| ObjectivePatients with advanced NSCLC cancer who received compounds of TCM therapy were studied in this retrospective research,to observe the efficacy of compounds of TCM and different integrated Chinese and western medicine treatments based on compounds of TCM in the real world,to analyses the influence of clinical and pathological characteristics of patients on survival prognosis,to screen the dominant population of the treatment based on compounds of TCM,and to provide the real world evidence for the treatment of advanced NSCLC by TCM syndrome differentiation and treatment.MethodsA total of 170 patients with advanced NSCLC hospitalized in Guangdong Provincial Hospital of TCM during 2011/01/01-2016/12/31 were included in this study,the general information,clinical features,pathological genetic status,baseline status,treatment status and other information of the collected cases were reviewed,and survival time after TCM compound intervention was recorded.Statistical analysis was carried out on the cases information,and the relevant information was analyzed by single factor and multi-factor survival analysis to explore the influence of each factor on survival time after TCM compound intervention.Results1.General condition:a total of 170 patients with advanced NSCLC were included in this study,included 104 males(61.2%)and 66 females(38.8%),aged 30～80 years,with an average age of 60.98±9.7 years.There were 89(52.4%)smokers and 74(43.5%)smokers with smoking index ≥400.2.Clinical features:mostly Ⅳ stage patients(86.5%);the most common metastatic sites were lymph nodes(80.6%),lung(51.8%),bone(38.8%),brain(28.8%)and pleura(24.1%).More than half of the patients(52.9%)had a history of previous treatment(36.5%chemotherapy,11.2%radiotherapy,23.5%targeted therapy).3.Pathological features:most of them were adenocarcinoma(77.6%)and squamous cell carcinoma(15.3%).The sensitive mutation rate of EGFR gene was 34.2%in 73 patients who completed the gene test,and 38.5%in 65 patients with adenocarcinoma.4.Baseline status:before treatment,most of the patients were in good physical condition,with 109(64.1%)patients with PS score of 0～1 and 45(26.5%)patients with PS score of 2.The most common syndromes in TCM were qi deficiency with phlegm and dampness(30.6%)and qi stagnation with blood stasis(33.5%).Before treatment,58.8%of the patients had abnormal CEA,22.9%had anemia,22.9%had elevated PLT,and 21.2%had abnormal ALB.5.Treatment status:32 cases(18.8%)were treated with traditional Chinese medicine alone,74 cases(43.5%)were treated with TCM combined with chemoradiotherapy(mainly radiotherapy or chemotherapy),and 64 cases(37.6%)were treated with TCM combined with targeted therapy(joint or non-joint chemoradiotherapy).Only 21 patients(32.8%)who received targeted therapy had a sensitive mutation of the EGFR gene.The median time of receiving compounds of TCM treatment was 8 months.6.Survival analysis:By the statistical deadline(December 1,2019),8 of the 170 patients with advanced NSCLC were still alive,with a median survival time of 12 months after TCM compound intervention.Results of single factor analysis of k-m showed that gender,smoking history,smoking index,bone metastasis,lymph node metastasis,distant metastasis,previous surgical history,gene status,initial PS score,Hb,ALB,treatment mode and treatment time of compounds of TCM were correlated with patients’ survival time after TCM compound intervention(P<0.05).There was no significant correlation between TCM syndrome type and survival time after TCM compound intervention(P=0.062),15 months median survival time after TCM compound intervention of patients of qi deficiency with phlegm and dampness was higher than those with other syndromes.In the single-factor survival analysis of the treatment mode,the median survival time after TCM compound intervention of the patients with the TCM treatment mode alone was 6 months,the median survival time after TCM compound intervention of the patients with the TCM combined with chemoradiotherapy treatment mode was 12 months,and the median survival time after TCM compound intervention of the patients with TCM combined with targeted therapy treatment mode was 18 months,the difference was statistically significant(P<0.01).COX multivariate regression analysis showed that gene status,PS score and treatment time of compounds of TCM were independent influencing factors of survival time after TCM compound intervention(P<0.05),but treatment mode was not independent influencing factors of survival time after TCM compound intervention.Conclusion1.Possible characteristics of the dominant population in patients with advanced NSCLC who receive a compounds of TCM based treatment include:women,no smoking or smoking index<400,no distant metastasis,no bone metastasis,no lymph node metastasis,previous radical surgery recurrence or palliative surgery treatment,sensitive mutation of EGFR gene,PS score of 0～1,Hb or ALB were at normal levels,TCM combined with traditional western medicine treatment mode or TCM combined with targeted therapy treatment mode,long-term compounds of TCM treatment.The TCM syndrome type of qi deficiency with phlegm and dampness has a tendency of survival benefit.2.Gene status,PS score and the duration of compounds of TCM treatment were independent prognostic factors for patients with advanced NSCLC.3.Compared with the survival time of chemotherapy alone in previous literatures,the median survival time after TCM compound intervention of the patients with the treatment mode of TCM combined with chemoradiotherapy in this study was extended,suggested that the curative effect of integrative Chinese and western medicine in the treatment of advanced NSCLC patients is worthy of recognition. |
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