| Objective:A retrospective clinical study was carried out on126advanced (Ⅲb-IV) non-small cell lung cancer (NSCLC) patients who accepted the therapy of cryosurgery combined with TCM, to analyze local microdialectics characteristic of lung cancer and TCM mechanism of cryosurgery therapy, which can provide clinical evidence and guidance, furthermore, to evaluate the clinical value of the "Cryosurgery-TCM" green therapy model, optimize cryosurgery and provid a mor perfect therapy for advanced lung cancer patients.Methods:126advanced NSCLC patients who accepted cryosurgery-TCM therapy during September2003to May2013in oncology department, Dongfang hospital, were enrolled in this study. The clinical data, including lung cancer characteristic, cryosurgery related image data, local microdialectics characteristic of lung cancer and TCM mechanism of cryosurgery were collected in order to analyze survival time of different patients. Meanwhile,30relative normal control cases were also enrolled. Peripheral immune status was compared between the two groups. Then clinical value of the cryosurgery-TCM therapy model was evaluated on advanced NSCLC patients.Results:[1] Patients’ endurance summaryAll the126NSCLC patients underwent cryosurgery successfully and received TCM therapy for long time. During ablation no death occurred. The complications during and after ablation were mild and revovered fast.[2] Survival rate analysis①General description:For the total126patients, the median survival time was12months and the overall survival time was18months.②Survival rate description:The survival rates were69.8%(88/126),42.9%(51/119),26.8%(30/112),12.7%(14/110) and5.6%(6/108) at the time of the6th,12th,18th,24th and36th months after cryosurgery, respectively. When calculating from the date of NSCLC diagnosis, the survival rates were91.3%,71.3%,48.3%,31.6%and13.5%correspondingly.③Survival analysis based on incident age:Younger patients (<65years old) achieved15months overall survival time and9months after-cryosurgery survival time, while older patients (≥65years) achieved22months overall survival time with14months after-cryosurgery survival time. Significant difference was observed of after-cryosurgery survival time (p=0.013). The elder tended to accept conservative choice of minimal invasive and less toxic therapy, Which gained a better survival benefits.④Survival analysis based on pathology: 80adenocarcinoma lung cancer patients, achieved17months overall survival time and11months median survival time. While30squamous cell carcinoma lung cancer patients, achieved19months overall survival time with8months median survival time (after-cryosurgery p=0.213,overall p=0.838). There were on significant differences between the two pathologic types.⑤Survival time based on TNM stages:For the40Ⅲb phase patients, they got25months survival time and14months median survival time. Eighty-six IV stage patients gained17months overall survival time and8months median survival time. Ⅲb stage patients had a longer survival time (after-cryosurgery p=0.029, overall p=0.045)⑥Survival time based on primary lung cancer locations:56central lung cancer patients had17months overall survival time and9months median survival time, meanwhile,70peripheral lung cancer patients had20overall survival time and12months median survival time (after-cryosurgery p=0.238, overall p=0.367).Advanced peripheral lung cancer patients had more advantages when accepted this therapy model.⑦Survival time based on target cryo-lesions size:There were13、53、42and18patients whose target cryo-lesions size were≤3cm,3-5cm、5～8cm and≥8cm, respectively. Their overall and median survival times were29、22、15、14months and23、14、7、7months correspondingly. The more tumor load, the shorter survival time was.(p<0.05)⑧Survival time based on therapy time points:According to the time points, there were46,18,9and53patients suffering from lung cancer for1,2～3,4～6and>6months when patients accepted cryosurgery, respectively. Their median survival times were13,12,10and9months correspondingly(P>0.05).[3]Lesion cryoablation coverage rate analysis:Lesion cryoablation coverage rate was evaluated in94patients. There were8,37,33and16patients with≤3cm,3～5cm,5～8cm and≥8cm lung cancer cryo-lesions. Their mean cryoablation coverage rates were98.5%,85.0%,73.7%and49.6%, respectively. The higher cryo-coverage rate can be found in small size lesions.In the94patients,55patients were central lung cancer and39patients were peripheral lung cancer. Their mean cryo-coverage rates were73.2%and84.8%, respectively. The mean cryo-coverage rate in11patients with heart vascular invasion was64.8%which that in13patients with large areas of atelectasis was69.1%. Higher cryo-coverage rate can be seen in peripheral lung cancer patients than that in central lung cancer patients.The association between cryo-coverage rate and survival time was analyzed. There were20,23,28and23patients with≤50%,50%-80%,80%-100%and≥100%cryo-coverage rate. Their median survival times were8,6,14and18months. Patients who got higher cryo-coverage rate gained a longer survival time.[4]Cryosurgery time analysis:The patients who received cryosurgery can have a longer survival time in the period of initial treatment or disease progression. However, advanced lung cancer patients who accepted cryosurgery-TCM earlier would get more benifits.[5]Immune status analysis:Peripheral blood was got from38lung cancer patients and30relative mormal control cases. The amounts of T cells, NK cells were tested. CD4+cell ratio in peripheral blood decreased (p=0.003), while CD8+cells ratio increased significantly (p=0.010). Advanced lung cancer patients had a relative bad immune function or were in immunosuppression status. Which means the cryosurgery didn’t change immune function in the short time.[6] Local micro dialectics characteristic analysis:According to documents and morden image technology, the features, such as "red","swollen","hot" and "pain", were obvious. Meantime, the lung cancer had "Yang" features, such as unlimited growth, invasion and metastases, which showed the local tumor belonged to toxic heat syndrome.[7] TCM mechanism of cryosurgery application for lung cancer:A principle for lung cancer cryosurgery application is "treating hot syndrome with cold natured drugs", which is a classic TCM theory. TCM theory indicates that the solid tumor of a "hot" feature can disappear if the "cold" can reach. The cryosurgery for lung cancer is a differential treatment.Conclusion:[1] It is safe and effective for advanced NSCLC patients (stage Ⅲb-Ⅳ) who accept cryosurgery plus TCM therapy.[2] Cryosurgery plus TCM therapy model is a new and promisingstrategy for advanced NSCLC patients (stage IIIb-IV), and it can decrease tumor load rapidly and sequential low toxic green TCM therapy providing the possibility for patients" physique adjustment.[3] It is feasible to treat lung cancer with cryosurgery therapy based on local lung cancer micro dialectics characteristic. The ice ball forming during cryosurgery therapy is "cold", and it matches with "hot" of local lung cancer. It can be clarified by TCM principle "treating hot syndrome with cold natured drugs".[4] The immune function should be enhanced for advanced lung cancer during our clinical practice.[5] The method of lesion cryo-coverage rate was established, higher cryo-coverage rate of lung cancer is useful for better survival time. |
PDF Full Text Request