A Retrospective Study Of Syndrome Differentiation Of Traditional Chinese Medicine In The Treatment Of Elderly Patients With Advanced Lung Cancer

OBJECTIVE:To investigate the efficacy differences between traditional Chinese medicine(TCM)and integrative medicine in the treatment of elderly patients with lung cancer aged 80 and above hospitalized in Oncology department of Guang’anmen Hospital having longer survival time and explore the prognostic factors of lung cancer in elderly patients to provide a preliminary basis for treatment strategy.METHODS:A retrospective survey was conducted in the study.Non-Small Cancer Lung Cancer(NSCLC)patients aged 80 years and above who were hospitalized for the first time from January 01,2002 to December 31,2015 having longer survival time were recruited and divided into Chinese medicine treatment group and integrative medicine treatment group.Main statistical indicators were patients’ general situation,clinical features of tumor,TCM syndromes and herbal medicine prescription,survival time.The endpoint indicators of the study are overall survival and 1,3,5-year survival rate till the follow-up date December 31,2016.RESULTS:1,the basic characteristics:the study group of 68 patients,the average age of 82.19 ± 2.645 years old.Divided into simple Chinese medicine group 47 cases,accounting for 69.1%;integrated traditional Chinese and Western medicine group 21 cases,accounting for 30.9%.Among them,23 cases of clinical stage Ⅲ,accounting for 33.8%;clinical Ⅳ 45 cases,accounting for 66.1%.PS score 1 point 40 cases,accounting for 58.8%;PS score 2 points in 28 cases,accounting for 41.2%.Pathological type of clear a total of 37 cases,accounting for 54.4%,of which 11 cases of squamous cell carcinoma,accounting for 16.2%;26 cases of adenocarcinoma,accounting for 23.5%;pathological unknown in 31 cases,accounting for 45.6%.Syndrome classification:including spleen phlegm dampness syndrome,Qi and Yin Deficiency,phlegm mutual mutual evidence,phlegm and blood stasis syndrome,lung and spleen deficiency syndrome,lung and kidney deficiency syndrome,Qi deficiency and blood stasis syndrome and other combinations.2,Survival analysis:The median overall survival of the study population was 22 months.1,3,5 years cumulative survival rates were 66.2%,44.1%,17.6%.There was no significant difference in the 1,3,and 5 year cumulative survival rates between the TCM group and the TCM group(P = 0.098).The median survival time was 19.0 months in 37 patients with pathology,23 cases(median survival time was 18.0 months),14 cases of middle and western medicine group(median survival time was 23.0 months)There was no significant difference between the two groups(P>0.05).(P = 0.013).The median survival time was 8.0 months in patients with score of 2,but the patients with PS score of 1 were not able to score a score of 1,and the difference was statistically significant(P=0.013)Median survival was considered to be related to higher censored data(60.0%).The median survival time was 24.0 months in 31 patients with unknown pathology,including 24 patients in traditional Chinese medicine group and 7 patients with western medicine combined group.Stratified analysis of 37 patients with pathologically clear patients with simple combination of traditional Chinese medicine and traditional Chinese medicine treatment of the median survival time:PS score 2 points(6.0 months vs 17.0 months),clinical stage III(28.0 months vs 17.0 months)(16.0 months vs 23.0 months),single syndromes(18.0 months vs 17.0 months),mild comorbidities(28.0 months vs 19.0 months),moderate comorbidity(16.0 months vs 23.0 months)(16.0 months vs 17.0 months),squamous cell carcinoma(10.0 months vs 17.0 months),and there was no statistically significant difference between the two groups.The incidence of adverse reactions was 60.0%in the TCM group,which was higher than that in the traditional Chinese medicine group(8.3%),the difference was statistically significant(P<0.05).3,Cox regression analysis:the variables in the equation for the PS score and TCM syndromes,regression equation model was statistically significant(P<0.05).4,the characteristics of traditional Chinese medicine treatment analysis:37 cases of pathologically clear patients admitted to the most common TCM syndromes for phlegm and blood stasis syndrome,and then for the Qi and Yin deficiency Syndrome,spleen deficiency phlegm syndrome,lung and spleen deficiency syndrome,phlegm and heat syndrome,lung and kidney deficiency syndrome,Qi deficiency and blood stasis.31 cases of pathologically unknown patients admitted to the most common TCM syndromes for Qi and Yin deficiency,and then for the phlegm and blood stasis syndrome,spleen deficiency phlegm syndrome,lung and spleen deficiency syndrome,phlegm and heat syndrome,lung and kidney deficiency syndrome,Qi deficiency and blood stasis syndrome.Regardless of whether pathologically clear,the frequency of use of Qi invigorating drugs,expectorant,cough relieving and antiasthmatic drugs,Qi regulating drugs and tonifying Yin drugs in patients admitted to the hospital were the highest.The patients in the treatment of pathological diagnosis of Regulating Qi and resolving phlegm,Strengthening Qi,with detoxification,nourishing Yin,promoting blood circulation,digestion and hemostasis;pathology of unknown patients to Boosting Qi and Nourishing Yin,Regulating Qi and resolving phlegm,with clearing away heat and toxic material,clearing damp and promoting diuresis,promoting blood circulation,digestion,astringent method etc.CONCLUSIONS:1.There is no significant difference in the efficacy of combination therapy between Western medicine and TCM,and pure TCM therapy in the treatment of 80 years old and older patients having longer survival time with NSCLC.The treatment of pure traditional Chinese medicine is more safe than the treatment of combination therapy.2,PS score is the possible influencing factors of the prognosis of 80 years old and older patients with advanced lung cancer.PS score and a single TCM syndrome type are independent prognostic factors in patients with prognosis.3.It is difficult for elderly patients with advanced lung cancer to tolerate surgery,radiotherapy and chemotherapy and other means of treatment because of weak constitution.They are more willing to accept traditional Chinese medicine(including traditional Chinese and Western Medicine)treatment.Their syndrome differentiation are asthenia in origin and asthenia in superficiality,intermingled deficiency and excess and deficiency centered.The Chinese medicine treatment for them gives first place to strengthening the body resistance,such as strengthening the body resistance and strengthening the body resistance,with eliminating evil like clearing away heat and toxic material,activating blood circulation to dissipate blood stasis,reduce phlegm and clearing dampness.