中西医结合治疗对晚期胰腺癌患者生存期的影响  

Effect of integrated traditional Chinese and western medicine treatment on survival time of patients with advanced pancreatic adenocarcinoma

作　　者：王强[1] 曹妮达[1] 王盼盼 高峰[1] 朱莹杰[1] 赵爱光[1] 杨金坤[1] 王小林 江联萍 WANG Qiang;CAO Nida;WANG Panpan;GAO Feng;ZHU Yinjie;ZHAO Aiguang;YANG Jinkun;WANG Xiaolin;JIANG Lianping(First Department of Oncology,Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200032,China;Community Health Service Center of Ruhe East Road,Zhengzhou Hospital of Traditional Chinese Medicine,Henan Province,Zhengzhou 450000,China;Department of Interventional Therapy,Zhongshan Hospital Affiliated to Fudan University,Shanghai 200032,China;Department of Oncology,Minhang Branch of Cancer Hospital Affiliated to Fudan University,Shanghai 201100,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]河南省郑州市中医院汝河东路社区卫生服务中心,河南郑州450000 [3]复旦大学附属中山医院介入科,上海200032 [4]复旦大学附属肿瘤医院闵行分院肿瘤内科,上海201100

出　　处：《上海中医药杂志》2020年第9期50-54,共5页Shanghai Journal of Traditional Chinese Medicine

基　　金：上海市卫计委中医药公共卫生服务补助资金项目(LH 02.55);上海中医药大学附属龙华医院龙医学者(育苗计划)项目(LYTD-44)。

摘　　要：目的评价中西医结合治疗对晚期胰腺癌患者生存期的影响。方法采用非随机同期病例对照的方法,按是否接受中医药治疗,将晚期胰腺癌患者分为中药组、非中药组,并以是否接受西医常规抗肿瘤治疗(化疗和/或放疗)作为进一步预设分层条件,将患者分为中西医结合组、西医治疗组。以总生存期(OS)作为主要疗效评价指标,运用Cox多因素回归分析影响晚期胰腺癌生存期的因素,采用Kaplan-Meier法估算中位生存期,进而评价中西医结合治疗对晚期胰腺癌患者生存期的影响。结果①共纳入晚期胰腺癌患者305例,其中中药组157例,非中药组148例;共245例患者接受西医常规抗肿瘤治疗(化疗和/或放疗),其中中西医结合组127例,西医治疗组118例。②中药组的中位OS为14.9个月,较非中药组的9.6个月显著延长(P<0.001,HR=0.471,95%CI:0.361~0.613);中西医结合组中位OS为14.1个月,较西医治疗组的9.7个月显著延长(P<0.001,HR=0.491,95%CI:0.367~0.658)。③中药组1、2、3、5年的生存率分为41%、23%、16%、11%,非中药组分别为18%、11%、6%、3%,组间差异有统计学意义(P<0.001);中西医结合组1、2、3、5年生存率分别为37%、19%、12%、8%,西医治疗组分别为16%、10%、5%、1%,组间差异有统计学意义(P<0.001)。④多因素分析结果显示,发病年龄(P=0.003)、KPS评分(P<0.001)、手术方式(P<0.001)、化疗(P<0.001)和中药(P<0.001)是影响晚期胰腺癌患者生存期的独立预后因素,其中年龄和化疗为非保护性独立预后因素。⑤中西医结合组白细胞降低、中性粒细胞降低、血小板降低、恶心呕吐的发生率低于西医治疗组(P<0.05);同时,中西医结合组Ⅲ~Ⅳ度白细胞降低、血小板降低的发生率低于西医治疗组(P<0.05)。结论中医药治疗是影响晚期胰腺癌患者生存期的独立预后因素;中西医结合治疗可以延长晚期胰腺癌患者的生存期,并减少化疗后白细胞降低、血Objective To evaluate the effect of integrated traditional Chinese and western medicine treatment on the overall survival of patients with advanced pancreatic adenocarcinoma.Methods By adopting non-randomized simultaneous case-control method,patients with advanced pancreatic adenocarcinoma were divided into traditional Chinese medicine(TCM)group and non-TCM group according to whether they received TCM or not;Patients with advanced pancreatic adenocarcinoma were divided into integrated treatment group and western medicine treatment group according to whether they received standard anti-tumor western medicine treatment(chemotherapy and/or radiotherapy).Taking the overall survival(OS)as the main efficacy evaluation index,Cox multivariate regression analysis was used to analyze the factors influencing the survival time of advanced pancreatic adenocarcinoma,and Kaplan-Meier method was used to estimate the median survival time,and the impact of integrated traditional Chinese and western medicine treatment on the survival time of patients with advanced pancreatic adenocarcinoma was evaluated.Results(1)A total of 305 patients with advanced pancreatic adenocarcinoma were included,with 157 cases in the TCM group and 148 cases in the non-TCM group;245 patients were treated with standard anti-tumor western medicine treatment(chemotherapy and/or radiotherapy),127 cases in the integrated treatment group and118 cases in the western medicine treatment group.(2)The median OS of the TCM group was 14.9 months,significantly longer than that of the non-TCM group,which was 9.6 months(P<0.001,HR=0.471,95%CI:0.361~0.613);The median OS was 14.1 months in the integrated treatment group,which was significantly longer than 9.7 months in the western medicine treatment group(P<0.001,HR=0.491,95%CI:0.367~0.658).(3)The 1-,2-,3-,and 5-year survival rates were 41%,23%,16%and 11%in the TCM group while those of non-TCM group were 18%,11%,6%and 3%respectively,with statistically significant difference(P<0.001);The 1-,2-,3-,and 5-year survival rates i

关 键 词：中西医结合组 晚期胰腺癌 白细胞降低 多因素回归分析 中医药治疗 疗效评价指标 发病年龄 病例对照 

分 类 号：R735.9[医药卫生—肿瘤]