中医辨证综合治疗对ⅢB/Ⅳ期非小细胞肺癌疗效的影响
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摘要
研究背景:肺癌是目前世界上恶性肿瘤死亡的主要原因,发病率和死亡率呈上升趋势。其中约80%为非小细胞肺癌(NSCLC),而在NSCLC患者中,有近70%的患者在确诊时己经是晚期(ⅢB-Ⅳ期)。现代医学对ⅢB、Ⅳ期等晚期NSCLC的治疗都是姑息性的,化疗是最主要的手段,在综合治疗中占有较重要的地位。现以铂类药物为基础的联合化疗方案是晚期NSCLC的标准化疗方案,尤其是紫杉醇(TAX),长春瑞宾(NVB)、吉西他宾(GEM)、紫杉特尔(DOC)等第三代化疗药物的问世,以及羟基喜树碱(CPT)、培美曲塞等新药的出现,使得晚期NSCLC的药物疗效进一步提高。而易瑞沙、特罗凯等分子靶向药物的问世为肺癌的治疗提供了新的方向。但长期以来,化疗对NSCLC的治疗结果并不令人满意。非细胞毒性药物的研究逐渐引起了人们的重视,中医药作为我国传统的方法,对晚期肺癌的疗效研究有重要意义。
研究目的:探讨中药干预治疗ⅢB/Ⅳ期非小细胞肺癌(NSCLC)的优越性和优势环节。
研究方法:对中西医结合治疗的150例与单纯西医治疗的120例晚期NSCLC患者进行回顾调查,按照两组患者住院病历如实填写由研究者统一设计制定的《中晚期非小细胞肺癌患者回顾性研究调查表》,其内容主要包括患者所用化疗方案(包括疗程完成情况)以及治疗效果(包括近期和远期疗效指标)。另外,中西医结合组还需记录所用中药静脉制剂、口服中成药的名称、用法及用量;所用中药汤剂的立法及方剂等情况。全部数据结果采用SPSS13.0统计软件进行分析。根据计数计量资料的不同,选择合适的检验方法。
研究结果:中西医结合组和单纯西医组分别纳入150例和120例病人,治疗前对两组性别、年龄、卡氏评分均进行比较,其中年龄及卡氏评分单纯西医组稍占优。在年龄与体质状况均不占优势的情况下,两组病例完全缓解(CR)+部分缓解(PR)+稳定(NC)中西医结合组与单纯西医组相似(P＞0.05),但中西医结合组肿瘤控制率有高于单纯西医组趋势,中位生存期与疾病进展时间相近(P＞0.05),远期疗效相当。卡氏评分在治疗前后比较,中西医结合组优于单纯西医组,提示中西医结合组在改善生活质量方面占优。
研究结论:中西医结合治疗晚期非小细胞肺癌在稳定病灶、改善临床症状、改善生存质量、延长生存时间等方面显示出一定优势。在中晚期非小细胞肺癌的治疗中,中西医结合应为未来的一种发展方向,尤其是改善患者生存质量方面。
Background:Lung cancer,included 80 percent of non-small cell lung cancer (NSCLC),is currently the world's cancer the leading cause of death and on the rise.in NSCLC patients,nearly 70 percent of the patients at the time of diagnosis has been advanced(HIB-Ⅳstage).The therapy of Modern medicine onⅢB-Ⅳstage,is palliative,one of which the most important is chemotherapy playing in the integrated treatment of a important position.Is to platinum-based drug combined with chemotherapy is the standard chemotherapy in advanced stage,especially the third generation of chemotherapy drugs available,Such as Taxol(TAX),vinorelbine(NVB),gemcitabine(GEM), docetaxel(DOC),HCPT(CPT),and Alimta,which makes further improve the efficacy of the drug.Iressa and tarceva as the advent of molecular targeted drugs for the treatment of lung cancer provides a new direction.But a long time,chemotherapy for the treatment of NSCLC result is not satisfactory. Non-cytotoxic drug research gradually attracted people's attention, traditional Chinese medicine as a therapy of advanced lung cancer research is important.
Objective:To explore the superiority and its links of treatment of Chinese drugs for advanced non-small-cell lung cancer(NSCLC).
Methods:Restrospective research of 150 cases of advanced NSCLC treated with integrated treatment of Chinese medicine and western medicine and 120 cases with simple western medicine were carried out,according to two groups of patients with medical records truthfully filled out a unified design developed by researchers of the "advanced non-small cell lung cancer patients retrospective study questionnaire" Its contents include used by chemotherapy patients(including the completion of treatment)and treatment(including the near-and long-term effect indicators).In addition,the combination of Chinese and Western Medicine Group also recorded by intravenous preparation of Chinese medicine,oral proprietary Chinese medicine of the name,dosage and usage; decoction of Chinese medicine used by the legislative and prescriptions,and so on.Results of all the data used SPSS13.0 statistical software for analysis. According to count the different measurement data,choose the appropriate test methods.
Results:Integrative Medicine in the group and the group were purely Western medicine into 150 cases and 120 patients,treatment before the two groups by gender,KPS,were to compare age and the KPS slightly dominant group only Western medicine.In the age and physical condition not in a dominant situation, there is no significant difference in cases of the complete relief(CR)plus partial relief(PR)and no-change(NC),the median survival duration and the time to progression(TTP)in both groups(P＞0.05),but on the tumor control the group f integrated treatment of Chinese and western medicine is with a higher rate higher.KPS and the situation in weight before and after treatment,the combined group of the integrated treatment of Chinese and Western Medicine is better than the simple Western medicine group,prompted in Integrative Medicine Group in improving the quality of life advantage.
Conclusion:The integrated treatment of Chinese and western medicine for advanced non- small cell lung cancer has a certain superiority in stabilizing foci and quality of life,improving clinical symptoms,and prolonging lifetime and so on.In advanced non-small cell lung cancer treatment,combining Chinese and Western Medicine for a future development direction,and in particular to improve the quality of life of patients with respect.
研究目的:探讨中药干预治疗ⅢB/Ⅳ期非小细胞肺癌(NSCLC)的优越性和优势环节。
研究方法:对中西医结合治疗的150例与单纯西医治疗的120例晚期NSCLC患者进行回顾调查,按照两组患者住院病历如实填写由研究者统一设计制定的《中晚期非小细胞肺癌患者回顾性研究调查表》,其内容主要包括患者所用化疗方案(包括疗程完成情况)以及治疗效果(包括近期和远期疗效指标)。另外,中西医结合组还需记录所用中药静脉制剂、口服中成药的名称、用法及用量;所用中药汤剂的立法及方剂等情况。全部数据结果采用SPSS13.0统计软件进行分析。根据计数计量资料的不同,选择合适的检验方法。
研究结果:中西医结合组和单纯西医组分别纳入150例和120例病人,治疗前对两组性别、年龄、卡氏评分均进行比较,其中年龄及卡氏评分单纯西医组稍占优。在年龄与体质状况均不占优势的情况下,两组病例完全缓解(CR)+部分缓解(PR)+稳定(NC)中西医结合组与单纯西医组相似(P＞0.05),但中西医结合组肿瘤控制率有高于单纯西医组趋势,中位生存期与疾病进展时间相近(P＞0.05),远期疗效相当。卡氏评分在治疗前后比较,中西医结合组优于单纯西医组,提示中西医结合组在改善生活质量方面占优。
研究结论:中西医结合治疗晚期非小细胞肺癌在稳定病灶、改善临床症状、改善生存质量、延长生存时间等方面显示出一定优势。在中晚期非小细胞肺癌的治疗中,中西医结合应为未来的一种发展方向,尤其是改善患者生存质量方面。
Background:Lung cancer,included 80 percent of non-small cell lung cancer (NSCLC),is currently the world's cancer the leading cause of death and on the rise.in NSCLC patients,nearly 70 percent of the patients at the time of diagnosis has been advanced(HIB-Ⅳstage).The therapy of Modern medicine onⅢB-Ⅳstage,is palliative,one of which the most important is chemotherapy playing in the integrated treatment of a important position.Is to platinum-based drug combined with chemotherapy is the standard chemotherapy in advanced stage,especially the third generation of chemotherapy drugs available,Such as Taxol(TAX),vinorelbine(NVB),gemcitabine(GEM), docetaxel(DOC),HCPT(CPT),and Alimta,which makes further improve the efficacy of the drug.Iressa and tarceva as the advent of molecular targeted drugs for the treatment of lung cancer provides a new direction.But a long time,chemotherapy for the treatment of NSCLC result is not satisfactory. Non-cytotoxic drug research gradually attracted people's attention, traditional Chinese medicine as a therapy of advanced lung cancer research is important.
Objective:To explore the superiority and its links of treatment of Chinese drugs for advanced non-small-cell lung cancer(NSCLC).
Methods:Restrospective research of 150 cases of advanced NSCLC treated with integrated treatment of Chinese medicine and western medicine and 120 cases with simple western medicine were carried out,according to two groups of patients with medical records truthfully filled out a unified design developed by researchers of the "advanced non-small cell lung cancer patients retrospective study questionnaire" Its contents include used by chemotherapy patients(including the completion of treatment)and treatment(including the near-and long-term effect indicators).In addition,the combination of Chinese and Western Medicine Group also recorded by intravenous preparation of Chinese medicine,oral proprietary Chinese medicine of the name,dosage and usage; decoction of Chinese medicine used by the legislative and prescriptions,and so on.Results of all the data used SPSS13.0 statistical software for analysis. According to count the different measurement data,choose the appropriate test methods.
Results:Integrative Medicine in the group and the group were purely Western medicine into 150 cases and 120 patients,treatment before the two groups by gender,KPS,were to compare age and the KPS slightly dominant group only Western medicine.In the age and physical condition not in a dominant situation, there is no significant difference in cases of the complete relief(CR)plus partial relief(PR)and no-change(NC),the median survival duration and the time to progression(TTP)in both groups(P＞0.05),but on the tumor control the group f integrated treatment of Chinese and western medicine is with a higher rate higher.KPS and the situation in weight before and after treatment,the combined group of the integrated treatment of Chinese and Western Medicine is better than the simple Western medicine group,prompted in Integrative Medicine Group in improving the quality of life advantage.
Conclusion:The integrated treatment of Chinese and western medicine for advanced non- small cell lung cancer has a certain superiority in stabilizing foci and quality of life,improving clinical symptoms,and prolonging lifetime and so on.In advanced non-small cell lung cancer treatment,combining Chinese and Western Medicine for a future development direction,and in particular to improve the quality of life of patients with respect.
引文
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[2]孙燕等.中国肺癌杂志.2003;3:404-405.
[3]裘法祖.外科学2003版一前沿与争论1:363
[4]RiveraM P,DetterbeckF c,LoomisDP.Diagnosis and Treatment of Lung Cancer.2001,edl.Philadelphia,PA,Saunders,25-44
[5]吴一龙.国外医学肿瘤学分册.1998;25,353-356
[6]NSCLCCG(1995)BMJ3 11,899-909
[7]Thomgprasert S.Lung cancer and quality of life[J].Auxt NZ J Med,1998;28:397-399.
[8]Anderson H,Hopwood P,Stephens RJ,et al.Gemcitabine plus best supportive care(BSC)vs BSC in inoperable nun-small-cell lung -a randomized trial with quality of life as the primary outcome.UK NSCLC Gemcitabine Group.Non-Small-Cell Lung Cancer.Br J Cancer,2000;83:447453.
[9]Shepherd FA,Dancey J,Ramlau R,et al.Prospective randomized trial of docetaxel versus best supportive care in patients with non-small-cell lung cancer previously treated with platinum-based chemotherapy.J Clin Oncol,2000;18:2095-2103.
[10]Ranson M,Davidson N,Nicolson M,et aL.Randomized trial of paclitaxel plus supportive care versus supportive care for patients with advanced non-small-cell lung cancer.J Natl Cancer Inst,2000;92:1074-1080.
[11]Schiller J H,Harrington D,Belani CP,et al.Comparison of four chemotherapy regimens for advanced non-small-cell lung cancer.N End J Med,2002;346:92-98.
[12]Fossella F,Pereira JR,von Pawel J,et al.Randomized,multinational,phase Ⅲ study of docetaxel plus platinum combinations versus vinorelbine plus cisplatin for advanced non-small-cell lung cancer:the TAX 326 study group.J Clin Oncol,2003;21:3016-3024.
[13]Smith IE,Brient ME,Talbot DC,et al.Duration of chemotherapy in advanced non-small-cell lung cancer:a randomized trial of three versus six courses of mitomycin,vinblastine,and cisplatin.J Clin Oncol,2001;19:1336-1343.
[14]SocinskiMA,Schell MJ,et al.phase Ⅲ trail comparing a defined duration of therapy versus continuous therapy followed by second-line therapy in advanced stage Ⅲb/Ⅳ non-small-cell lung cancer.J Clin Oncol,2002;20(5):1335-1343.
[15]Oeorgoulias V,Papadakis E,Alexopoulos A,et al.platinum-based and non-platinum-based chemotherapy in advanced non-small-cell lung cancer:a randomized muticentre trial.Lancet,2001;357:1478-1484.
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