中西医结合治疗91例老年晚期非小细胞肺癌疗效观察

作者	单位
游捷	上海中医药大学附属龙华医院肿瘤科
单孟俊	上海中医药大学附属龙华医院肿瘤科
赵慧	上海中医药大学附属龙华医院肿瘤科
谭翔文	上海中医药大学附属龙华医院肿瘤科

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中文摘要:

目的观察中西医结合疗法对老年晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)临床疗效的影响,为进一步研究提供临床依据。方法将91例老年晚期NSCLC患者随机分成中医组(31例)、化疗组(30例)及中医加化疗组(30例)。中医组采用中药汤剂加中成药静脉滴注治疗;化疗组单纯接受化疗方案治疗;中医加化疗组采用化疗方案治疗的同时服用中药汤剂,均以28天为1个周期,治疗2个周期。采用中医原发性肺癌症状分级量化表、骨髓抑制评分、无疾病进展生存期(progression-free survival,PFS)等作为疗效评价指标,同时建立Cox回归模型,分析对患者PFS产生影响的有利及危险因素。结果中医组与中医加化疗组治疗后中医症状积分优于治疗前,差异有统计学意义(P<0.01);中医加化疗组骨髓抑制发生率较化疗组低,骨髓抑制程度也较化疗组轻,但组间比较差异无统计学意义(P=0.097,P=0.299);PFS中医加化疗组为202天,中医组168天,化疗组129天,中医加化疗组优于化疗组(P=0.0157);经Cox回归模型分析,影响老年晚期NSCLC患者PFS有统计意义的预后因素有:治疗因素(中医治疗和中医加化疗为有利因素)、手术史(无手术史为有利因素)及治疗前行为状态评分(performance status,PS评分,1为有利因素)。结论中医药治疗可改善老年晚期NSCLC患者的症状;中医加化疗对老年患者PFS可能存在优势。

英文摘要:

Objective To observe the effects of integrative therapy on elderly patients with advanced non-small cell lung cancer(NSCLC),thus providing clinical evidence for further studies.Methods Totally 91 elderly patients with advanced NSCLC were randomly assigned to three groups,i.e.,the Chinese medicine(CM) group(Group Ⅰ,31 cases),the chemotherapy group(Group Ⅱ,30 cases),and the CM and chemotherapy combination group(Group Ⅲ,30 cases).Oral administration of CM decoction and intravenous dripping of Chinese patent medicine were given to patients in Group Ⅰ.Patients in Group Ⅱ received chemotherapeutic protocol alone.Patients in Group Ⅲ received chemotherapeutic protocol while taking CM decoction.Twenty-eight days were taken as one therapeutic course,and two courses in total.They were observed for two treatment courses by taking Symptoms Scale of CM to Primary Lung Cancer,bone marrow depression score,and progression-free survival(PFS) as therapeutic efficacy indices.Meanwhile,the Cox’s proportional hazards regression model was established to analyze the favorable factors and risk factors that influenced patients’ PFS.Results The CM symptom integral of Group Ⅰ and Group Ⅲ was superior to that before treatment,showing statistical difference(P<0.01).The occurrence of bone marrow depression in Group Ⅲ was lower than that in Group Ⅱ.The degree of bone marrow depression was also milder in Group Ⅲ than in Group Ⅱ,but there was no statistical difference in inter-group comparison(P=0.097,P=0.299).The PFS was 202 days in Group Ⅲ,168 days in Group Ⅰ,and 129 days in Group Ⅱ.It was better in Group Ⅲ than in Group Ⅱ(P=0.0157).The Cox regression analysis showed that positive factors to longer PFS included CM+chemotherapy,no surgical management,and PS=1.Conclusions CM therapy could improve the symptoms of elderly patients with advanced NSCLC.It might extend the PFS of the elderly patients by CM therapy combined with chemotherapy.

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