结直肠癌术后中医证型与预后相关性的巢式病例对照研究

Correlation Analysis Between Syndromes of Traditional Chinese Medicine and the Prognosis in Postoperative Patients with Colorectal Cancer: A Nested Case-Control Study

目的:本研究对Ⅱ、Ⅲ期结直肠癌术后中医证型与预后相关性进行探索分析。方法:采用巢式病例对照研究方法回顾就诊于中国中医科学院西苑医院肿瘤科的结直肠癌患者,对5年内出现复发转移的20例患者(观察组),按1:4匹配80例未复发转移患者为对照组,分别从肿瘤部位、TNM分期中医证型、术后辅助治疗及中药治疗时间等因素进行分析。结果:观察组以肝脾不和居多(P=0.027),对照组脾肾两虚更多(P=0.029)。Logistic回归模型显示中药治疗时间对预后是一种保护因素(OR<1),而肝肾阴虚证(OR>1)较脾肾两虚证的复发转移几率大大增加。结论:特定的中医证候与Ⅱ、Ⅲ期结直肠癌术后患者的预后可能具有相关性,中药治疗可能对预后具有改善作用。

This study aimed to determine the correlations between Traditional Chinese Medicine（TCM） syndromes and their prognoses in postoperative patients with stage II and III colorectal cancer. Outpatients of colorectal cancer from TCM oncology clinic of Xiyuan Hospital were analyzed by nested case-control study method. Patients with metastasis recurrence within five years after surgery（excluding the group which recurrences appeared within six months） were included in the case group; while patients with more than five years whose recurrence did not appear were served as the control group. The ratio of patients in the case and the control group was 1 to 4, paired according to the rule of nested case-control study. Factors, such as age, gender, tumor location, TNM stage, TCM syndromes, adjuvant therapy and a cumulative TCM treatment duration, were included in the analysis. As a result, the syndrome of disharmony between liver and spleen mostly emerged in patients of the case group（P = 0.027）, while the syndrome of deficiency of spleen and kidney occurred in patients of the control group（P = 0.029）. Results of Logistic regression analysis showed that the cumulative TCM treatment duration may be a protective factor in terms of prognosis（OR1）, and the risk of recurrence in patients with syndrome of yin deficiency of liver and kidney increased compared with those with the syndrome of deficiency of spleen and kidney（OR1）. In conclusion, it was demonstrated that specific TCM syndromes may associated with the prognosis in patients with stage II and III colorectal cancer, which improved the disease prognosis.