基于健脾为基础的辨证治疗方案对ⅢC期胃癌根治术后患者无病生存期的影响  

TCM Syndrome Differentiation and Treatment Based on Invigorating Spleen for Patients with Stage Ⅲ C Gastric Cancer after Curative Surgery

作　　者：朱晓虹[1] 赵爱光[1] 李宏伟[1] 曹妮达[1] 徐燕[1] 赵刚[2] 严敏[3] 郑坚[1] 杨金坤[1] 

机构地区：[1]上海中医药大学附属龙华医院,上海200032 [2]上海交通大学医学院附属仁济医院,上海200127 [3]南京中医药大学附属张家港市中医医院,江苏张家港215600

出　　处：《中国肿瘤》2016年第7期569-574,共6页China Cancer

基　　金：上海市卫生系统优秀人才培养计划(优秀学科带头人)项目(XBR2013103);上海市中医药事业发展三年行动计划(重大研究)项目(ZYSNXD-CC-ZDYJ044)

摘　　要：[目的]探讨基于健脾为基础的辨证治疗方案对ⅢC期胃癌根治术后患者无病生存期（disease-free survival,DFS）的影响。[方法 ]采用多中心、前瞻性同期对照研究方法 ,将ⅢC期胃癌根治术后病例,以是否自愿接受基于健脾为基础的辨证治疗方案分为中药治疗组和非中药治疗组。以DFS为主要疗效评价指标,通过Cox比例风险模型对影响DFS的预后因素进行多因素分析,应用Kaplan-Meier法估算中位无病生存时间。[结果]Cox多因素分析显示,中药治疗（P=0.035）是影响ⅢC期胃癌根治术后患者DFS的独立预后因素。中药组的中位DFS为36.67个月,非中药组为21.47个月（P=0.016）,接受基于健脾为基础的辨证治疗方案的相对危险度为0.593（95%CI：0.365~0.964）。中药组的1、2、3、5年无病生存率分别为84%、59%、49%、34%,非中药组分别为74%、44%、28%、18%。[结论 ]基于健脾为基础的辨证治疗方案是影响ⅢC期胃癌根治术后患者预后的独立保护性因素。在延长ⅢC期胃癌根治术后患者的无病生存期方面显示出一定的优势。[Purpose] To evaluate the effect of TCM syndrome differentiation and treatment based on invigorating spleen on disease-free survival（DFS） for patients with stage ⅢC gastric cancer after curative surgery. [Method] One hundred and ninety three patients with stage IIIC gastric cancer who accepted radical resection were enrolled in this multi-central and prospective controlled study.Patients were assigned to either traditional Chinese herbal medicine treatment based on invigorating spleen（TCM group,n=72） or non-TCM group（n=121） by their own wills.Multivariate Cox-regression analysis was performed to determine survival trends adjusted for clinical and demographic factors. Kaplan-Meier curves were used to assess the differences in DFS. [Results] Cox-regression analysis showed that TCM treatment（HR=0.593,95%CI：0.365-0.964,P=0.035） was independent prognostic factor for DFS. Median disease-free survival time was 36.67 months in the TCM group compared with 21.47 months in non-TCM group（P=0.016）. One-,two-,three-,and five-year DFS in the TCM group were 84%,59%,49%,34% and those in non-TCM group were 74%,44%,28%,18%,respectively. [Conclusion] TCM syndrome differentiation and treatment based on invigorating spleen can prolong DFS of patients with stage ⅢC gastric cancer after curative surgery.

关 键 词：胃癌 健脾 无病生存 病例对照研究 

分 类 号：R735.2[医药卫生—肿瘤]