基于生存和聚类分析探讨Ⅰ-Ⅲ期结直肠癌术后的中医证型及其优势人群

Investigation on TCM syndromes and optimal population of postoperative patients with colorectal cancer at stages Ⅰ-Ⅲ based on survival and clustering analysis

目的:基于生存和聚类分析,探讨Ⅰ-Ⅲ期结直肠癌患者术后的中医证型及其优势人群。方法:选择符合评价条件的Ⅰ-Ⅲ期结直肠癌术后患者,将术后连续服用中药≥6个月者设为中药组,其余为对照组;采用Logistic回归计算倾向值,并对两组患者的基线资料进行1∶1倾向性匹配。收集患者的中药处方,分析用药情况,通过K-means动态样品聚类法将患者归类,并选择最佳分类数;分析中医证型,并评价不同证型人群的无病生存情况。结果:本研究共纳入817例患者,获得中药组308例的完整处方。根据用药情况,将患者分3类时,"人群1"中比例最高的分别是补气药、祛湿药,"人群2"为清热解毒药,"人群3"为补气药、消食药;对应的中医证型可分为脾虚湿盛、热毒内盛和脾胃虚弱证,其中脾虚湿盛证患者接受系统中药治疗后复发转移的风险最低。结论:Ⅰ-Ⅲ期结直肠癌患者术后的中医证型可主要分为脾虚湿盛、热毒内盛和脾胃虚弱证,其中脾虚湿盛证患者为接受中药治疗的优势人群。

Objective： To discuss traditional Chinese medicine（ TCM） syndromes and optimal population of postoperative patients with stages Ⅰ-Ⅲ colorectal cancer patients based on clustering and survival analysis. Methods： The postoperative patients with stage Ⅰ-Ⅲ colorectal cancer who met the criteria of evaluation were enrolled. After operation,those in the TCM group were asked to continuously take Chinese medicine more than 6 months,and the others were taken as the control group. The propensity score was calculated by logistic regression,and the 1 ∶ 1 tendency matching was performed for the baseline data of patients in both groups. The prescriptions of Chinese medicine were collected and the medication was analyzed. K-means clustering method was used to classify the patients and the best classification number was selected. TCM syndrome types were analyzed and the disease free survival of patients with different syndromes was evaluated. Results： 817 patients and 308 complete prescriptions from Chinese medicine group were included in the study. According to the medication,when the patients were divided into 3 categories,the highest proportion in＂population 1＂was qi-tonifying medicine and dampness-eliminating medicine,the highest proportion in the＂population 2＂was heat-clearing and detoxifying medicine,and the highest proportion in the＂population 3＂was qi-tonifying medicine and digestive medicine. The corresponding TCM syndrome types can be divided into dampness abundance due to spleen deficiency,heat-toxicity in the interior and deficiency of spleen and stomach. Among of these,the risk of recurrence and metastasis was the lowest in the patients with syndrome of dampness abundance due to spleen deficiency after the systemic Chinese medicine treatment. Conclusion： TCM syndrome types of postoperative patients with stage I-III colorectal cancer can be mainly divided into the syndromes of dampness abundance due to spleen deficiency,heat-toxicity in the interior and deficiency of spleen and stomach. Among of these,patients with dampness abundance due to spleen deficiency were the optimal population who treated with Chinese medicine.