987例晚期非小细胞肺癌化疗患者的生存分析

Survival analysis of 987 patients with advanced non small cell lung cancer treated with chemotherapy

目的分析晚期非小细胞肺癌(non small cell lung cancer,NSCLC)化疗患者的生存信息,获得中西医结合治疗背景下影响晚期NSCLC化疗患者生存的独立预后因素,以更好地探索中西医的融合发展,推动中西医结合治疗的规范化研究和应用。方法采用回顾性研究,选取2015年1月1日—2020年12月31日于天津中医药大学第一附属医院肿瘤科住院部接受化疗的晚期NSCLC患者,通过天津中医药大学第一附属医院病历系统查阅并收集患者联系方式,记录研究相关资料,并进行电话随访。主要结局指标为无进展生存期(progression-free survival,PFS),次要结局指标为总生存期(overall survival,OS)。采用乘积极限法(Kaplan-Meier)进行单因素生存分析,绘制生存曲线,同时使用Log-rank非参数检验分析比较组间PFS及OS的差异。单因素分析中P<0.05的因素纳入多因素分析中,通过比例风险回归模型(proportional hazards model,COX)分析构建预后模型,获得天津中医药大学第一附属医院治疗背景下影响晚期NSCLC化疗患者生存的独立预后因素。结果整体人群中位PFS(median PFS,m PFS)为6.4个月,行为状态(Karnofsky performance status,KPS)评分、身体质量指数(body mass index,BMI)、临床分期、癌性发热、既往手术、伴随靶向治疗、伴随免疫治疗、“黜浊培本”法方药暴露是影响晚期NSCLC化疗患者PFS的独立因素(P<0.05)。整体人群中位OS(median OS,m OS)为17.3个月,KPS评分、BMI、临床分期、基因突变、癌性疼痛、上腔静脉综合征、既往化疗、“黜浊培本”法方药暴露是影响晚期NSCLC化疗患者OS的独立因素(P<0.05)。结论“黜浊培本”法方药可延缓晚期NSCLC化疗耐药时间,提高晚期NSCLC化疗患者的远期疗效。

Objective To analyze the survival information of advanced non small cell lung cancer(NSCLC)chemotherapy patients,obtain independent prognostic factors that affect the survival of advanced NSCLC chemotherapy patients in the context of integrated traditional Chinese and Western medicine treatment,in order to better explore the integrated development of traditional Chinese and Western medicine,and promote standardized research and application of integrated traditional Chinese and Western medicine treatment.Methods A retrospective study was conducted to collect advanced NSCLC patients who underwent chemotherapy in the Oncology Department of the First Teaching Hospital of Tianjin University of Traditional Chinese Medicine from January 1,2015 to December 31,2020.The patient's contact information,record research-related data,and telephone follow-up was collected through the medical record system of the hospital.The primary outcome measure was progression free survival(PFS),while the secondary outcome measure was overall survival(OS).Kaplan Meier method was used for univariate survival analysis,plot survival curves,and compare the differences in PFS and OS between groups using Log-rank nonparametric test analysis.In the univariate analysis,factors with P<0.05 were included in the multivariate analysis.A prognostic model was constructed through proportional hazards model(COX)regression analysis to obtain independent prognostic factors that affect the survival of advanced NSCLC chemotherapy patients in the context of treatment in the First Teaching Hospital of Tianjin University of Traditional Chinese Medicine.Results The overall population had a median PFS of 6.4 months,and Karnofsky performance status(KPS)score,BMI,clinical staging,cancerous fever,previous surgery,accompanied by targeted therapy,accompanied by immunotherapy,and exposure to the“Chuzhuo Peiben”method were independent factors affecting the PFS of advanced NSCLC chemotherapy patients(P<0.05).The overall population has a median OS of 17.3 months,and KPS score,BMI,clinical stage,gene mutation,cancerous pain,superior vena cava syndrome,previous chemotherapy,and exposure to the“Chuzhuo Peiben”method are independent factors that affect the OS of advanced NSCLC chemotherapy patients(P<0.05).Conclusion Independent prognostic factors influencing survival of patients with advanced NSCLC treated with chemotherapy were obtained.The method of“Chuzhuo Peiben”can delay the resistance time of advanced NSCLC chemotherapy and improve the long-term efficacy of patients with advanced NSCLC chemotherapy.