A Comparative Study Of Survival And Clinical Benefits In Patients With Stage â…¢/â…£ Gastric Cancer Receiving Sequential Or Consolidated Treatment Mode With Traditional Chinese Medicine

Objective:To observe the different modes of Comprehensive treatment by Integrative Medicine on advanced stage gastric cancer overall survival (OS), Median Survival Time (MST), survival situation and Clinical Benefit Response (CBR) of the patients enrolled in Traditional Chinese Medicine (TCM) Hospital. One mode is TCM sequential treatment which is called a full course treatment with TCM, the other is TCM consolidated treatment which is called a stage treatment with TCM. We analyze the advantages of Integrative medicine treatment, therefore to provide evidence for its clinical application.Methods:The clinical records of patients with stage Ⅲ/Ⅳ gastric cancer receiving integrative medicine (Western medicine integratedwith TCM) between January1,2007and January1,2010were retrospectively reviewed. According to the treatment mode, the patients is divided into TCM sequential treatment group and consolidated treatment group,88cases were screened out for inclusion criteria, Of the88patients,38received sequential treatment mode with TCM, and50received consolidated treatment mode with TCM. The survival was followed up with a phone call and calculated by Kaplan-Meier method. The factors related with the survival were analyzed by stratified analysis.Results:(1) The Univariate analysis of88patients with stage Ⅲ/Ⅳ stomach cancer on median Overall Survival (mOS):The mOS of88cases was22.0months. It was33.0months in TCM sequential treatment group, longer than that of the consolidated treatment group, which was20.0months (P=0.047). Analysis of the factor on OS by gender, age, clinical stage, Borrmann type, metastasis, syndrome type, the results showed no significant difference, but Borrmann Ⅱ (mOS is18.2months)and BorrmannⅢ(mOS is16.8months) respectively vs Borrmann IV(mOS is11.3months) group are more significant differences on OS (P=0.019, P=0.029); The factor of chemotherapy in Western medicine treatment on the OS was statistically significant (=0.049);Taking the decoction is OS affecting factors:the result is the mOS of taking decoction group is23.8months longer than that not taking decoction group, which is15.6months (P=0.012)(2) The OS and MST of Sequential treatment with TCM group and consolidated treatment with TCM group:The MST of88cases was16.00months. It was33.47months in TCM sequential treatment group, longer than that of TCM Consolidated treatment group, which was20.54months (P=0.245).The comparison of patients with OS and MST on the baseline equilibrium conditions of Age, Borrmann type, histologic type, sites of metastases, clinical stage, treatment. Sub-layer of single-factor (chemotherapy, clinical stage IV) respectively analysis on the mOS of TCM sequential treatment group and TCM consolidated treatment group: chemotherapy group:16.5months,7.3(P=0.017); clinical stage Ⅳ group:21.3months,13.5months (P=0.022).stratified by Age, Borrmann II+Borrmann III+Borrmann IV, G2+G2/G3+G3, surgery, surgery plus chemotherapy, lymph node metastasis, clinical stage III, single syndromes, composite syndromes, taking decoction, no significant difference between groups. By mOS was statistically significant (P<0.05) factor stratified, comparison of MST between TCM sequential treatment group and consolidated treatment group. By clinical stage IV stratified, it was25.00months in TCM sequential treatment group, longer than that of the consolidated treatment group, which was13.17months; months; By chemotherapy stratified, it was17.00months in TCM sequential treatment group, longer than that of the consolidated treatment group, which was10.00months. We can be seen from the results, TCM sequential treatment group longer than TCM consolidated treatment group in mOS and MST. By Borrmann II+Borrmann III+Borrmann IV stratified, it was26.40months in TCM sequential treatment group, longer than that of the consolidated treatment group, which was21.10months; By taking decoction stratified, it was26.95months in TCM sequential treatment group, longer than that of the consolidated treatment group, which was20.64months.(3) The survival rates and Chinese medicine usage of88patients with stage III/IV stomach cancer: Taking decoction in88patients accounted for63.6percent, Chinese medicine injection accounted for100%, oral proprietary Chinese medicines accounted for40.9%. As of March1,2011,88patients survival conditions:53.4percent of patients had died,46.6patients is survival; one-year, two-year and three-year survival rates respectively were68.2percent,34.1percent,12.5percent.(4) The clinical evaluation of clinical benefit related indicator for advanced gastric cancer patients:①The symptom and KPS score of88patients as a whole have improved after one month treatment, the difference was statistically significant (P <0.05). The comparison of TCM sequential treatment group and TCM consolidated treatment group after treatment,the median of symptom score decreased after treatment, the than before treatment, the median of KPS score increased after treatment than before treatment, the two statistical tests did not see the difference (P>0.05), it may be associated with abnormal values.②The comparison of symptom score, KPS score, tumor grading on two groups patients, classification of symptoms (a significant improvement and improvement in sum):between the two groups by chi-square test results, it’s no significant difference (P=0.38). But the rate of improvement of TCM sequential treatment group accounted for71.1percent higher than that of TCM consolidated treatment group accounted for60%.KPS score classification (significantly improved, improved,and stability in sum):TCM sequential treatment group improvement rate was84.2percent higher than that of TCM consolidated treatment group accounted for82percent. It was statistically significant between the two groups (P=0.097). The evaluation in tumors:the response rate of TCM sequential treatment group is81.6percent higher than that of TCM consolidated treatment group accounted for80percent.③The evaluation of total clinical benefit:35patients benefit from TCM consolidated treatment, accounting for70percent.30patients benefit from TCM sequential treatment, accounting for86percent. Although not see significant difference (P=0.485), the rate of clinical benefit with TCM sequential treatment higher than TCM consolidated treatment. It shows that advanced gastric cancer patients can get a greater benefit from TCM sequential treatment.Conclusion:(1) OS of the patients from TCM hospital is significantly longer than that reported by the literature, indicating that integrative medicine may significantly prolong the OS of advanced stage gastric cancer.(2) TCM sequential treatment mode has more advantage than consolidated treatment mode in prolonging OS.(3) The rate of total clinical benefit from TCM sequential treatment higher than TCM consolidated treatment. It shows that advanced gastric cancer patients can gain a greater benefit from TCM sequential treatment. (4) Individualized and combined modality therapy of Chinese medicine treatment program at every stage and in long term is critical to improve survival and clinical benefit rate for patients with advanced gastric cancer.