中医药序贯和巩固治疗模式对Ⅲ/Ⅳ期胃癌生存期影响的对比观察

A comparative study of survival benefits in patients with stage Ⅲ/Ⅳ gastric cancer receiving sequential or consolidated treatment mode with Traditional Chinese medicine

目的:观察Ⅲ/Ⅳ期胃癌患者接受中医药序贯治疗或中医药巩固治疗的不同中西医结合治疗模式对总生存(overall survival,OS)和中位生存期(median survival time,MST)的影响。方法:回顾性分析2007年1月1日—2010年1月1日接受中西医结合治疗的88例Ⅲ/Ⅳ期胃癌患者,分为中医药序贯治疗组(38例)和中医药巩固治疗组(50例)。电话随访患者生存情况,分析2组患者的生存情况及其影响因素,应用Kaplan-Meier法计算中位OS和MST。结果:88例患者的中位OS为16.0个月,中医药序贯治疗组中位OS为33.0个月,较中医药巩固治疗组的20.0个月明显延长(P=0.047)。服用中药汤剂患者的中位OS较未服用中药汤剂患者明显延长(分别为23.8和15.6个月,P=0.012)。BorrmannⅢ与BorrmannⅣ患者的中位OS差异有统计学意义(分别为16.8和11.3个月,P=0.029)。分层分析结果显示,中医药序贯治疗组化疗或临床Ⅳ期患者的MST均较中医药巩固治疗组明显延长(P<0.05);而2组单一证型、复合证型和服用汤剂患者之间的MST差异无统计学意义。结论:中西医结合治疗能够延长Ⅲ/Ⅳ期胃癌患者的生存期,中医药序贯治疗与中医药巩固治疗相比,在延长患者生存期方面更具优势。

Objective：To observe the effects of sequential or consolidated treatment mode with TCM（Traditional Chinese medicine） in the comprehensive treatment on the OS（overall survival） and MST（median survival time） in patients with stage Ⅲ/Ⅳ gastric cancer.Methods：The clinical records of eighty-eight patients with stage Ⅲ/Ⅳ gastric cancer receiving integrative medicine（Western medicine integrated with TCM） between January 1,2007 and January 1,2010 were retrospectively reviewed.Of the 88 patients,38 received sequential treatment mode with TCM,and 50 received consolidated treatment mode with TCM.The survival was followed up with a phone call and calculated by Kaplan-Meier method.The factors related with the survival were analyzed by stratified analysis.Results：The median OS of the 88 patients was 16.0 months.The median OS in the sequential treatment group was significantly prolonged as compared with that in the consolidated treatment group（33.0 vs 20.0 months,P = 0.047）.The patients receiving TCM decoction had a longer median OS than the patients without receiving TCM decoction（23.8 vs 15.6 months,P = 0.012）.There was a significant difference in the median OS between the patients with Borrmann Ⅲ and Borrmann Ⅳ（16.8 vs 11.3 months,P = 0.029）.The results of the stratified analysis revealed that the MST of the patients with clinical stage Ⅳ was obviously prolonged in the sequential treatment group than in the consolidated treatment group（P0.05）;and the MST of patients with single syndrome,composite syndromes or receiving TCM decoction between the two groups had no significant differences.Conclusion：The integrative medicine can provide survival benefits for patients with stage Ⅲ/Ⅳ gastric cancer.As compared with the consolidated treatment mode,the sequential treatment mode with TCM has more advantages in prolonging the OS.