A Real-world Study Of Paclitaxel Combined With Platinum Chemotherapy In The Treatment Of Patients With Advanced Non-small Cell Lung Cancer Of Different TCM Syndrome

Objective: To observe whether there are differences in the efficacy and adverse reactions of paclitaxel combined with platinum chemotherapy in patients with different syndrome types of advanced non-small cell lung cancer,screen out the dominant TCM syndrome types of this chemotherapy regimen,promote the individualized selection of chemotherapy regimens for patients with advanced NSCLC,and provide a real world basis for the clinical application of integrated Chinese and western medicine in the treatment of lung cancer.Methods: This study searched the electronic medical record system of the inpatient department of the First Affiliated Hospital of Hunan University of Chinese Medicine as the database,and screened 79 cases who were admitted to our hospital from January 2015 to October 2020 and met the inclusion criteria.Among them,29 cases were in the qi deficiency and phum-dampness group,18 cases were in the qi and Yin deficiency group,18 cases were in the Yin deficiency and phum-heat group,and 14 cases were in the qi and blood stasis group.Four groups of patients with different syndrome types were treated with paclitaxel combined with platinum chemotherapy,and the specific regimens were as follows: Paclitaxel/paclitaxel liposome(135-175 mg/m2)d1+ cisplatin(75mg/m2)/carboplatin(AUC= 5-6)intravenous infusion(divided into3 days),at the same time,all groups were given routine hydration,diuresis,antiemetic,liver protection and traditional Chinese medicine to treat adverse reactions(such as nausea,vomiting,diarrhea,etc.),a total of 2 cycles of chemotherapy.By referring to the clinical data before and after 2 cycles of chemotherapy,the objective remission rate,tumor markers,TCM syndrome improvement rate,and the incidence of moderate to severe bone marrow suppression were compared among different syndrome types,and the dominant TCM syndrome type of this chemotherapy regimen was screened.Results: 1.Objective remission rate: the total remission rate was 28%,and the remission rate from high to low was 57% in the qi and blood stasis group,28% in the Yin deficiency and phlegm heat group,17% in the qi deficiency and phlegm dampness group,and 17% in the both qi and Yin deficiency group.The differences among the four groups were statistically significant(P < 0.05).Further pairwise comparison showed that there were significant differences between the qi and blood stasis group,the qi deficiency and phlegm dampness group and the qi and Yin deficiency group(P < 0.01).2.TCM syndrome improvement rate: there were significant differences among the four groups(P < 0.05).The improvement rate of TCM syndrome from high to low was the qi and blood stasis group(86%),the Yin deficiency and phlegm heat group,the qi and Yin deficiency group(both 44%),and the qi deficiency and phlegm dampness group(41%).Further pairwise comparison showed that there was a significant difference between the qi and blood stasis group(86%)and the qi deficiency and phlegm dampness group(41%)(P <0.01).3.Tumor markers: The baseline value of serum CEA was the highest in the qi stagnation and blood stasis group,followed by the Yin deficiency and phlegm heat group and the qi deficiency and phlegm dampness group,and the lowest in the qi and Yin deficiency group.Further pairwise comparison showed that the qi stagnation and blood stasis group was significantly higher than the qi and Yin deficiency group(P<0.05).The serum CYFRA21-1 level was Yin deficiency and phlegm heat group,qi deficiency and phlegm dampness group,both qi and Yin deficiency group and qi and blood stasis group.There was no significant difference among the four groups.4.Side effects of chemotherapy: The incidence of ⅲ-ⅳ degree bone marrow suppression was significantly different among the 4 groups(P < 0.05),and the descending order was qi and blood stasis group,Yin deficiency and phlegm heat group,qi deficiency and phlegm dampness group and both qi and Yin deficiency group.Further pairwise comparison showed that there was a significant difference between the qi and blood stasis group(14%)and the qi and Yin deficiency group(67%)(P < 0.01).Conclusions: 1.There are differences in the efficacy of paclitaxel combined with platinum chemotherapy in patients with different syndrome types of non-small cell lung cancer,and the short-term efficacy of chemotherapy in patients with qi and blood stasis type is relatively better.2.There are differences in the myelosuppression response of paclitaxel combined with platinum chemotherapy in patients with different syndrome types of non-small cell lung cancer.The incidence of moderate and severe myelosuppression in patients with qi and blood stasis is relatively low.3.The baseline level of serum CEA in patients with different syndrome types of non-small cell lung cancer was different.The serum CEA level of patients with qi and blood stasis type was higher,and the improvement after chemotherapy with this regimen was better.4.The effect of paclitaxel combined with platinum chemotherapy may be similar to the effect of removing qi and blood stasis in traditional Chinese medicine.