| Objective:With a retrospective analysis of the experimental design method,by analyzing the relevant factors affecting the disease-free survival and overall survival of patients with gastric cancer after D2 radical resection,the application of Jianwei Sanjie Recipe in patients after radical resection of gastric cancer was analyzed,and its observation The clinical efficacy further clarifies the advantages and safety of Jian Wei San Jie Fang based on the academic thought of "strengthening the body and eliminating evils and treating cancer",and provides a research basis for the application of Jian Wei San Jie Fang in patients with various stages of gastric cancer.Methods: Strictly follow the inclusion criteria and exclusion criteria,and select the Ⅱ(ⅡA,ⅡB)-Ⅲ(ⅢA,ⅢB,ⅢC)patients who attended the Affiliated Hospital of Shandong University of Traditional Chinese Medicine-Yantai Traditional Chinese Medicine Hospital from January 2012 to January 2020 Patients after radical resection of gastric cancer D2.Collect the original data such as hospitalization and outpatient medical records,and use Excel table to record the patient’s gender,age,surgical site,postoperative pathological type,TCM syndrome differentiation,postoperative treatment methods,disease recurrence or metastasis time,clinical death time,etc.Analyze the data to understand basic clinical characteristics such as age of onset of gastric cancer,location,pathological classification,staging,and composition of TCM syndromes;at the same time,single-factor and multi-factor analysis are used to obtain correlations that affect the survival time and disease-free survival time of patients after radical resection of gastric cancer Factors,univariate analysis adopts Kaplan-Meier method and uses Log-Rank and Breslow to perform hypothesis testing;factors that are statistically significant for disease-free survival and overall survival time are selected and included in the Cox proportional hazard model for multivariate analysis to obtain Independently related factors affecting the survival and disease-free survival of patients after radical gastric cancer,and the effect of Jian Wei San Jie Fang on disease-free survival was analyzed by TNM staging.Finally,according to different treatment methods,the patients were divided into treatment group(Jian Wei San Jie Fang plus chemotherapy group)and control group(chemotherapy group).By analyzing the disease-free survival period,survival period,survival rate,and laboratory test indicators of the two groups before and after treatment(CA19-9,CEA,CA72-4),ECOG ps score,TCM syndrome score,and improvement of TCM syndrome curative effect.Observe the clinical curative effect of Jian Wei San Jie Fang.At the same time,monitor and record the occurrence of adverse reactions in patients.Results:1.A total of 160 patients were included in the study,105 males and 55 females,with a male-to-female ratio of 1.91:1.62 cases(38.8%)were between61 and 70 years old,and 48(30.0%)were between Between 71-80 years old,24patients(15.0%)were between 51-60 years old,suggesting that gastric cancer mostly occurs in elderly people over 60 years old,followed by middle-aged people between 50-60 years old.Therefore,middle-aged and elderly men with gastrointestinal symptoms should pay attention to gastric cancer screening.2.Gastric cancer mostly occurs in the antrum of the stomach,and most of the surgical resection sites are the distal stomach,accounting for 73.8%of the total.In the postoperative pathological classification,the incidence of adenocarcinoma was the highest,with a total of 136 people,accounting for85.0% of the total number,of which 106 cases were poorly differentiated adenocarcinoma,accounting for 66.3% of the total number.Followed by signet ring cell carcinoma,a total of 15 people,accounting for 9.4% of the total.It suggests that the pathological type is mostly poorly differentiated adenocarcinoma with higher malignancy,followed by signet ring cell carcinoma with higher malignancy.There are 54 cases of stage II patients and 106 cases of stage III patients,suggesting that the early onset of gastric cancer is hidden and difficult to detect.Even if there is a chance for surgery,it is mainly locally advanced.It can be seen that the majority of patients with gastric cancer are poorly differentiated adenocarcinoma,locally advanced,and highly malignant.Early screening and intervention for precancerous lesions should be performed,and gastroscopy should be performed regularly.3.In the differentiation of gastric cancer,the liver-stomach discordant type is the main type,a total of 48 patients,accounting for 30.0% of the total;30 patients with qi stagnation and blood stasis type,accounting for18.8%;17 patients with spleen deficiency,phlegm and dampness aggregation type,Accounted for 10.6%;26 patients with gastric-heat-yin deficiency type,accounting for 16.3%;26 patients with Qi-blood deficiency type,accounting for 16.3%;13 patients with spleen and kidney-yang deficiency type,accounting for 8.1%.According to Kaplan-Meier analysis The relationship between syndrome differentiation and disease-free survival and overall survival,qi stagnation and blood stasis type(12.330±1.253 months)and qi and blood deficiency type(14.800±3.277 months)have a shorter disease-free survival period,while spleen deficiency and phlegm dampness The conglomerate type(59.230 ± 33.055 months)has a longer disease-free survival period.Qi stagnation and blood stasis type(46.558±8.263 months),stomach heat and yin deficiency type(47.835±7.884 months),qi and blood deficiency type(47.385±8.705 months)have a shorter survival period,while spleen deficiency and phlegm-dampness type(85.996±9.253 months)The survival time is longer.4.45 people in the treatment group had recurrence and metastasis,accounting for 51.7% of the total number of people in the treatment group,and 68 people in the control group had recurrence and metastasis,accounting for 93.2% of the total number of people in the control group.There were 23 deaths in the treatment group,accounting for 26.4%,and 39 deaths in the control group,accounting for 53.4%.According to the χ~2 test,there were significant differences in the number of recurrences and metastases and deaths between the two groups(p=0.000<0.05).The 1,3,and 5-year survival rates of the treatment group were 98.9%,83.3%,and 57.6%,respectively,and the control group were 97.2%,32.9%,and 18.5%.The 3-year and 5-year survival rates were significantly different.5.The results of univariate and multivariate analysis of disease-free survival time of patients with gastric cancer: the median disease-free survival time of the treatment group was 39.170±10.845 months,and the control group was 12.100±1.058 months.The two groups were disease-free survival The period difference is obvious(p=0.000).Among them,the effect of Jianwei Sanjie Recipe on disease-free survival was analyzed by stages.The average disease-free survival time of the treatment group of stage II patients was 64.888±7.547 months,the control group was 19.424±3.529 months;the average treatment group of stage III patients The disease-free survival time was 47.964±5.735 months,and the control group was 14.498±1.067 months.The results showed that patients at stage II or III could benefit significantly from TCM treatment(P=0.00).The multivariate COX risk proportional regression model of disease-free survival showed that the treatment method(p=0.000),the surgical site(p=0.005),and the stage(p=0.019).Syndrome differentiation(p=0.000)is an independent factor that affects disease-free survival.Among them,traditional Chinese medicine combined with chemotherapy is compared with chemotherapy,remote gastrectomy,stage II is relative to stage III,and liver disease Stomach discord,spleen deficiency,phlegm and dampness accumulation,stomach heat and yin deficiency are protective factors for recurrence and metastasis of gastric cancer.Unfavorable risk factors include proximal gastrectomy(Exp(B)=2.514),syndrome differentiation and stagnation of qi Blood stasis type(Exp(B)=1.739),Qi and blood deficiency type(Exp(B)=2.886).6.The results of univariate and multivariate analysis affecting the overall survival time of gastric cancer: the average survival time of the treatment group was 76.201±5.136 months,and the control group was 33.685±2.582 months.The persistence of taking traditional Chinese medicine is a related factor of overall survival time.The average survival time of the continuous taking traditional Chinese medicine group is 89.412±5.206 months,the non-continuous taking traditional Chinese medicine group is 35.379±3.934 months,and the non-taking traditional Chinese medicine group is 33.168±2.529 months.The P value is 0.00 by Log Rank and Breslow test.The factors that affect overall survival are included in the multivariate COX risk proportional regression model.The results show that the independent related factors that affect the overall survival time of patients after surgery include treatment(p=0.000),staging(p=0.034),and syndrome differentiation(p=0.004).7.In terms of tumor markers,the treatment group and the control group showed differences in the levels of CA19-9,CEA,and CA72-4 before and after treatment,but there was a significant difference between the two groups after treatment(p=0.000);ECOG ps scores were different before and after treatment,but different from the treatment group,the ECOG ps score(1.40±0.996)after treatment in the control group increased compared with before(1.04±0.655)(p=0.001);In terms of TCM syndrome scores,there was a significant difference between the treatment group before and after treatment(p=0.000),while the control group did not show a significant difference(p=0.235);in terms of the improvement of TCM syndromes,the treatment group had a total effect of75 Cases in 87 cases,another 12 cases were invalid;the total effective rate was 86.2%,and the inefficiency was 13.8%.There were 73 cases in the control group,the effective rate was 17.8%,and the inefficiency was 82.2%.about13 cases were effective and 60 cases were ineffective;the difference was statistically significant(P=0.000<0.05);in the occurrence of adverse reactions,the treatment group was in the bone marrow Inhibition,diarrhea,and vomiting were significantly different from the control group in the occurrence of the three common toxic and side effects of chemotherapy(P<0.05),but there were no significant differences in the three aspects of peripheral neuritis,alanine aminotransferase elevation,and creatinine elevation.(P>0.05).Conclusion:1.Jian Wei San Jie Fang combined with chemotherapy,postoperative staging and syndrome differentiation are independent related factors that affect disease-free survival and overall survival of patients after D2 radical resection of gastric cancer.The disease-free survival and survival period of stage II is longer than that of stage III.In the syndrome differentiation,Qi stagnation and blood stasis type and Qi and blood deficiency type have shorter disease-free survival and overall survival,while spleen deficiency and phlegm-dampness aggregation type have longer disease-free survival and overall survival.2.Compared with chemotherapy alone,Jian Wei San Jie Fang combined with chemotherapy has an advantage in prolonging disease-free survival and overall survival of stage II and III patients,and it can reduce CEA,CA19-9,CA72-4levels,and increase patients 3 The annual and 5-year survival rate,the improvement of ECOG ps score and the score of TCM syndromes are more prominent.3.The combination of Jian Wei San Jie Fang with chemotherapy based on the academic idea of "strengthening the body and eliminating pathogens and treating cancer" has advantages over chemotherapy alone in reducing the occurrence of common side effects of chemotherapy such as bone marrow suppression,diarrhea,and vomiting.It is clinically worthy of promotion. |
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