| BackgroundLung cancer is the most familiar malignancy carcinoma, it ranks the first place in incidence rate and mortality in many place. Epidemiology and etiology of lung cancer Research Survey in China remind that the incidence of lung cancer increases with age, it rises rapidly since50,70reaches the peak. In recent years, with the accelerate growing trend of the aging, incidence rates and mortality of elderly lung cancer have tended to increase. Surgery is the reliable treatment of early patients with advanced lung cancer to cure the disease, but the truth is that, about70%of NSCLC patients are advanced when they diagnosed the first time, they lose the chance to have surgery and they can only receive the palliative treatment. Chemotherapy is the most important treatment for patients with advanced NSCLC, and elderly patients are hard to tolerate the treatment, and it will appears complex clinical symptoms. In many clinical trials, patients above70were excluded, so it is urgent to study a effective treatment for elderly NSCLC patients.Traditional Chinese Medicine takes an important place in the treatment of lung cancer, TCM considers both part and entire body, it follows the principles of diagnosis and treatment, combines surporting "Zheng" and lustrating "xie" to treat lung cancer. The cause of lung cancer is inseparable from the phlegm, blood stasis, toxin, weakness, and "phlegm" and "weakness" is an important cause of lung cancer,"phlegm" is the temporary cause, and "weakness" is the source of the diseases. My tutor Professor Lin Lizhu erected the therapy of "Benefiting Vital Energy and Eliminating Phlegm", based on the long-term clinical practices and combines the nature of the course of the disease. In the study of National Tenth Five Year Plan and National Eleven Five Support Program we have verified that the therapy of this method could stablized tumor and extend the median suvival period of lung cancer patients with stage Ⅲ and IV. Eliminating phlegm to lustrating "xie", when "xie" is gone, the organism will return to normal. Treat patient with therapy of warming cold phlegm, clearing heat phlegm, drying dampness and moisten dryness and transform phlegm, according to the syndromes of patients. Benefiting Vital Energy is to support "Zheng", in addition to disperse Qi of lung, we should also treat with the therapy of strengthening spleen to generate lung and replenishing Qi to invigorate the spleen. In recent years, the clinical research of treat NSCLC with TCM had made some progress in stabilizing tumor, prevention of complications, reducing toxic and side-effects, improving quality of life and extending survival etc.These can’t be ignored.PurposeUse the methods of retrospective analysis to evaluate change of tumor, prevention of complications, reduction of toxic and side-effects, improving quality of life and survival and tolerability in patients with advanced-stage (Ⅲ、Ⅳ) elderly NSCLC receiving "Benefiting Vital Energy and Eliminating Phlegm" of TCM therapy. To search the safe and effective treatment strategy for elderly patients with advanced NSCLC.Patients and Method:The retrospective study was performed on100cases of senile Ⅲ, IV NSCLC who was seen in the First Affiliated HosPital of Guangzhou University of TCM, in last10years, seperates them in2groups according to their received treatment,group A received treatment of TCM and group B received combined treatment of TCM and Western medicine, to observe the index of survival, PFS, change of tumor, syndrome improvement, change of KPS, weight, CEA and fuction of bone marrow, live and kidney. Multivariate analysis was calculated by the Cox Proportional hazard model.Results:The median survival time of two groups were group A is496days, group B691days, the median survival time of group B is4.5months longer than group A, with a3-years survival rate of8.1%、24.8%, there were no statistical significance between two groups. In senile Ⅲ, the median survival time of group A is496days, while group B is691days, with a2-years survival rate of15.4%、43.8%, there are statistical significance between two groups. The median survival time of pattern FRTY in senile Ⅲ is441days, while PXTS is778days, YXTR is441days, QYLX is363days.PXTS is the longest in senile Ⅲ. There are statistical signigicance among those groups. The median survival time of group A in senile IV is428days, group B is569days, there were no statistical significance between two groupsThe PFS of two groups were group A295days, group B335days, there were no statistical significance between two groups. In each group, we separate patients in4patterns which are:phlegmatic stagnatin due to passive congestin of lungs(FRTY), phlegmatic hygrosis due to spleen asthnia (PXTS), yin deficiency and phlegmopyrexia(YXTR), and deficiency of both qi and yin(QYLX). The PFS of each patter in group B were:193days(FRTY),499days(PXTS),255days(YXTR),335days(QYLX). We can conclude that the PFS of PXTS in group B is the longest, there are obvious statistical significance among each patterns. The Cox regression analysis involves14covariates. The result showed that independent Prognosis included, the protective factors are major axis before treat, family history of cancer, the dangerous factors are KPS before treat and sexAccording to the evaluation of theraoeutic efficiency of tumor, in group A, the tumor response rate (CR+PR) were79.2%, the disease control rate is96.2%, in group B they were80.9%and100%, there were no statistical significance between two groups. KPS improvement rate in group A is41.5%, in group B it is42.6%, there were no statistical significance between two groups. After treatment, improvement of chest pain, fever and anhelation is more obvious in group A, improvement of cough and tired is more obvious in group B, there are statistical signigicance between2groups of the improvement of syndromes of chest pain, anhelation and cough. In group B, the average weight increased1.72kg after treatment and in group A the average weight declined0.15kg, there are statistical signigicance between2groupsConclusions:The treatment of TCM can extends the overall suvival of elderly patients with advanced NSCLC, it also have certain effect in stablised tumor, improving syndroms, declined the occurrence of arrest of bone marrow and damage of liver and kidney. The treatment of TCM combines western medical which extends the overall suvival and PFS is superior than TCM. Chemotherapy and other western medical combines TCM is an efficient treatment of patients with greater KPS. The patients in patterns of PXTS accepts the treatment of "Benefiting Vital Energy and Eiiminating Phlegm" benefits in overall survival, and the median PFS of patients in patters of PXTS is longer than other patterns.The protective factors of independent prognosis of elderly patients with advanced NSCLC are major axis before treat, family history of cancer, CEA before treat, the dangerous factors are metastatic lymph nodes, KPS before treat and symptoms before treatThere is no obvious difference between the effects of treatment in2groups. The tumor response rate and disease control rate of group B is higher than group A, the imorovement of chest pain, fever and anhelation in group A is better than group B, while the improvement of cough and tired in group Bis better than group A. The average weight of group B increaces1.72kg after the treatment... |
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