健脾为主的中药复方改善女性晚期胃癌预后的临床评价  

Clinical evaluation on effects of Chinese medicine compound recipe for invigorating spleen on prognosis of female patients with advanced gastric cancer

作　　者：徐燕[1] 赵爱光[1] 赵秋枫[2] 朱晓虹 曹妮达[1] 刘天舒 赵刚[4] 郭伟剑 孟志强 丁红华[7] 刘丽坤[8] 朱莹杰[1] 顾缨[1] 韩颖盈[1] 高峰[1] 王强[1] 陶丽[1] XU Yan;ZHAO Aiguang;ZHAO Qiufeng;ZHU Xiaohong;CAO Nida;LIU Tianshu;ZHAO Gang;GUO Weijian;MENG Zhiqiang;DING Honghua;LIU Likun;ZHU Yingjie;GU Ying;HAN Yingying;GAO Feng;WANG Qiang;TAO Li(First Department of Oncology,Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200032,China;Department of Radiology,Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200032,China;Department of Medical Oncology,Zhongshan Hospital Affiliated to Fudan University,Shanghai 200032,China;Department of Surgery,Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200120,China;Department of Medical Oncology,Cancer Hospital of Fudan University,Shanghai 200032,China;Department of Integarated Traditional Chinese and Western Medicine,Cancer Hospital of Fudan University,Shanghai 200032,China;Department of Oncology,First People＇s Hospital Affiliated to Shanghai Jiao Tong University,Shanghai 200080,China;Department of Oncology,Shanxi Provincial Hospital of Traditional Chinese Medicine,Taiyuan 030012,China)

机构地区：[1]上海中医药大学附属龙华医院肿瘤一科,上海200032 [2]上海中医药大学附属龙华医院放射科,上海200032 [3]复旦大学附属中山医院肿瘤内科,上海200032 [4]上海交通大学医学院附属仁济医院普外科,上海200120 [5]复旦大学附属肿瘤医院肿瘤内科,上海200032 [6]复旦大学附属肿瘤医院中西医结合科,上海200032 [7]上海交通大学附属第一人民医院肿瘤科,上海200080 [8]山西省中医院肿瘤科,山西太原030012

出　　处：《上海中医药大学学报》2018年第4期22-27,共6页Academic Journal of Shanghai University of Traditional Chinese Medicine

基　　金：上海市进一步加快中医药事业发展三年行动计划项目(ZY3-CCCX-3-2003);国家中医临床研究基地业务建设科研专项项目(JDZX2015068);上海市科技创新行动计划项目(13401903700);上海中医药大学附属龙华医院爱建捐赠基金资助项目(AJ021)

摘　　要：目的:评价健脾为主的中药复方对女性晚期胃癌预后的影响。方法:多中心采集女性晚期胃癌患者,采用回顾性非随机同期对照研究方法,以总生存期(OS)作为主要的观察指标,用Kaplan-Meier生存分析计算中位OS,各因素组间用Log-rank进行显著性检验生存分布差异,并用Cox风险比例回归模型进行预后多因素的分析。结果:依据病例选择标准共收集初治女性晚期胃癌患者457例,单因素分析提示,中药(P=0.00)、姑息化疗(P=0.02)是影响女性晚期胃癌生存的预后因素,而原发部位(P=0.71)、组织学分型(P=0.07)、腹膜转移(P=0.17)、靶向治疗(P=0.71)、放疗(P=0.54)则不是。Cox风险比例模型分析亦提示,中药(P=0.00,相对危险度为0.62,95%CI:0.48~0.78)、姑息化疗(P=0.01,相对危险度为0.72,95%CI:0.57~0.92)为影响女性晚期胃癌生存的独立预后因素;而发病年龄(P=0.58)、原发部位(P=0.63)、组织学分型(P=0.18)、腹膜转移(P=0.16)、放疗(P=0.98)、靶向治疗(P=0.58)则为非影响因素。中药组中位生存期为17.6个月、非中药组为11.4个月,差异具统计学意义(P=0.00);中药组的1、2、3、5年生存率分别为72%、36%、19%、14%,而非中药组1、2、3、5年生存率分别为48%、23%、15%、10%。结论:健脾为主的中药复方可改善女性晚期胃癌的预后,联合姑息化疗是目前我国治疗女性晚期胃癌的主要方法。Objective： To evaluate the effects of Chinese medicine compound recipe for invigorating spleen on the prognosis of female patients with advanced gastric cancer. Methods： Female patients with advanced gastric cancer were collected in multi centre. A retrospective non-randomized concurrent control study was conducted. The overall survival（ OS） was taken as the primary endpoint.Kaplan-Meier survival analysis was used to calculate the median OS. The difference of survival distribution among the groups was analyzed by Log-rank. The cox proportional hazard model was used to analyze the multivariate prognostic factors. Results： According to the criteria of case selection,457 female cases of advanced gastric cancer were collected. Single factor analysis suggested that Chinese medicine（ P =0.00）,palliative chemotherapy（ P = 0.02） were the prognostic factors which affected the survival of female patients with advanced gastric cancer,while the primary site（ P = 0. 71）,histological type（ P = 0. 07）,peritoneal metastasis（ P = 0. 17）,target therapy（ P = 0. 71） and radiotherapy（ P = 0.54） were not the prognostic factors. Cox regression analysis suggested that Chinese medicine（ P = 0. 00,hazard ratio[HR]= 0.62,95%CI： 0. 48-0.78）,palliative chemotherapy（ P = 0. 01,HR = 0. 72,95% CI： 0.57-0. 92） were independent prognostic factors.,while age of onset（ P = 0.58）,primary site（ P = 0.63）,histological type（ P = 0.18）,peritoneal metastasis（ P = 0.16）,radiotherapy（ P = 0.98） and targete therapy（ P = 0.58） were not the risk factors. The median overall survival of Chinese medicine group was 17.6 months and that of non-Chinese medicine group was 11.4 months,with statistically significant difference（ P = 0.00）. The one-year,twoyear,three-year and five-year survival rates of Chinese medicine group were 72%,36%,19% and 14% respectively,while the one-year,two-year,three-year and five-year survival rates of non-Chinese medicine group were 48%,23%,15% and 10% respectiv

关 键 词：晚期胃癌 女性 生存期 中医药疗法 健脾 化疗 多因素分析 

分 类 号：R273[医药卫生—中西医结合]