| Background:The incidence and mortality of lung cancer rank first in malignant tumors,and non-small cell lung cancer(NSCLC)accounts for 80%-85%of lung cancer.In stage Ⅰ-ⅢA non-small cell lung cancer,surgery as its main treatment,some can achieve radical(R0)resection,however,local recurrence and distant metastasis seriously threaten the survival of patients.Postoperative adjuvant therapy is an important means to prolong the survival of patients.Chemotherapy and radiotherapy are classic treatment methods,and the efficacy of traditional Chinese medicine has been confirmed in many previous studies.At present,in the guidelines for cancer treatment,Chinese medicine treatment has been included.However,to date,the research data provided by evidence-based medicine can only prove that Chinese medicine can reduce the recurrence and metastasis of lung cancer after surgery.In the guidelines,only the traditional Chinese medicine treatment method for lung cancer surgery is defined.However,there is no objective basis for reference of what kind of therapy is suitable for the patient.Objective:This study aims to summarize the effective TCM treatment methods for prevention of postoperative recurrence and metastasis of NSCLC,and to analyze the relationship between TCM treatment and pathological types,staging,treatment history and other objective factors.Explore the best duration of TCM intervention.It can provide an objective basis for clinical prevention of postoperative recurrence and metastasis of NSCLC after TCM treatment,and promote the standardized development of evidence-based medicine for TCM.Methods:200 cases were screened from the inpatient and outpatient system of Guang’anmen Hospital of China Academy of Chinese Medical Sciences according to the inclusion-exclusion criteria for retrospective study,observed by December 31,2018.Then inductive Chinese medicine treatment methods,analyze the relationship between TCM treatment and pathological classification and other objective factors,and explore the best duration of TCM intervention.Inclusion criteria:(1)patients with stage Ⅰ-ⅢA non-small cell lung cancer diagnosed after January 1,2006;(2)between 18-80 years old;(3)no targeted therapy after surgery(4)Chinese medicine exposure time is more than 6 months,and DFS ≥24 months.Exclusion criteria:(1)serious,uncontrolled organic lesions or infections;(2)mentally ill patients,pregnant or lactating women;(3)the main data are incomplete.Results:Among the 200 patients,the median observation time was 50.60 months,and a total of 36 patients had recurrence and metastasis.112 males and 88 females were included in the study;the age of surgery was between 31 and 80 years old,the median age of surgery was 60 years old;110 cases of smoking history,accounting for 55%of the total,67 cases smoking index was above 400,accounting for 33.5%;75 cases with family history,accounting for 37.5%;10 cases of radioactive substances,poisons and chemical exposure,accounting for 5%of the total;pathological type of 152 cases of adenocarcinoma,43 cases of squamous cell carcinoma,and the other 5 cases(including adenosquamous carcinoma,sarcomatoid carcinoma,large cell carcinoma);the primary site was 156 cases of periph eral type,44 cases of central type;26 cases of high differentiation,8 cases of high-medium differentiation,54 cases of medium differentiation,19 cases of moderate-poor differentiation,31 cases with poor differentiation,and 62 cases with unknown differentiation.The pathological stage was 114 cases in stage Ⅰ,41 cases in stage Ⅱ,and 45 cases in stage ⅢA.There were 111 cases in T1 and 83 cases in T2.There were 11 cases of T3,5 cases of T4;131 cases of NO,35 cases of N1,34 cases of N2;89 cases of unchemotherapy after operation,106 cases of postoperative chemotherapy without radiotherapy,5 cases of postoperative chemotherapy with radiotherapy.The principles of TCM treatment are mainly 112 cases of strengthening body resistance,77 cases of eliminating pathogenic factors restore body resistance,11 cases of eliminating pathogenic factors.The specific treatment was 98 cases of tonifying qi and yin,79 cases of invigorating spleen and lung,79 cases of tonifying qi to dissipate phlegm,21 cases of resolving stasis to disintegrate mass,21 cases of dissipating phlegm and expelling dampness,10 cases of invigorating spleen and stomach,7 cases of clearing away heat to remove toxin,6 cases of reinforcing liver and kidney,2 cases of nourishing qi and blood,other(warming yang to disintegrate mass,soothing liver to relieve depression,etc.)10 cases.The specific medication was 160 cases of qi,126 cases of yin,12 cases of yang,10 cases of blood,134 cases of phlegm,119 cases of heat,102 cases of stasis,83 cases of stagnation of qi,93 cases of spleen,66 cases of lung,52 cases of kidney,43 cases of tranquilization,21 cases of liver.TCM treatment:(1)The most postoperative patients with non-small cell lung cancer are treated with the principle of strengthening body resistance or eliminating pathogenic factors restore body resistance,and have no obvious correlation with each index.(2)The application of more treatments is tonifying qi and yin,invigorating spleen and lung,and tonifying qi to dissipate phlegm,and has no obvious correlation with various indicators.(3)In terms of medication,the use of qi and yin are the most common types of invigorator,the main expelling pathogen medicines are to treat phlegm,followed by heat,stasis and stagnation of qi.(4)Relevance:tonifying qi,warming yang,invigorating lung and soothing liver are related to observed variables.Phase Ⅱ patients used tonifying qi 6.43 times of patients with stage I.It is expected that the use of warming yang drugs in patients within 2 months is 5.78 times that of patients in 2-4 months;6.757 times that of patients 4-6 months.The expected use of invigorating lung in patients within 2 months was 6.803 times(P<0.05)that of patients 6-18 months.soothing liver drugs in female patients was 3.984 times that of male patients(P<0.05).(5)Evolution of the treatment method:There was a statistically significant difference in the application of postoperative without chemotherapy in patients with tonifying qi and yin.After half a year,the application of tonifying qi and yin was significantly reduced compared with half a year.The statistically significant changes after chemotherapy were invigorating spleen and lung,tonifying qi to dissipate phlegm.Within 2 months,the application frequency of invigorating spleen and lung,tonifying qi to dissipate phlegm was higher.The application of nourishing qi and blood increased(P<0.1),and the products that damage the human body such as clearing away heat to remove toxin and resolving stasis to disintegrate mass were reduced(P<0.1).(6)Duration of intervention:In patients with stage I NSCLC,there was no correlation between the duration of TCM intervention and DFS.In patients with stage Ⅱ-ⅢA NSCLC,the duration of TCM intervention showed a strong correlation with DFS.The duration of the intervention was significantly higher in the more than 36 months group than in the less than 36 months group,but there was no significant difference between the groups more than 36 months.Conclusions:(1)Postoperative TCM treatment for NSCLC is mainly based on strengthening body resistance and eliminating pathogenic factors restore body resistance.The main treatment for strengthening body resistance is to tonify qi and yin and to invigorating spleen and lung.The main eliminating pathogenic factors methods are clearing away heat to remove toxin,resolving stasis to disintegrating mass and dissipating phlegm and expelling dampness.The specific medications invigorator are mainly for qi and yin.The main expelling pathogen medicines are to treat phlegm,heat,stasis and stagnation of qi.(2)There is no significant correlation between TCM treatment and objective factors.Clinical treatment is still based on syndrome differentiation.(3)The use of tonics increased within 2 months after standard treatment.The application of tonifying qi and yin in patients without post-chemotherapy was significantly increased,and there was no significant change in expelling pathogen medicine.After chemotherapy,doctors should pay attention to invigorating spleen and lung,tonifying qi to dissipate phlegm.And reduce the use of expelling pathogen methods such as clearing away heat to remove toxin and resolving stasis to disintegrate mass.(4)The optimal Chinese medicine intervention duration for patients with stage Ⅰ was 6 months,and the best Chinese medicine intervention duration for patients with stage Ⅱ-ⅢA was 36-48 months. |
PDF Full Text Request