中医辨证治疗提高肝细胞癌根治术后患者生存率的回顾性队列研究

Retrospective cohort study on traditional chinese medicine dialectical treatment improving survival rate of patients with hepatocellular carcinoma after radical resection

目的 评估中医辨证治疗对肝细胞癌(HCC)根治术后患者生存率及无瘤生存率的影响。方法 纳入上海2个三甲医院HCC根治术后随访超过5年患者619例,将术后接受中医治疗时间≥6个月的设为中西医队列,反之则为西医队列,采集患者临床数据并分析研究。结果 西医队列患者1、2、3、5年无瘤生存率分别为70.00%、54.86%、48.65%、38.92%;中西医队列患者1、2、3、5年无瘤生存率分别为82.33%、69.08%、59.44%、40.03%。Log-rank检验提示两队列差异无统计学意义(P=0.300),Breslow检验提示两队列差异有统计学意义(P=0.026)。西医队列患者1、2、3、5年总生存率分别为88.92%、80.27%、76.49%、65.68%;中西医队列患者1、2、3、5年总生存率分别为99.20%、96.79%、91.79%、75.50%。Log-rank检验提示两队列差异有统计学意义(P=0.002)。对中西医队列进行亚组分析,发现高暴露组(≥12个月)5年生存率明显好于较高暴露组(≥6个月且<12个月),分别为81.46%和47.73%(P<0.01)。结论 HCC根治术后患者行中医辨证治疗的中西医队列较西医队列患者生存率提高、生存期延长,中西医队列较西医队列患者近期无瘤生存率提高、近期无瘤生存期延长,中西医队列无瘤生存情况在60个月前好于西医队列,而在60个月后趋于相同。

Objective To evaluate the influence of traditional chinese medicine dialectical treatment on the survival rate and disease-free survival rate of patients with hepatocellular carcinoma after radical resection by retrospective cohort study. Methods A total of 619 patients with hepatocellular carcinoma who were followed up for more than 5 years after radical operation in two third-class hospitals in Shanghai were enrolled. Those who received traditional chinese medicine dialectical treatment for more than 6 months after operation were assigned as the Chinese and western medicine cohort, otherwise, they were assigned as the western medicine cohort.The clinical data of patients were collected and analyzed. Results 1. The 1, 2, 3 and 5-year disease-free survival rates of patients in western medicine cohort were 70.00%, 54.86%, 48.65% and 38.92% respectively;The 1, 2, 3 and 5-year disease-free survival rates of Chinese and Western medicine patients were 82.33%, 69.08%, 59.44% and 40.03% respectively. Log-rank test showed that there was no significant difference between the two groups(P=0.300), while Breslow test showed that there was significant difference between the two groups(P=0.026). 2.The 1, 2, 3 and 5-year overall survival rates of patients in western medicine cohort were 88.92%, 80.27%, 76.49% and 65.68% respectively. The 1, 2, 3 and 5-year overall survival rates of Chinese and Western medicine patients were 99.20%, 96.79%, 91.79% and 75.50% respectively. Log-rank test showed that the difference between the two cohorts was statistically significant(P=0.002). 3. By subgroup analysis of Chinese and Western medicine cohort, it was found that the 5-year survival rate of high exposure group(≥12 months) was significantly better than that of high exposure group(≥6 months and < 12 months).81.46% and 47.73% respectively(P<0.001). Conclusion For the patients after radical resection of hepatocellular carcinoma, the survival rate and survival time of patients in the TCM-WM group treated with traditional chinese medicine dialectical treatment are higher and longer than those in the Western medicine group. Among them, those who have been treated with traditional chinese medicine dialectical treatment for a long time(≥12 months) have higher survival rate and longer survival time.Compared with the western medicine group, TCM-WM group have higher disease-free survival rate and longer disease-free survival time in short-term. The disease-free survival condition of the TCM-WM groups is better than that of the western medicine group before 60 months, while the disease-free survival condition of the two groups tends to be the same after 60 months.