石龙解毒方辅助化疗对弥漫大B细胞淋巴瘤预后和生活质量的影响

Effect of Shilong Jiedu Prescription with Adjuvant Chemotherapy on the Prognosis and Quality of Life of Diffuse Large B-Cell Lymphoma

目的评价石龙解毒方辅助化疗对弥漫大B细胞淋巴瘤预后和生活质量的影响。方法将96例患者随机分为对照组和治疗组各48例。对照组采用CHOP方案(环磷酰胺+表柔比星+长春地新+强的松),21 d为1个疗程,共6个疗程;治疗组在对照组的基础上加服石龙解毒方,与化疗同期服用,并于化疗结束后再继续服用3个月(或至疾病进展)。治疗前和化疗结束后采用CT或PET-CT测量瘤体,并评价化疗后客观缓解率(ORR)和疾病控制率(DCR);化疗结束后,每3个月进行1次随访,连续随访2年,记录2年内无进展生存率、2年总生存率和无进展生存期(PFS);化疗前后评价欧洲生命质量协作组癌症核心量表(EORTC QLQC30)、美国国家综合癌症网络国际预后指数(NCCN-IPI)和中医症状;比较化疗前后可溶性白细胞介素2受体(sIL-2r)、中性粒细胞/淋巴细胞比值(NLR)、淋巴细胞与单核细胞计数比值(LMR)、血小板/淋巴细胞比值(PLR)等预后分子标志物。结果 (1)治疗后,治疗组ORR为89.58%(43/48),高于对照组的72.92%(35/48)(χ^(2)=4.376,P<0.05);治疗组DCR为95.83%(46/48),高于对照组的89.58%(43/48)(χ^(2)=0.616,P>0.05)。(2)治疗后,对照组患者EORTC QLQ-C30的社会功能、认知功能、情绪功能、角色功能、躯体功能和整体生存质量等维度评分均降低(P<0.01),治疗组各维度变化无统计学意义(P>0.05),且治疗组EORTC QLQ-C30以上各维度评分均高于对照组(P<0.01)。(3)治疗后,两组患者NCCN-IPI和中医症状评分均降低(P<0.01);且治疗组NCCN-IPI和中医症状评分均低于对照组(P<0.01)。(4)治疗后,两组患者sIL-2r、NLR、PLR降低(P<0.01),LMR升高(P<0.01);且治疗组sIL-2r、NLR、PLR均低于对照组(P<0.01),LMR高于对照组(P<0.01)。(5)治疗组PFS为(17.32±2.14)个月,长于对照组的(14.86±2.27)个月;治疗组2年内无进展生存率为79.17%(38/48),高于对照组的60.42%(29/48)(χ^(2)=4.015,P<0.05);两组患者2年总生存率比较差异无统计学意义(P>0.05)。结论石龙解毒方联合CHOP方案治疗弥漫大B细胞淋巴瘤可减轻临床症状,提高生活质量,近期可提高ORR,远期可提高2年内无进展生存率和PFS,明显改善了患者的预后,值得临床使用。

Objective To evaluate the effect of Shilong Jiedu prescription adjuvant chemotherapy on the prognosisand quality of life of diffuse large B-cell lymphoma. Methods Ninety-six patients were randomly divided into acontrol group and a treatment group with 48 cases each. In the control group, the CHOP(cyclophosphamide +epirubicin+vindesine+prednisone)regimen was used for 21 days as a course of treatment,a total of 6 courses. In thetreatment group,Shilong Jiedu prescription was added on the basis of the control group,during the chemotherapy,and continued for 3 months after the chemotherapy(or until the disease progresses). The CT or PET-CT was used tomeasure the tumor before and after chemotherapy to evaluate the objective response rate(ORR)and disease control rate(DCR) after chemotherapy. After chemotherapy is over, follow-up was conducted every 3 months for2 consecutive years,and the 2-year progression-free survival rate,2-year overall survival rate,and progression-freesurvival(PFS) were recorded. The European quality of life collaborative group cancer core scale(EORTC QLQ-C30),national comprehensive cancer network international prognostic index(NCCN-IPI)and symptoms of Chinesemedicine before and after chemotherapy were evaluated. The prognostic molecular markers such as soluble interleukin2 receptor(s IL-2 r), neutrophil/lymphocyte ratio(NLR), lymphocyte to monocyte count ratio(LMR), platelet/lymphocyte ratio(PLR),etc.,were compared before and after chemotherapy. Results(1)After treatment,the ORRof the treatment group was 89.58%(43/48),and the control group was 72.92%(35/48)(χ^(2)=4.376,P<0.05). TheDCR of the treatment group was 95.83%(46/48),and the control group was 89.58%(43/48),the difference was notstatistically significant(χ^(2)=0.616,P>0.05).(2)After treatment,the social function,cognitive function,emotionalfunction,role function,physical function,and overall quality of life scores of EORTC QLQ-C30 in the controlgroup decreased(P<0.01), while the changes in the dimensions of the treatment group were not statisticallysignificant(P>0.05);and after treatment,the scores of all dimensions above EORTC QLQ-C30 in the treatmentgroup were higher than those of the control group(P<0.01).(3)After treatment,the NCCN-IPI and TCM symptomscores of the two groups of patients were reduced(P<0.01);and after treatment,the NCCN-IPI and TCM symptomscores of the treatment group were lower than those of the control group(P<0.01).(4)After treatment,the s IL-2 r,NLR,and PLR of the two groups decreased(P<0.01),and the LMR increased(P<0.01). Besides,the s IL-2 r,NLR,and PLR of the treatment group were lower than those of the control group(P<0.01),and the LMR washigher than that of the control group(P<0.01).(5)The PFS of the treatment group was(17.32±2.14)months,whichwas longer than the PFS of the control group [(14.86±2.27) months]. The progression-free survival rate within2 years of the treatment group was 79.17%(38/48),higher than that of the control group 60.42%(29/48)(χ^(2)=4.015,P<0.05). There was no significant difference in the 2-year overall survival rate between the two groups of patients(P>0.05). Conclusion Shilong Jiedu prescription combined with CHOP regimen in the treatment of DLBCL canreduce clinical symptoms,improve quality of life,enhance the ORR in the short term,and improve progression-free survival and PFS within 2 years in the long term. It significantly improved the prognosis of patients and wasworthy of clinical use.