基于生存分析的胃肠安方辨证治疗对不可切除性结直肠癌肝转移预后影响的双向队列研究

发布时间：2017-12-30 18:37

本文关键词：基于生存分析的胃肠安方辨证治疗对不可切除性结直肠癌肝转移预后影响的双向队列研究　出处：《上海中医药杂志》2017年01期 　论文类型：期刊论文

【摘要】：目的观察中药胃肠安方辨证治疗对不可切除性结直肠癌肝转移患者总生存期(overall survival,OS)和无进展生存期(progression free survival,PFS)的影响。方法收集131例不可切除性结直肠癌肝转移患者的临床资料,采用双向队列同期对照方法,将其分为中西医结合组(65例)与西医组(66例)。运用Microsoft Excel及SPSS 21.0软件建立数据库,采用寿命表法统计患者的1、2、3、4、5年生存率;采用Kaplan-Meier法计算中位OS及PFS,并进行单因素分析,差异经Log-rank检验进行组间比较;将经单因素分析有统计学意义的因素纳入Cox回归模型进行多因素分析,筛选出不可切除性结直肠癌肝转移患者的预后相关因素。结果 (1)西医组中位OS为18.5个月,中西医结合组中位OS为23.2个月,两组中位OS比较差异有统计学意义(P=0.0060.05)。(2)西医组与中西医结合组的1、2、3、4、5年生存率分别为69.7%vs 87.2%、33.3%vs47.4%、14.5%vs28.4%、1.3%vs23.7%、0%vs 0%,提示中西医结合组5年内的生存率明显优于西医组(P0.05)。(3)影响本病患者OS的独立保护因素是原发灶切除(P=0.003)、化疗(P=0.000)、中药辨证治疗(P=0.004);原发灶切除的风险比为0.433(95%CI:0.251~0.748),化疗的风险比为0.148(95%CI:0.060~0.365),服用中药的风险比为0.532(95%CI:0.347~0.816)。(4)西医组中位PFS为6.1个月,中西医结合组中位PFS为9.2个月,两组中位PFS比较差异有统计学意义(P=0.0490.05)。(5)影响本病患者PFS的独立保护因素是原发灶切除(P=0.022)、肝转移灶局部治疗(P=0.020);原发灶切除的风险比为0.466(95%CI:0.242~0.895),肝转移灶局部治疗的风险比为0.576(95%CI:0.362~0.918)。结论胃肠安方为主的中医药辨证治疗是改善不可切除性结直肠癌肝转移预后的有效保护性因子;中西医结合治疗在延长不可切除性结直肠癌肝转移OS和PFS方面均显示出一定的优势。
[Abstract]:Objective to observe the effect of traditional Chinese medicine Weichangan recipe on the total survival time of patients with liver metastases from unresectable colorectal cancer (unresectable colorectal cancer). OS and progression free survival. Methods the clinical data of 131 patients with liver metastases from unresectable colorectal cancer were collected. It was divided into two groups: 65 cases of integrated traditional Chinese and western medicine group and 66 cases of western medicine group. The database was established by Microsoft Excel and SPSS 21.0 software. The 4- and 5-year survival rates of 1, 2, 3 and 5 years were calculated by life table method. The median OS and PFSs were calculated by Kaplan-Meier method, and the single factor analysis was carried out. The differences were compared by Log-rank test. Univariate analysis of the statistical significance of factors into the Cox regression model for multivariate analysis. The prognostic factors of non-resectable colorectal cancer patients with liver metastasis were screened. Results 1) the median OS was 18.5 months in western medicine group and 23.2 months in integrated traditional Chinese and western medicine group. The difference of median OS between the two groups was statistically significant (P < 0.0060.05).) the difference between the western medicine group and the integrated traditional Chinese and western medicine group was 1 / 2 / 3 / 4. The 5-year survival rate was 69.7 vs 87.2 and 33.3Vs47.4and 14.5vs28.4and 1.3vs23.70.It was lower than that of 33.3 vs 0%. The results suggest that the survival rate in the integrated TCM group is significantly better than that in the Western medicine group (P0.05A. 3) the independent protective factor for OS in the patients with this disease is primary resection of the lesion (P0. 003). Chemotherapeutic drugs were treated with PX 0.000, and with traditional Chinese medicine (TCM), the patients were treated by differentiation of symptoms and signs. The risk ratio of primary tumor resection was 0.43395% (CI: 0.251) and the risk ratio of chemotherapy was 0.148% (CI: 0.060 0.365). The risk ratio of taking traditional Chinese medicine was 0.532n95% (CI: 0.3470.0.816) the median PFS of western medicine group was 6.1 months, and the median PFS of integrated traditional Chinese and western medicine group was 9.2 months. The difference of median PFS between the two groups was statistically significant (P < 0.05). The independent protective factor of PFS was primary tumor resection. Local treatment of liver metastases. The risk ratio of primary resection was 0.46695 CI: 0.2420.895. The risk ratio for local treatment of liver metastases is 0.576C95 CI: 0.362K0.918). Conclusion the treatment of traditional Chinese medicine based on Weichangan prescription is an effective protective factor to improve the prognosis of liver metastasis of unresectable colorectal cancer. The combination of traditional Chinese and western medicine has some advantages in prolonging liver metastasis OS and PFS of unresectable colorectal cancer.
【作者单位】：上海中医药大学附属龙华医院肿瘤一科;上海中医药大学附属第七人民医院肿瘤科;上海市第八人民医院中医科;
【基金】：上海市卫计委青年科研基金项目(20134y141);上海市卫计委科研课题资助项目(20134173) 国家自然科学基金青年科学基金项目(81603548)
【分类号】：R273
【正文快照】： 肝脏是结直肠癌血行转移最主要的靶器官[1-2]。肿瘤转移至肝脏;(4)合并有严重的可能明显影响治疗大约有15%~25%的患者在确诊结直肠癌时即伴有肝和预后的急慢性疾病,如心肌梗死、脑卒中、严重肾功转移,另有15%~25%的患者在结直肠癌根治术后发能不全、精神疾病等;(5)孕妇、哺乳

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