不同证型胃癌患者79例3年生存期影响因素分析

Influencing factors of the survival for 3 years in 79 patietns with gastric carcinoma of different syndrome types

目的分析不同中医辨证分型初诊胃癌患者预后影响因素,确定初诊时胃癌中医辨证分型是否为胃癌独立的预后因素。方法①选择2000-01/2001-12福建省肿瘤医院中西医结合科收治的初诊胃腺癌患者79例,男48例,女31例。均自愿接受规范化中西医结合治疗或西医治疗。生存期≥3年者为30例,<3年者为49例。胃癌中医辨证分型脾胃气虚17例,气阴两虚10例,痰瘀互阻19例,虚实夹杂33例。治疗方式接受中西医结合治疗51例,单纯西医治疗27例。②胃癌中医分型与TNM分期之间的相关性分析用Kendall等级相关。预后因素统计学处理各因素组间生存期差别,用单因素分析,随具体情况分别选用卡方检验或蒙特卡罗精确概率法。在单因素分析结果的基础上,用逐步前进法进行多因素Logistic回归。结果胃腺癌患者79例均进入结果分析。①胃癌中医证型与TNM分期无关(Kendall’stau_b为0.089,P=0.395)。②单因素分析结果提示不同性别、年龄、胃癌分型患者3年生存期差异明显(χ2=5.133,9.642,16.201,P<0.05～0.01)。不同的治疗方式、TNM分期、肿瘤部位、分化程度、肿瘤病理类型、大体分型患者的3年生存期差异不明显(P>0.05)。③多因素Logistic回归分析结果提示不同的胃癌分型、TNM分期、治疗方式与3年生存期显著相关。在胃癌中医分型中,虚实夹杂型与脾胃气虚、气阴两虚、痰瘀互阻型患者3年生存期差异明显(OR=5.422,95%CI1.455～20.204,P=0.012;OR=11.681,95%CI1.459～93.526,P=0.021;OR=16.387,95%CI2.639～101.769,P=0.003),但脾胃气虚、气阴两虚、痰瘀互阻型患者间差异不明显。TNM2期与3期3年生存期差异不明显(P>0.05)。TNM2期与1期患者3年生存期差异明显(OR=16.211,95%CI1.636～160.594,P=0.017);TNM4期与3期患者3年生存期差异明显(OR=23.756,95%CI2.9～194.624,P=0.003)。接受中西医结合治疗患者的3年生存率明显高于单纯西医治疗组(OR=5.422,95%CI1.455～20.204,P=0.012)。④预测准确率引入变量前为62%,引入变量后预测准确率上升到82.3%。结论①性别、年龄、胃癌分型可影响胃癌患者3年生存期。②胃癌中医分型可能是胃癌独立的预后因素之一,胃癌中医分型为虚实夹杂型以及高TNM分期是胃癌预后的不良因素。③中西医结合治疗胃癌患者的3年生存率高于单纯西医治疗患者。

AIM： To analyze the factors that influence the prognosis of patient firstly diagnosed to have gastric carcinoma of different traditional Chinese medicine （TCM） syndrome types, and identify whether TCM syndrome types are the indep, endent prostic factors for gastric carcinoma at the first diagnosis. METHODS： （1）Seventy-nine patients （48 males and 31 females）, who were firstly diagnosed to have gastric adenocarcinoma, were selected from the Department of Integrated Chinese and Western Medicine of Fujian Provincial Cancer Hospital between January 2000 and December 2001. They all voluntarily accepted the standardized integrated Chinese and western treatment or western treatment. The survival was ≥ 3 years in 30 cases, 〈 3 years in 49 cases. TCM syndrome types of gastric carcinoma： 17 cases of the deficiency of qi in spleen and stomach, 10 cases of the deficiency of both yin and yang, 19 cases of the retention of blood stasis and phlegm damp, and 33 cases of the combination of retention and deficiency of qi or y/n. Therapeutic means： 51 cases accepted integrated Chinese and western treatment and 27 cases accepted western treatment. （2） The correlation between the TCM syndrome types of gastric carcinoma and TNM staging was analyzed by Kendall correlation. Statistical disposal of the prognostic factors： The difference of survival among the groups were compared with the univariate analysis, the chi-square test and Monte Carlo exact probability were applied according to the specific condition, and then the multivariate Logistic regression analysis was applied by means of stepwise progress. RESULTS： All the 79 patients with gastric carcinoma entered the analysis of results. （1） The TCM syndrome types of gastric carcinoma had no correlation with TNM staging （Kendall＇s tau_b was 0.089, P=0.395. （2） The results of univariate analysis showed that the 3-year survival was obviously different among the patients with gastric carcinoma of different age, gender and TCM syndrome types （X^2=5.133, 9.642, 16.201, P 〈 0.05- 0.01）, but it was not markedly different among patients with different therapeutic pattern, TNM stage, location of cancer, severity of differentiation, pathological pattern and general typing （P 〉 0.05）. （3） The results of multivariate Logistic analysis indicated that the TCM syndrome types, TNM stage and treatment pattern were the independent prognostic factors for 3-year survival. Of the TCM syndrome types, 3-year survival in the patients with the combination of the retention and deficiency of qi or yin was significantly different from those in the patients with the deficiency of qi in spleen and stomach, deficiency of both yin and yang, and retention of blood stasis and phlegm damp （OR=5A22, 95% CI： 1A55-20.204, P =0.012; OR=11.681, 95% CI： 1.459-93.526, P=0.021; OR=16.387, 95% CI： 2.639-101.769, P=0.003）, but there was no obvious difference among the latter three groups. The 3-year survival was obviously between patients of TNM2 stage and TNM1 stage （0R=16：211, 95% CI： 1.636-160.594, P =0.017）, also between patients of TNM4 stage and TNM3 stage （OR =23.756, 95% CI： 2.9-194.624, P=0.003）. The 3-year survival, rate in the patients accepted integrated Chinese and western treatment was obviously higher than that in these accepted western treatment only （OR=5.422, 95% CI： 1.455-20.204, P=0.012）. （4） Predicted exact rate raised from 62% to 82.3% after bringin in the variance. CONCLUSION： （1） Age, gender and TCM syndrome types can affect the 3-year survival of the patients with gastric carcinoma. （2） The TCM syndrome types of gastric carcinoma may be one of the an independent prognostic factor in gastric carcinoma. The TCM syndrome type of the combination of the retention and deficiency of qi or yin and higher TNM stage are the adverse factors for the prognosis of gastric carcinoma. （3） The 3-year survival rate in the patients accepted integrated Chinese and western treatment is higher than that in those accepted western treatment only.