中医药联合化疗对大肠癌Ⅱ、Ⅲ期患者生存期的影响

作者	单位
吕仙梅	浙江金华广福医院肿瘤内科
郑坚	上海市龙华医院肿瘤一科
朱莹杰	上海市龙华医院肿瘤一科
顾缨	上海市龙华医院肿瘤一科

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中文摘要:

目的探讨中医药联合化疗对大肠癌根治术后复发、转移、生存期的影响。方法选择366例2002年1月—2008年12月上海中医药大学龙华医院肿瘤一科、第二军医大学长海医院住院和门诊大肠癌根治术后Ⅱ、Ⅲ期患者,采用非随机同期对照研究的方法,根据患者是否自愿接受中医药治疗持续6个月以上,将患者分为中药+化疗组(联合组,189例)和化疗组(177例)。采用门诊随访、信访和电话随访的方式,观察患者随访无病生存期(disease free survival,DFS)及1、2、3、5年无病生存率,分析DFS与性别、发病年龄、发病部位、临床病理分期、病理类型、化疗周期、放疗、中药治疗、终点事件(转移复发)的相关性。结果根治术后Ⅱ、Ⅲ期大肠癌366例,145例出现复发转移者(39.61%),其中发生局部复发者17例(11.72%),肝转移者45例(31.03%),肺转移者52例(35.86%),其他部位转移者53例(36.55%)。DFS单因素分析结果显示,原发部位、病理类型、临床病理分期、化疗周期、放疗及中药治疗6个因素与DFS相关,差异均有统计学意义(P<0.01,P<0.05)。DFS多因素分析结果显示,临床病理分期、化疗周期及中药治疗与DFS相关,差异均有统计学意义(P<0.01)。亚层分析显示,Ⅱ期大肠癌DFS相关因素为原发部位(P=0.016)和病理类型(P=0.047),两组中位DFS尚未出结果;Ⅲ期大肠癌DFS相关因素为化疗周期(P=0.017)和中药治疗(P=0.000),对两组化疗周期构成比比较,结果显示两组化疗周期基线平衡,进一步比较显示Ⅲ期大肠癌化疗组中位DFS为24.16个月,联合组中位DFS尚未出结果。Ⅲ期大肠癌联合组及化疗组1、2、3、5年无病生存率分别为92%、72%、61%、59%和74%、50%、36%、20%。结论中医药联合化疗可延长Ⅲ期大肠癌根治术后DFS。

英文摘要:

Objective To study the effects of Chinese materia medica(CMM) combined chemotherapy on the recurrence,metastasis,and the disease free survival(DFS) of stageⅡ and Ⅲ colorectal cancer(CC) patients after radical cure.Methods Recruited were 366 inpatients and outpatients with stageⅡ and Ⅲ colorectal cancer(CC) from Changhai Hospital,Second Military Medical University,and Tumor Department of Longhua Hospital,Shanghai University of Traditional Chinese Medicine from January 2002 to December 2008.A non-randomized concurrent control method was adopted.Patients were assigned to the combination group(treated by CMM+chemotherapy,189 cases) and the chemotherapy group(177 cases) according to whether they were willing to receive the CMM treatment for more than 6 successive months.By using follow-ups at clinics,by letter,and by telephone,the DFS,1-,2-,3-,and 5-year DFS ratios were observed.The correlations between DFS and the gender,age,tumor location,staging of clinical pathology,pathological type,chemotherapeutic cycle,radiotherapy,CMM treatment,end point event(recurrence and metastasis) were analyzed.ResultsThe recurrence or metastasis occurred in 145 cases(39.61%) of the 366 patients.Of them,local recurrence occurred in 17 cases(11.72%),liver metastasis in 45 cases(31.03%),lung metastasis in 52 cases(35.86%),and metastasis in other parts in 53 cases(36.55%).Results of one-factor analysis showed six factors such as the tumor location,pathological type,staging of clinical pathology,chemotherapeutic cycle,radiotherapy,and CMM treatment were correlated with the DFS,showing statistical difference(P<0.01,P<0.05).Results of multifactor analysis showed staging of clinical pathology,chemotherapeutic cycle,and CMM treatment were correlated with the DFS,showing statistical difference(P<0.01).Results of stratified study on the staging of clinical pathology indicated that the primary tumor location(P=0.016) and the pathological type(P=0.047) were the independent predictors for DFS of stage Ⅱ CC.The median DFS of the two groups could not be calculated.Results of stratified study on the stages of clinical pathology indicated that CMM treatment(P=0.000) and chemotherapeutic cycle(P=0.017) were independent predictors for DFS of stage Ⅲ CC.As for comparing the composition ratio of the two therapeutic cycles,results showed the baselines of the chemotherapeutic cycle of the two groups were balanced.Further comparison showed the median DFS for the chemotherapy group at stage Ⅲ was 24.16 months,while it could not be calculated in the combination group.The DFS,1-,2-,3-,and 5-year DFS ratios were 92%,72%,61%,and 59%,respectively in the stage Ⅲ CC combination group,while they were 74%,50%,36%,and 20%,respectively in the stage Ⅲ CC chemotherapy group.Conclusion CMM combined chemotherapy could prolong the DFS of stage Ⅲ CC patients after radical cure.

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