晚期肺腺癌患者生存结局与中医证型的相关性分析

Analysis on Correlation between Survival Outcome and TCM Syndromes of Advanced Lung Adenocarcinoma

目的:分析晚期肺腺癌患者中医证型与其一线化疗后生存结局之间的相关性。方法:选择2017年5月至2018年5月中山大学附属肿瘤医院肿瘤内科刘俊玲门诊晚期(Ⅳ期)肺腺癌患者62例,收集所有患者性别、年龄、中医证候、分期、病理及影像学等资料,通过门诊、住院随访所有病例。将大于整组中位生存期(mPFS)的患者分为优势组,将小于整组mPFS的患者分为劣势组,分析优、劣势组的相关性。采用Kaplan Meier法绘制生存曲线,Log-Rank检验生存曲线,将单因素分析中P<0.05的指标纳入多因素Cox回归分析。结果:优势组气虚痰湿患者的比例高于劣势组(P<0.05),劣势组气滞血瘀、气阴两虚患者的比例高于优势组(P<0.05);整组单因素分析,气虚痰湿、气滞血瘀、气阴两虚组患者mPFS差异均有统计学意义(P<0.05);Cox多因素回归分析显示气滞血瘀[P<0.05,OR=6.01,95%CI(2.29,15.78)]、气阴两虚[P<0.05,OR=24.45,95%CI(6.30,94.90)]是影响生存结局的独立预后因素。结论:中医证型与晚期肺腺癌预后相关,气虚痰湿患者是化疗的优势人群,气滞血瘀、气阴两虚患者是化疗的劣势人群,也是影响晚期肺腺癌一线化疗生存结局的独立预后因素。

Objective:To analyze the correlation between TCM syndrome survival outcomes of advanced lung adenocarcinoma after complete the first-line chemotherapy.Method:Totally 62 patients with advanced(stageⅣ)lung adenocarcinoma treated by Professor LIU Jun-ling were selected,in department of oncology medicine,Affiliated Tumor Hospital of Sun Yat-Sen University from May 2017 to May 2018.The data of gender,age,TCM symptoms,stages,pathology and imaging examination of all these patients were collected.All patients were followed up through outpatient and inpatient visits.Patients with mPFS longer than the average mPFS of the whole group were divided into the advantage group and those with mPFS shorter than the average mPFS of the whole group were divided into the disadvantage group.Then the correlation between advantage and disadvantage groups was analyzed.Survival curve was drawn by Kaplan Meier method and survival curve was tested by log-rank test;The index with P<0.05 in univariate analysis was included in multivariate Cox regression analysis.Results:The advantage group showed higher proportion of patients with Qi deficiency,phlegm and dampness than disadvantage group(P<0.05).The disadvantage group showed higher proportion of patients with Qi stagnation and blood stasis and Deficiency of Qi and Yin than advantage group(P<0.05).The results of single factor analysis of whole group showed that there was statistical difference in mPFS among the Qi deficiency and phlegm dampness,Qi stagnation and blood stasis,and Qi and Yin deficiency groups(P<0.05).Cox multivariate regression analysis showed that Qi stagnation and blood stasis[P<0.05,OR=6.01,95%CI(2.29,15.78)]and Qi-Yin deficiency[P<0.05,OR=24.45,95%CI(6.30,94.90)]were independent prognostic factors affecting survival outcome.Conclusion:TCM syndromes are related to the prognosis of advanced lung adenocarcinoma.Pa-tients with Qi deficiency and phlegm dampness syndrome are the predominant group of chemotherapy.Patients with Qi stagnation and blood stasis syndrome and deficiency of Qi and Yin syndrome are the disadvantageous groups of chemotherapy,as well as the independent prognostic factors affecting the survival outcome of first-line chemotherapy.