中医药辅助治疗600例老年非小细胞肺癌患者的生存分析
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摘要
目的探讨影响老年非小细胞肺癌(NSCLC)患者预后的相关因素。方法回顾性研究上海中医药大学附属龙华医院600例接受中医药治疗年龄≥65岁的老年NSCLC患者的临床资料,建立病例报告表并采集患者信息,统计患者1、2、3、5年生存率并计算中位生存期(MST),对患者信息进行单因素分析;经单因素分析有意义的因素纳入COX回归模型进行多因素分析,筛选出影响老年NSCLC预后的因素。结果600例老年NSCLC患者的MST为26. 80个月(0. 53～192. 40个月),其中Ⅰ期、Ⅱ期、ⅢA期、ⅢB-Ⅳ期的MST分别为103. 00、 82. 00、 71. 27、 20. 77个月。1、 2、 3、 5年生存率分别为74. 13%、 53. 75%、40. 02%、26. 77%。单因素分析显示,吸烟史、病理类型、临床分期、PS评分、中医证型、手术、化疗、中药静脉制剂疗程、中医药治疗干预持续时间为预后相关因素。多因素分析显示,PS评分、手术、中医药治疗干预持续时间是影响老年NSCLC预后的独立保护因素。结论手术治疗是延长老年NSCLC患者生存期的重要手段;诊断时PS评分越低,生存期越长;中医药治疗持续时间越长,患者生存期越长。
Objective To explore the factors that influence the prognosis of elderly patients with non-small cell lung cancer( NSCLC). Methods The clinical data of 600 elderly NSCLC patients aged 65 years or older and treated by traditional Chinese medicine( TCM) in Longhua Hospital,Shanghai University of Traditional Chinese Medicine was reviewed to establish a case report form and to collect patient information,Patient's survival rates of 1,2,3,5 year and the median survival( MST) were calculated,and the patient information was analyzed by single factor analysis. Factors that were meaningful by single factor analysis were included in the COX regression model for multivariate analysis,and factors affecting the prognosis of elderly NSCLC were screened. Results MST of 600 elderly patients with NSCLC was 26. 80 months( 0. 53 months to 192. 40 months),and the MST of phase Ⅰ,Ⅱ,ⅢA and ⅢB-Ⅳpatients were 103. 00 months,82. 00 months,71. 27 months and 20. 77 months respectively. Survival rates of 1,2,3,and 5 years were 74. 13%,53. 75%,40. 02% and 26. 77% respectively. Single factor analysis showed that smoking history,pathological type,clinical stage,PS score,TCM syndrome type,surgery,chemotherapy,treatment courses of TCM intravenous preparation and duration of TCM treatment were prognostic factors. Multi-factor analysis showed that PS score,surgery,duration of TCM treatment were independent protective factors affecting the prognosis of elderly patients with NSCLC. Conclusion Surgical treatment is an important means to prolong the survival of elderly patients with NSCLC. The lower the PS score at diagnosis,the longer the survival period. The longer the duration of TCM treatment,the longer the patients will survival.
Objective To explore the factors that influence the prognosis of elderly patients with non-small cell lung cancer( NSCLC). Methods The clinical data of 600 elderly NSCLC patients aged 65 years or older and treated by traditional Chinese medicine( TCM) in Longhua Hospital,Shanghai University of Traditional Chinese Medicine was reviewed to establish a case report form and to collect patient information,Patient's survival rates of 1,2,3,5 year and the median survival( MST) were calculated,and the patient information was analyzed by single factor analysis. Factors that were meaningful by single factor analysis were included in the COX regression model for multivariate analysis,and factors affecting the prognosis of elderly NSCLC were screened. Results MST of 600 elderly patients with NSCLC was 26. 80 months( 0. 53 months to 192. 40 months),and the MST of phase Ⅰ,Ⅱ,ⅢA and ⅢB-Ⅳpatients were 103. 00 months,82. 00 months,71. 27 months and 20. 77 months respectively. Survival rates of 1,2,3,and 5 years were 74. 13%,53. 75%,40. 02% and 26. 77% respectively. Single factor analysis showed that smoking history,pathological type,clinical stage,PS score,TCM syndrome type,surgery,chemotherapy,treatment courses of TCM intravenous preparation and duration of TCM treatment were prognostic factors. Multi-factor analysis showed that PS score,surgery,duration of TCM treatment were independent protective factors affecting the prognosis of elderly patients with NSCLC. Conclusion Surgical treatment is an important means to prolong the survival of elderly patients with NSCLC. The lower the PS score at diagnosis,the longer the survival period. The longer the duration of TCM treatment,the longer the patients will survival.
引文
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[14]毕经旺,王宝成,刘欣,等.益气养阴清热解毒方剂联合化疗治疗晚期NSCLC疗效分析[J].山东医药,2010,50(14):82-83.
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[16]FORREST LM,MCMILLAN DC,MCARDLE CS,et al.A prospective longitudinal study of performance status,an inflammation-based score(GPS)and survival in patients with inoperable non-small-cell lung cancer[J]. Br J Cancer,2005,92(10):1834-1836.
[17]ARTI HURRIA MD,KRIS MG. Management of lung cancer in older adults[J]. CA Cancer J Clin,2010,53(6):325-341.
[18]刘苓霜,姜怡,沈丽萍,等.中医药干预老年晚期非小细胞肺癌患者的生存研究[J].上海中医药大学学报,2011,25(6):26-29.
[19]夏玉婷,刘苓霜,姜怡,等.中医药治疗晚期非小细胞肺癌的生存相关因素分析[J].上海中医药大学学报,2013,27(5):24-29.
[20]DALWADI SM,SZEJA SS,BERNICKER EH,et al.Practice patterns and outcomes in elderly stageⅠnon-smallcell lung cancer:a 2004 to 2012 SEER analysis[J]. Clin Lung Cancer,2017,19(2):e269-e276.
[21]ZHANG L,GAO S,HE J. The role of maintenance therapy in the treatment of elderly non-small-cell lung cancer patients:a meta-analysis of randomized controlled trials[J]. Drug Des Devel Ther,2017,11:3435-3440. doi:10. 2147/DDDT. S145025.
[2]HERBST RS,HEYMACH JV,LIPPMAN SM. Lung cancer[J]. N Engl J Med,2008,359(13):1367-1380.
[3]张明云,张菁华,李兴德,等.老年肺癌流行病学及临床治疗现状[J].现代肿瘤学,2010,18(12):2505-2507.
[4]韦静妮,程雄飞,周福详,等. 150例老年非小细胞肺癌临床特点与预后因素分析[J].武汉大学学报(医学版),2013,34(3):372-376.
[5]中国抗癌协会.新编常见恶性肿瘤诊治规范(合订本)[M].北京:中国协和医科大学出版社,1999:773-781.
[6]郑筱萸.中药新药临床研究指导原则(试行)[M].北京:中国医药科技出版社,2002:219.
[7]周彩存. NCCN 2008年非小细胞肺癌临床实践指南更新[J].肿瘤,2008,28(3):183-186.
[8]OKEN MM,CREECH RH,TORMEY DC,et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group[J]. Am J Clin Oncol,1982,5(6):649-655.
[9]孙振球,徐勇勇.医学统计学[M]. 4版.北京:人民卫生出版社,2014:288-289.
[10]方积乾,陆盈.现代医学统计学[M].北京:人民卫生出版社,2002:536-537.
[11]LO LC,CHEN CY,CHEN ST,et al. Therapeutic efficacy of traditional Chinese medicine,Shen-Mai San in cancer patients under going chemotherapy or radiotherapy:study protocol for a randomized,double-blind,placebo-controlled trial[J]. Trials,2012,3(13):232-237.
[12]徐振晔,龚亚斌.未来10余年肺癌中西医诊疗展望[J].上海中医药大学学报,2011,25(1):10-14.
[13]郭勇.非小细胞肺癌的中医中药治疗[J].浙江中西医结合杂志,2003,13(9):529-530.
[14]毕经旺,王宝成,刘欣,等.益气养阴清热解毒方剂联合化疗治疗晚期NSCLC疗效分析[J].山东医药,2010,50(14):82-83.
[15]叶林军.益气养阴方联合化疗治疗中晚期非小细胞肺癌31例临床观察[J].中国中医药科技,2011,18(6):529-530.
[16]FORREST LM,MCMILLAN DC,MCARDLE CS,et al.A prospective longitudinal study of performance status,an inflammation-based score(GPS)and survival in patients with inoperable non-small-cell lung cancer[J]. Br J Cancer,2005,92(10):1834-1836.
[17]ARTI HURRIA MD,KRIS MG. Management of lung cancer in older adults[J]. CA Cancer J Clin,2010,53(6):325-341.
[18]刘苓霜,姜怡,沈丽萍,等.中医药干预老年晚期非小细胞肺癌患者的生存研究[J].上海中医药大学学报,2011,25(6):26-29.
[19]夏玉婷,刘苓霜,姜怡,等.中医药治疗晚期非小细胞肺癌的生存相关因素分析[J].上海中医药大学学报,2013,27(5):24-29.
[20]DALWADI SM,SZEJA SS,BERNICKER EH,et al.Practice patterns and outcomes in elderly stageⅠnon-smallcell lung cancer:a 2004 to 2012 SEER analysis[J]. Clin Lung Cancer,2017,19(2):e269-e276.
[21]ZHANG L,GAO S,HE J. The role of maintenance therapy in the treatment of elderly non-small-cell lung cancer patients:a meta-analysis of randomized controlled trials[J]. Drug Des Devel Ther,2017,11:3435-3440. doi:10. 2147/DDDT. S145025.
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