70岁以上晚期非小细胞肺癌的预后研究及中医药治疗疗效

The Prognosis and Treatment Efficacy Research of Chinese Medicine among Elderly Patients Aged over 70 with Advanced Non-small Cell Lung Cancer

目的:探讨影响70岁以上晚期非小细胞肺癌患者预后的相关因素,评价中药干预70岁以上晚期非小细胞肺癌(Non-Small-Cell Lung Cancer,NSCLC)的临床疗效。方法:采用回顾性分析,复习210例70岁以上晚期非小细胞肺癌的病历资料,统计分析影响预后的相关因素,评价中医药疗效。结果:210例70岁以上晚期NSCLC的中位生存期为17.7个月;1年、2年、3年生存率分别为60.0%、42.2%、25.8%。单因素分析显示,年龄(是否大于75岁)、吸烟指数、组织学类型、ECOG评分、既往是否接受手术治疗、是否放疗、全身系统治疗(化疗、靶向治疗)及中医综合治疗周期与生存期均显著相关(P<0.05)。而性别、临床分期、首诊中医证型与生存期并无相关性(P>0.05)。多因素分析结果显示,吸烟(P=0.041,95%CI:1.017~1.415)、ECOG评分(P=0.044,95%CI:1.007~1.664)是预后的独立危险因素;既往手术史(P=0.002,95%CI:0.348~0.796)、全身治疗(P=0.038,95%CI:0.638~0.987)、中医综合治疗(P=0.001,95%CI:0.609~0.885)是预后的独立保护因素。结论:吸烟、ECOG评分高是老年肺癌患者预后的独立危险因素。既往手术治疗、系统全身治疗(包括化疗、靶向治疗)及中医综合治疗周期越长是70岁以上晚期NSCLC预后的独立保护因素。长期中药辨证治疗能有效延长老年晚期NSCLC生存期。对于老年晚期肺癌无法耐受其他治疗的情况下,中医药治疗可作为首选方案。

Objective： To explore the influential factors for the prognosis of patients with advanced non-small cell lung cancer and evaluate the clinical curative effect of Chinese medicine intervention over 70 or older. Methods： Using ret- rospective analysis, 210 cases of advanced non-small cell lung cancer aged 70 medical records were reviewed, statistical a- nalysis was performed to find related factors affecting the prognosis and evaluation of curative effect of traditional Chinese medicine. Results： the median survival time of the 210 cases was 17.7 months. The survival rates for 1 year, 2 years, 3 year- were 60, 0% , 42.2% and 25.8% respectively. Single factor analysis showed that age, smoking index, histology, ECOG score, whether surgical treatment, radiotherapy, and systemic therapy （ chemotherapy, targeted therapy ） and combined treatment of traditional Chinese medicine were sig- nificantly different （P 〈 0.05 ）. Sex, clinical stage, the first diagnosis of TCM syndrome types （P 〉 0.05 ） were not corre- lated, according to the results of multivariate analysis, smok- ing（P =0. 041,95% CI：I. 017 - 1. 415） , ECOG score（P = 0. 044,95% CI：I. 007 - 1. 664） were independent risk factors for prognosis. History of surgery（P =0. 002,95% CI：O. 348 ~0. 796）, systemic therapy （P =0. 038,95% CI：O. 638 ~ 0. 987 ）, the comprehensive treatment of traditional Chinese medicine （P = 0. 001,95 % CI：O. 609 ~ 0. 885 ） were the in- dependent protection factors for prognosis. Conclusion： Smoking, ECOG score high independent risk factors for the prog- nosis for elderly patients with lung cancer. Surgery history, systemic treatment （including chemotherapy, targeted therapy） and the longer the comprehensive treatment of traditional Chinese medicine cycle are independent protection factors. Long traditional Chinese medicine （TCM） syndrome differentiation treatment can effectively extend the elderly advanced NSCLC survival. For elderly advanced lung cancer who eanl tolerate other treatment, treatment of Chinese medicine can be used as the preferred solution.