基于健脾法探讨中药胃肠安对晚期胃癌的影响
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摘要
目的:评价健脾中药胃肠安对晚期胃癌生存期的影响。方法:采用双向性同期对照临床研究,在基线均衡的条件下比较接受健脾中药联合化疗的治疗组和仅接受化疗的同期对照组的生存期。Cox多因素回归模型分析影响晚期胃癌独立预后因素,Kaplan-Meier法估算中位生存时间(OS)。结果:共有935例晚期胃癌病例纳入研究,包括597例对照组和338例治疗组。Cox多因素分析显示,性别(P=0.010),靶向治疗(P=0.037),姑息性手术(P=0.000),健脾中药(P=0.000)是影响晚期胃癌患者生存期的独立预后因素。以是否行姑息性手术分层:姑息性手术亚组中,治疗组(188例)的中位OS 21.8个月较对照组(249例)的15.6个月延长(P=0.004)。非姑息性手术亚组中,治疗组(150例)的中位OS 16.3个月较对照组(348例)的12.6个月延长(P=0.002)。结论:健脾中药胃肠安是影响晚期胃癌预后的独立保护性因素,联合化疗可使晚期胃癌患者生存获益。
Objective: To evaluate the herbal formula for invigorating spleen combined with chemotherapy in advanced gastric cancer based on Weichangan. Methods: Compared the lifetime of the treatment group receiving spleen Chinese medicine combined with chemotherapy and the control group receiving only chemotherapy under the baseline equilibrium conditions by bidirectional concurrent controlled clinical study. Cox multivariate regression model was used to analyze the independent prognostic factors of advanced gastric cancer. Kaplan-Meier method was used to estimate the median survival time(OS). Results:A total of 935 cases of advanced gastric cancer were included in the study, including 597 control groups and 338 treatment groups.Cox regression analysis suggested that sex(P=0.010), molecular targeted therapy(P=0.037), previous(P=0.000), invigorating spleen Chinese herbs(P=0.000) were independent prognostic factors affecting lifetime of patients with advanced gastric cancer.In the subgroup of palliative surgery, the median OS of the treatment group(188 cases) was 21.8 months longer than that of the control group(249 cases) for 15.6 months(P=0.004). In the subgroup of non-palliative surgery, the median OS of the treatment group(150 cases) was 16.3 months longer than that of the control group(348 cases) for 12.6 months(P=0.002). Conclusion: The herbal formula for invigorating spleen was dependent protective factor affecting the prognosis of advanced gastric cancer based on Weichangan, combined chemotherapy can benefit the lifetime of patients with advanced gastric cancer.
Objective: To evaluate the herbal formula for invigorating spleen combined with chemotherapy in advanced gastric cancer based on Weichangan. Methods: Compared the lifetime of the treatment group receiving spleen Chinese medicine combined with chemotherapy and the control group receiving only chemotherapy under the baseline equilibrium conditions by bidirectional concurrent controlled clinical study. Cox multivariate regression model was used to analyze the independent prognostic factors of advanced gastric cancer. Kaplan-Meier method was used to estimate the median survival time(OS). Results:A total of 935 cases of advanced gastric cancer were included in the study, including 597 control groups and 338 treatment groups.Cox regression analysis suggested that sex(P=0.010), molecular targeted therapy(P=0.037), previous(P=0.000), invigorating spleen Chinese herbs(P=0.000) were independent prognostic factors affecting lifetime of patients with advanced gastric cancer.In the subgroup of palliative surgery, the median OS of the treatment group(188 cases) was 21.8 months longer than that of the control group(249 cases) for 15.6 months(P=0.004). In the subgroup of non-palliative surgery, the median OS of the treatment group(150 cases) was 16.3 months longer than that of the control group(348 cases) for 12.6 months(P=0.002). Conclusion: The herbal formula for invigorating spleen was dependent protective factor affecting the prognosis of advanced gastric cancer based on Weichangan, combined chemotherapy can benefit the lifetime of patients with advanced gastric cancer.
引文
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[12]Xu Y,Zhao A G,Li Z Y,et al.Survival benefit of traditional Chinese herbal medicine(a herbal formula for invigorating spleen)for patients with advanced gastric cancer. Integrative Cancer Therapies,2013,12(5):414-422
[13]徐燕,赵爱光,赵秋枫,等.健脾为主的中药复方改善女性晚期胃癌预后的临床评价.上海中医药大学学报,2018,32(4):22-27
[14]Yilmaz U,OztoP I,Alacacioglu A,et al.Irinotecan combined with infusional 5-fluorouracil and high dose leucovorin for the treatment of advanced gastric carcinoma as the first line chemotherapy.Chemotherapy,2006,52(5):264-270
[15]Van C E,Moiseyenko V M,Tjulandin S,et al.PhaseⅢstudy of docetaxel and cisplatin plus fluorouracil compared with cisplatin and fluorouracil as first-line therapy for advanced gastric cancer:A report of the V325 Study Group.Journal of Clinical Oncology,2006,24(31):4991-4997
[16]Yamada Y,Higuchi K,Nishikawa K,et al.PhaseⅢstudy comparing oxaliplatin plus S-1 with cisplatin plus S-1 in chemotherapynaive patients with advanced gastric cancer.Annals of Oncology,2015,26(1):141-148
[17]Dittmar Y,Rauchfuss F,Goetz M,et al.Non-curative gastric resection for patients with stage 4 gastric cancer:A single center experience and current review of literature.Langenbecks Arch Surg,2012,397(5):745-753
[18]Sun J,Song Y,Wang Z,et al.Clinical significance of palliative gastrectomy on the survival of patients with incurable advanced gastric cancer:A systematic review and meta-analysis.BMC Cancer,2013,13(1):577
[2]Chen W,Zheng R,Baade P D,et al.Cancer statistics in China,2015.Ca Cancer J Clin,2016,66(2):115-132
[3]Ajani J A,Bentrem D J,Besh S,et al.Gastric cancer, version2.2013:featured updates to the NCCN Guidelines.Journal of the National Comprehensive Cancer Network Jnccn,2013,11(5):531-546
[4]刘宁宁,周利红,孙筱婷,等.健脾解毒方通过PTEN/PI3K/AKT信号通路抑制幽门螺杆菌诱导胃癌血管新生的研究.中华中医药杂志,2018,33(3):1052-1056
[5]吴坚,刘沈林,张星星,等.健脾养正消癥方对裸鼠皮下移植瘤中肿瘤转移相关因子的影响.中华中医药杂志,2015,30(9):3311-3314
[6]段连香,郑坚,赵爱光,等.中医药辨证治疗对老年晚期胃癌预后影响的同期对照研究.肿瘤学杂志,2018,24(8):800-807
[7]Zhao L,Zhao A G,Zhao G,et al.Survival benefit of traditional chinese herbal medicine(a herbal formula for invigorating spleen)in gastric cancer patients with peritoneal metastasis.EvidenceBased Complementray and Alternative Medicine,2014(2):625493
[8]陈伟霞,牛垚飞,陈彬,等.健脾中药胃肠安对胃癌MKN45细胞侵袭迁移能力的影响.中华中医药学刊,2018,36(9):2121-2124
[9]苑伟,陈彬,赵爱光,等.健脾复方对人胃癌细胞株MKN-45裸小鼠皮下移植瘤模型非特异性免疫功能的影响.中华中医药杂志,2013,28(9):2766-2770
[10]Bin C,Ai-Guang Z,Jin S,et al.The effects of PTBP3 silencing on the proliferation and differentiation of MKN45 human gastric cancer cells.Life Sciences,2014,114(1):29-35
[11]Liang X,Shi H,Yang L,et al.Inhibition of polypyrimidine tractbinding protein 3 induces apoptosis and cell cycle arrest,and enhances the cytotoxicity of 5-fluorouracil in gastric cancer cells.British Journal of Cancer,2017,116(7):903
[12]Xu Y,Zhao A G,Li Z Y,et al.Survival benefit of traditional Chinese herbal medicine(a herbal formula for invigorating spleen)for patients with advanced gastric cancer. Integrative Cancer Therapies,2013,12(5):414-422
[13]徐燕,赵爱光,赵秋枫,等.健脾为主的中药复方改善女性晚期胃癌预后的临床评价.上海中医药大学学报,2018,32(4):22-27
[14]Yilmaz U,OztoP I,Alacacioglu A,et al.Irinotecan combined with infusional 5-fluorouracil and high dose leucovorin for the treatment of advanced gastric carcinoma as the first line chemotherapy.Chemotherapy,2006,52(5):264-270
[15]Van C E,Moiseyenko V M,Tjulandin S,et al.PhaseⅢstudy of docetaxel and cisplatin plus fluorouracil compared with cisplatin and fluorouracil as first-line therapy for advanced gastric cancer:A report of the V325 Study Group.Journal of Clinical Oncology,2006,24(31):4991-4997
[16]Yamada Y,Higuchi K,Nishikawa K,et al.PhaseⅢstudy comparing oxaliplatin plus S-1 with cisplatin plus S-1 in chemotherapynaive patients with advanced gastric cancer.Annals of Oncology,2015,26(1):141-148
[17]Dittmar Y,Rauchfuss F,Goetz M,et al.Non-curative gastric resection for patients with stage 4 gastric cancer:A single center experience and current review of literature.Langenbecks Arch Surg,2012,397(5):745-753
[18]Sun J,Song Y,Wang Z,et al.Clinical significance of palliative gastrectomy on the survival of patients with incurable advanced gastric cancer:A systematic review and meta-analysis.BMC Cancer,2013,13(1):577