老年晚期非小细胞肺癌的生存研究及影响因素分析
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摘要
目的:探讨中西医结合治疗对老年晚期非小细胞肺癌患者生存期的影响,确定预后因素和中医药治疗的优势人群,为个体化治疗方案提供一定的参考依据。方法:回顾性分析2011年1月至2015年12月上海中医药大学附属龙华医院肿瘤三科收治的老年晚期非小细胞肺癌住院患者74例,根据治疗手段分为化疗组19例,中药组21例,中药联合化疗组34例。结果:中药组、化疗组和联合组的中位生存期分别为761、521和769 d,中位疾病无进展生存期分别为239、195和245d,组间比较差异均无统计学意义(均P> 0. 05); 3组1年生存率分别为89%、67%和67%,3年生存率分别为27%、16%和37%,5年生存率分别为9%、0%和17%。单因素分析得出中药静脉治疗≥8疗程或口服中药≥6月(P <0. 01,r=0. 48)、靶向治疗时间≥1年(P <0. 01,r=0. 33)和并发症(P <0. 01,r=-0. 28)为预后影响因素。对靶向和化疗进行分层后,仍得出中药干预为预后因素。多因素分析同样得出中药干预(OR=0. 09)和靶向治疗(OR=0. 15)为预后影响的独立因素。结论:中西医结合治疗可为老年晚期非小细胞肺癌群体带来获益。
Objective: To investigate the effects of integrative Traditional Chinese Medicine (TCM) and Western Medicine cancer treatment regimen's impact on survival time and rate,prognosis factors,and the suitable treatment group of elderly patients with advanced non-small cell lung cancer; and to provide a concrete reference for planning an individual' s cancer treatment regimen.Methods: Retrospective analysis was used to analyze 74 cases of elderly patients with advanced non-small cell lung cancer in Longhua Hospital Oncology Department from January 2011 to December 2015; and the patients were divided into chemotherapy group (n = 19),traditional Chinese medicine (TCM) group (n = 21),and chemotherapy combined with traditional Chinese medicine (n= 34). Results: The median survival time of TCM,chemotherapy and the combined group were 761 days,521 days and 769 days respectively. The median progression free survival time was 239 days,195 days and 245 days respectively (P > 0. 05). In addition,1-year survival rate are 89%,67% and 67% respectively; 3-year survival rates were 27%,16% and 37% respectively; and5-year survival rates were 9%,0%,and 17% respectively. Moreover,the univariable analysis showed receiving TCM intravenously8 treatments or orally 6 months (P < 0. 01,r = 0. 48),targeted therapy time 1 year (P < 0. 01,r = 0. 33),comorbidity (P < 0. 01,r=-0. 28) are the prognosis factors. After stratifying both targeted therapy and chemotherapy data,we still found TCM intervention played an important prognosis impact factor. Multivariate analysis also concluded that TCM intervention (OR = 0. 09) and targeted therapy (OR = 0. 15) were the independent prognosis factors. Conclusion: Elderly patients with advanced non-small cell lung cancer can benefit from receiving the integrative Traditional Chinese Medicine and Western Medicine cancer treatment regimen.
Objective: To investigate the effects of integrative Traditional Chinese Medicine (TCM) and Western Medicine cancer treatment regimen's impact on survival time and rate,prognosis factors,and the suitable treatment group of elderly patients with advanced non-small cell lung cancer; and to provide a concrete reference for planning an individual' s cancer treatment regimen.Methods: Retrospective analysis was used to analyze 74 cases of elderly patients with advanced non-small cell lung cancer in Longhua Hospital Oncology Department from January 2011 to December 2015; and the patients were divided into chemotherapy group (n = 19),traditional Chinese medicine (TCM) group (n = 21),and chemotherapy combined with traditional Chinese medicine (n= 34). Results: The median survival time of TCM,chemotherapy and the combined group were 761 days,521 days and 769 days respectively. The median progression free survival time was 239 days,195 days and 245 days respectively (P > 0. 05). In addition,1-year survival rate are 89%,67% and 67% respectively; 3-year survival rates were 27%,16% and 37% respectively; and5-year survival rates were 9%,0%,and 17% respectively. Moreover,the univariable analysis showed receiving TCM intravenously8 treatments or orally 6 months (P < 0. 01,r = 0. 48),targeted therapy time 1 year (P < 0. 01,r = 0. 33),comorbidity (P < 0. 01,r=-0. 28) are the prognosis factors. After stratifying both targeted therapy and chemotherapy data,we still found TCM intervention played an important prognosis impact factor. Multivariate analysis also concluded that TCM intervention (OR = 0. 09) and targeted therapy (OR = 0. 15) were the independent prognosis factors. Conclusion: Elderly patients with advanced non-small cell lung cancer can benefit from receiving the integrative Traditional Chinese Medicine and Western Medicine cancer treatment regimen.
引文
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[18]刘苓霜,姜怡,沈丽萍,等.中医药干预老年晚期非小细胞肺癌患者的生存研究[J].上海中医药大学学报,2011,25(6):26-29.
[19]夏玉婷,刘苓箱,姜怡,等.中医药治疗晚期非小细胞癌的生存相关因素分析[J].上海中医药大学学报,2013,27(5):24-29.
[20]游捷,单孟俊,赵慧,等.中西医结合治疗91例老年晚期非小细胞肺癌疗效观察[J].中国中西医结合杂志,2012,32(6):774-778.
[21]周之毅,李和根,田建辉,等.辨证颗粒剂配方联合化疗治疗老年晚期非小细胞肺癌生存质量分析[J].上海中医药大学学报,2017,31(1):13-17.
[22]刘俊波,黄常江,廖天华,等.益气清肺汤联合化疗治疗老年晚期非小细胞肺癌对患者生活质量的影响[J].世界中医药,2014,9(10):1303-1306.
[23]杨扬,范振林.养肺解毒汤联合化疗对老年晚期非小细胞肺癌的疗效分析[J].吉林医学,2015,36(10):2080-2081.
[24]陈黎,李红,邱婷,等.益气养阴法联合吉西他滨对老年晚期非小细胞肺癌生活质量的影响[J].南京中医药大学学报,2016,2(4):330-333.
[25]张恩欣,周岱翰,侯超.益气除痰方抑制肿瘤相关巨噬细胞的抗肿瘤免疫功能研究[J].中华肿瘤防治杂志,2016,23(10):627-635.
[26]张星星,童佳兵,李泽庚.芪玉三龙汤对荷肺癌小鼠免疫功能的影响[J].临床肺科杂志,2016,21(11):2038-2043.
[27]毕凌,金莎,郑展,等.肺积方对IDO诱导Lewis肺癌小鼠模型免疫逃逸的影响[J].中国中西医结合杂志,2016,36(1):69-74.
[28]丁雨钦,曲杰,张晶晶,等.鸦胆子油乳联合siRNA-ERCC1对肺腺癌A549/DDP细胞的耐药逆转作用[J]中国实验方剂学杂志,2012,18(20):235-239.
[29]Abe T,Takeda K,Ohe Y,et al.Randomized phase III trial comparing weekly docetaxel plus cisplatin versus docetaxel monotherapy every 3 weeks in elderly patients with advanced non-small-cell lung cancer:the intergroup trial JCOG0803/WJOG4307L[J].J Clin Oncol,2015,33(6):575-581.
[30]Moro-Sibilot D,Audigier-Valette C,Merle P,et al.Non-small cell lung cancer recurrence following surgery and perioperative chemotherapy:Comparison of two chemotherapy regimens(IFCT-0702:Arandomized phase 3 final results study)[J].Lung Cancer,2015,89(2):139-145.
[31]Des Guetz G,Landre T,Westeel V,et al.Similar survival rates with first-line gefitinib,gemcitabine,or docetaxel in a randomized phase IItrial in elderly patients with advanced non-small cell lung cancer and a poor performance status(IFCT-0301)[J].J Geriatr Oncol.2015,6(3):233-240.
[32]Quoix E,Zalcman G,Oster JP,et al.Carboplatin and weekly paclitaxel doublet chemotherapy compared with monotherapy in elderly patients with advanced non-small-cell lung cancer:IFCT-0501 randomised,phase 3 trial[J].Lancet,2011,378(9796):1079-1088.
[33]Fiteni F,Anota A,Bonnetain F,et al.Health-related quality of life in elderly patients with advanced non-small cell lung cancer comparing carboplatin and weekly paclitaxel doublet chemotherapy with monotherapy[J].Eur Respir J,2016,48(3):861-872.
[2]Bethesda,MD.SEER Cancer Statistics Factsheets:Lung and Bronchus Cancer,National Cancer Institute[DB/OL].(2016-04)[2016-08-01]http://seer.cancer.gov/statfacts/html/lungb.html.
[3]National Comprehensive Cancer Network.NCCN Clinical Practice Guidelines in Oncology:Non-Small Cell Lung Cancer,Version 42017.[DB/OL].(2017.1.18)[2017.3.1]https://www.nccn.org/professionals/physician_gls/f_guidelines.asp.
[4]中国抗癌协会.中国肺癌临床指南[M].北京:人民卫生出版社,2010:12-15.
[5]中国抗癌协会.新编常见恶性肿瘤诊治规范[S].第九分册.北京:中国协和医科大学出版社,1997:737-781.
[6]国家食品药品监督管理局.中药新药临床研究指导原则(试行)[S].北京:中国医药科技出版社,2002:216-221.
[7]上海市卫生局.上海市中医病证诊疗常规[M].2版.上海:上海中医药大学出版社,2003:128-129.
[8]王延风,杨敏,彭黎黎,等.合并症对老年非小细胞肺癌患者预后及生存影响[J].中国肿瘤临床与康复,2012,19(3):213-217.
[9]Colinet B,Jacot W,Bertrand D,et al.A new simplified comorbidity score as a prognostic factor in non small cell lung cancer patients:description and comparison with the Charlson's index[J].B J Cancer,2005,93:1098-1105.
[10]史周华,何雁.中医药统计学与软件应用[M].北京:中国中医药出版社,2015:413.
[11]花宝金.中医临床诊疗指南释义(肿瘤疾病分册)[M].北京:中国中医药出版社,2015:1.
[12]Howlader N,Noone AM,Krapcho M,et al.SEER Cancer Statistics Review,1975-2013,based on November 2015 SEER data submission,posted to the SEER web site,April 2016.Bethesda,MD,National Cancer Institute[DB/OL].https://seer.cancer.gov/csr/1975_2013/browse_csr.php?sectionSEL=15&pageSEL=sect_15_table.28.html.(2016.9.12)[2017.3.1].
[13]崔红海,王红玲,康斐.蒋士卿教授治疗肺癌经验[J].中医学报,2015,30(21):158-160.
[14]上海中医药大学附属龙华医院.龙医华章[M].上海:上海中医药大学出版社,2010:152-193.
[15]Davidoff AJ,Tang M,Seal B,et al.Chemotherapy and survival benefit in elderly patients with advanced non-small cell lung cancer[J].J Clin Oncol,2010,28(13):2191-2197.
[16]Annis TR,Ding K,Seymour,et al.Age and comorbidity as independent prognostic factors in the treatment of non small-cell lung cancer:a review of National Cancer Institute of Canada Clinical Trials Group trials[J].J Clin Oncol,2008,26(1):54-59.
[17]宋作顺,郭其森.老年晚期非小细胞肺癌患者并存疾病及年龄对一线单药化疗耐受性的影响[J].中国老年学杂志,2014,17(34):4810-4811.
[18]刘苓霜,姜怡,沈丽萍,等.中医药干预老年晚期非小细胞肺癌患者的生存研究[J].上海中医药大学学报,2011,25(6):26-29.
[19]夏玉婷,刘苓箱,姜怡,等.中医药治疗晚期非小细胞癌的生存相关因素分析[J].上海中医药大学学报,2013,27(5):24-29.
[20]游捷,单孟俊,赵慧,等.中西医结合治疗91例老年晚期非小细胞肺癌疗效观察[J].中国中西医结合杂志,2012,32(6):774-778.
[21]周之毅,李和根,田建辉,等.辨证颗粒剂配方联合化疗治疗老年晚期非小细胞肺癌生存质量分析[J].上海中医药大学学报,2017,31(1):13-17.
[22]刘俊波,黄常江,廖天华,等.益气清肺汤联合化疗治疗老年晚期非小细胞肺癌对患者生活质量的影响[J].世界中医药,2014,9(10):1303-1306.
[23]杨扬,范振林.养肺解毒汤联合化疗对老年晚期非小细胞肺癌的疗效分析[J].吉林医学,2015,36(10):2080-2081.
[24]陈黎,李红,邱婷,等.益气养阴法联合吉西他滨对老年晚期非小细胞肺癌生活质量的影响[J].南京中医药大学学报,2016,2(4):330-333.
[25]张恩欣,周岱翰,侯超.益气除痰方抑制肿瘤相关巨噬细胞的抗肿瘤免疫功能研究[J].中华肿瘤防治杂志,2016,23(10):627-635.
[26]张星星,童佳兵,李泽庚.芪玉三龙汤对荷肺癌小鼠免疫功能的影响[J].临床肺科杂志,2016,21(11):2038-2043.
[27]毕凌,金莎,郑展,等.肺积方对IDO诱导Lewis肺癌小鼠模型免疫逃逸的影响[J].中国中西医结合杂志,2016,36(1):69-74.
[28]丁雨钦,曲杰,张晶晶,等.鸦胆子油乳联合siRNA-ERCC1对肺腺癌A549/DDP细胞的耐药逆转作用[J]中国实验方剂学杂志,2012,18(20):235-239.
[29]Abe T,Takeda K,Ohe Y,et al.Randomized phase III trial comparing weekly docetaxel plus cisplatin versus docetaxel monotherapy every 3 weeks in elderly patients with advanced non-small-cell lung cancer:the intergroup trial JCOG0803/WJOG4307L[J].J Clin Oncol,2015,33(6):575-581.
[30]Moro-Sibilot D,Audigier-Valette C,Merle P,et al.Non-small cell lung cancer recurrence following surgery and perioperative chemotherapy:Comparison of two chemotherapy regimens(IFCT-0702:Arandomized phase 3 final results study)[J].Lung Cancer,2015,89(2):139-145.
[31]Des Guetz G,Landre T,Westeel V,et al.Similar survival rates with first-line gefitinib,gemcitabine,or docetaxel in a randomized phase IItrial in elderly patients with advanced non-small cell lung cancer and a poor performance status(IFCT-0301)[J].J Geriatr Oncol.2015,6(3):233-240.
[32]Quoix E,Zalcman G,Oster JP,et al.Carboplatin and weekly paclitaxel doublet chemotherapy compared with monotherapy in elderly patients with advanced non-small-cell lung cancer:IFCT-0501 randomised,phase 3 trial[J].Lancet,2011,378(9796):1079-1088.
[33]Fiteni F,Anota A,Bonnetain F,et al.Health-related quality of life in elderly patients with advanced non-small cell lung cancer comparing carboplatin and weekly paclitaxel doublet chemotherapy with monotherapy[J].Eur Respir J,2016,48(3):861-872.