中药对初始治疗失败晚期结直肠癌患者总生存期的影响

The influence of TCM on the overall survival for the patients with advanced colorectal cancer after initial treatment failure

目的观察中药联合西医常规治疗对初始治疗失败晚期结直肠癌患者总生存期的影响。方法应用非随机同期对照研究方法,根据治疗方法不同将符合纳入排除标准的190例初始治疗失败的晚期结直肠癌患者分为中西医结合组77例和西医组113例,2组均给予常规化疗和/或联合分子靶向药物等内科治疗(至少完成3个周期)以及放疗,对复发灶或转移瘤进行姑息性切除、射频消融、肝动脉栓塞化疗等局部治疗。中西医结合组在化疗中或化疗后给予中医辨证治疗,其中脾气虚型以四君子汤为主,肾阳虚型以二仙汤为主,肾阴虚型以六味地黄汤为主,湿滞证型以二陈汤为主,血瘀证型以血府逐瘀汤为主,肠道湿热型以四藤汤为主,对于无证可辨者给予胃肠安方治疗。运用卡方检验检测基线均衡状况,采用KaplanMeier法估算中位总生存期,选用Log-rank法检验组间生存分布差异,通过Cox风险比例模型对影响总生存期的预后因素进行多因素分析。结果治疗组总生存期为19.46个月,对照组总生存期为15.39个月,治疗组总生存期明显长于对照组(P<0.05)。多因素分析显示中药治疗为初始治疗失败晚期结直肠癌患者总生存期延长的独立保护性因素。结论中药治疗能够延长初始治疗失败晚期结直肠癌患者的总生存期,是初始治疗失败晚期结直肠癌患者总生存期延长的保护因素。

Objective It is to observe the influence of traditional Chinese medicine combined with Western medicine rou- tine treatment on the overall survival of patients with advanced colorectal cancer after initial treatment failure. Methods A non randomized concurrent control study was conducted, 190 patients with advanced coloreetal cancer who met the inclusion and exclusion criteria were divided into integrative medicine group with 77 cases and western medicine group with 113 cases according to the different treatment methods. The 2 groups were received routine chemotherapy and/or combination of molecular targeted drugs （ at least 3 cycles） and radiotherapy, and the treatment of palliative resection, radiofrequency ablation, hepatic arterial chemoembolization and other local treatments for recurrent or metastatic tumors were performed. The integrative medicine group was given TCM syndrome differentiation treatment during and after chemotherapy, Sijunzi Soup for the spleen Qi deficiency type, Erxian decoction for kidney Yang deficiency, Liuwei Dihuang pill for kidney Yin deficiency type, Erchen decoction for dampness stagnation type, Xuefu Zhuyu decoction for blood stasis syndrome, Siteng soup for intestinal damp heat type, Weuchang＇ an decoction for unlicensed discernible person. Baseline equilibrium was checked by chi square test, median overall survival was estimated by Kaplan-Meier, Log-rank method was used to test the difference of survival distribution between groups, multivariate analysis of prognostic factors affecting overall survival was performed by means of the Cox risk scale model. Results The total survival time was 19.46 months in the integrative medicine group and was 15.39 months in the control group, the total survival time of the integrative medicine group was significantly longer than that of the control group （P 〈 0.05）. Multivariate analysis showed that traditional Chinese medicine treatment was an independent protective factor for overall survival prolongation in patients with advanced colorectal cancer after initial treatment failed. Conclusion Traditional Chinese medicine treatment can prolong the overall survival of patients with advanced colorectal cancer after initial treatment failed, and it is a protective factor for overall survival in patients with advanced colorectal cancer who have failed initial treatment.