (intravenons injection, decoction or Xiaoji Decoction) was given, to the WM group chemorherapy was given, and to the TCM-WM group, all the treatment used in both TCM and WM group were given. The long-term efficacy was analyzed by Kaplan-Meier method, the 24 prognostic factors that influencing survival rate were analyzed by COX regression model multiple factors analysis to screen the risk factor and protective factor. RESULTS: The median survival period in the TCM group was 285.00 +/- 17.92 days, in the WM group was 265.00 +/- 1.80 days, insignificant difference was found between them (P > 0.05), that in the TCM-WM group was 359.00 +/- 7.00 days, which was longer than that in the above two groups with significance (P < 0.05). The half-year and 1-year survival rates in the TCM group were 84.4% and 18.1%, in the WM group 82.5% and 20.6%, and in the TCM-WM group 92.5% and 42.7%. The 1-year survival rate in the TCM-WM group was higher than that in the TCM and WM group with significant difference (P < 0.05). Analysis on 24 prognostic factors indicated that there was significant difference (P < 0.05) in influence of such factors on survival rate as clinical stage, lymph node invasion, complications, TCM Syndrome typing, lactate dehydrogenase, carcinoembryonic antigen (CEA), CA199, Karnofsky scoring before treatment, therapeutic method, total scores of quality of life, stability of treatment, CD3+, etc. The former seven were the risk factors for prognosis of midlate NSCLC patients, and the latter 5 the protective factors. CONCLUSION: TCM-WM treatment could prolong patients' survival period, elevate the long-term survival rate, it could be taken as one of the best comprehensive therapies for mid-late NSCLC patients who have missed the opportunity of surgical resection.