The Real World Study Of The Clinical Efficacy Of Traditional Chinese Medicine In The Treatment Of Ⅲ-Ⅳ Stages Esophageal Squamous Cell Carcinoma

Objective:We used the case-control study to retrospectively analyze the related factors of the survival time of patients with stage III-IV esophageal squamous cell carcinoma from Henan Provincial Hospital of Traditional Chinese Medicine(TCM)and Linzhou TCM Hospital HIS information and evaluated the influence of TCM on the survival prognosis of patients.Further,we preliminary evaluated the related factors,which influenced the survival of patients with stage III-IV esophageal squamous cell carcinoma,in order to lay the foundation for the next step of randomized controlled study.Methods:(1)This study is a retrospective case-control study.We collected 595 III-IV stage of ESCC cases Information from the hospital information system of Henan Provincial Hospital of Traditional Chinese Medicine and Linzhou Hospital of Traditional Chinese Medicine from January 2013 to January 2017.In accordance with taking traditional Chinese medicine decoction or not,we divided Chinese medicine group and non-Chinese medicine group.Among them,there were 109 cases in the phase III Chinese medicine group and 84 cases in the non-Chinese medicine group;196 cases in the phase IV Chinese medicine group and 206 cases in the non-Chinese medicine group.Statistical analysis was performed after follow-up survival time and influencing factors,and P<0.05 was considered statistically significant.(2)Statistically analyze the information of Chinese medicine decoctions taken by patients during hospitalization and the types of TCM syndromes,and obtain the frequency of high-frequency medications and the distribution of syndrome types.Results:1.There are a total of 193 patients with stage III esophageal squamous cell carcinoma.Statistical analysis found that the age of patients in the traditional Chinese medicine group is older than that in the non-Chinese medicine group,and it is statistically significant(P<0.01).The sample size will be expanded in the later period and further research will be carried out on the patients.2.Through statistical analysis of the included 402 patients with stage IV esophageal squamous cell carcinoma,the results show:(1)The median survival time of the Chinese medicine group and the non-Chinese medicine group were 16 and 14 months,respectively,and the difference was statistically significant(χ~2=8.210,P=0.004).(2)The 6-month,12-month and 18-month survival rates of Chinese medicine group compared non Chinese medicine group were 72%,45%,27%vs 63%,38%,19%.(3)Univariate analysis showed that surgery,chemotherapy,traditional Chinese medicine,and liver metastasis were the factors influencing the survival time of patients with stage IV ESCC(P<0.05);gender,age,family history of malignant tumor,Radiotherapy,tumor markers CEA and CA199,lung metastasis,brain metastasis and bone metastasis had no significant correlation with the survival time of patients with stage IV ESCC,and the difference was not statistically significant(P<0.05).(4)Multi-factor analysis showed that traditional Chinese medicine,surgery and liver metastasis were independent factors influencing the survival time of patients with stage IV esophageal squamous cell carcinoma(P<0.05).3.In order to eliminate the influence of confounding factors on the curative effect of Chinese medicine decoctions,statistics on the combined use of Chinese patent medicine injections were made,and the results suggested that the combined use of Chinese patent medicine injections was mainly Astragalus injection and Shenmai injection,and the Chinese medicine group and the non-Chinese medicine combination were combined.There was no statistical difference in medication use(P<0.05).4.Among the TCM syndrome types of patients with stage IV ESCC,the higher proportion were 38.26%of phlegm-qi obstruction syndrome,27.04%of phlegm and blood stasis syndrome,and 19.39%of qi deficiency and yang micro-syndrome.5.In the high-frequency drug association analysis of various syndrome types,the core drug pairs for the syndrome of phlegm-qi crossover syndrome are honeysuckle and forsythia,honeysuckle and pinellia;The core drug pairs of Qi deficiency and Yang micro-syndrome are ochre and agrimony;the core pair of drugs for heat-reducing fluid-deficiency syndrome is Scrophulariae and Ophiopogon.Conclusion:1.Chinese medicine treatment can prolong the survival time of patients with stage IV esophageal squamous cell carcinoma.2.Chinese medicine,surgery and liver metastasis are the prognostic factors that affect the survival time of patients with stage IV esophageal squamous cell carcinoma.3.Chinese medicine and surgery are protective factors that affect the survival time of patients with stage IV esophageal squamous cell carcinoma,and liver metastasis is a risk factor.4.Among the TCM syndrome types of patients with with stage IV esophageal squamous cell carcinoma,phlegm-qi obstruction syndrome accounts for the largest proportion,followed by phlegm-stasis mutual-combination syndrome and Qi deficiency and Yang micro-syndrome.5.The core drugs for phlegm-qi obstruction syndrome are mainly regulating qi to dissipate phlegm,promoting blood circulation and dispersing stagnation;phlegm and stasis syndrome is mainly to dissolve blood stasis and dispel stagnation,and to eliminate phlegm and lower qi;Mainly;the medicines for heat-reducing body fluid deficiency syndrome are mainly nourishing yin and clearing away heat and sweetening and warming to remove heat.