益肺消积颗粒联合表皮生长因子受体-酪氨酸激酶抑制剂治疗不同证型晚期非小细胞肺癌疗效观察  

Observation on the effect of Yifei Xiaoji granules combined with epidermal growth factor receptor-tyrosine kinase inhibitor in the treatment of different syndrome of advanced non-small cell lung cancer

作　　者：李晓芳[1] 刘标[1] 国风 何志洁[1] LI Xiaofang;LIU Biao;GUO Feng;HE Zhijie(Suzhou Hospital Affiliated to Nanjing Medical University/Suzhou Tumor Diagnosis and Treatment Center, Suzhou 215006, Jiangsu, China)

机构地区：[1]南京医科大学附属苏州医院/苏州市肿瘤诊疗中心,江苏苏州215006

出　　处：《现代中西医结合杂志》2020年第36期3996-4001,共6页Modern Journal of Integrated Traditional Chinese and Western Medicine

基　　金：国家自然科学基金面上项目(81672975);江苏省中医药局科技项目(YB2015103);苏州市卫计委重点医学中心项目(Szzx201506)。

摘　　要：目的观察益肺消积颗粒联合表皮生长因子受体-酪氨酸激酶抑制剂(EGFR-TKIs)一线和二/三线治疗晚期非小细胞肺癌(NSCLC)的疗效,探讨中医辨证施治在中西医结合治疗晚期NSCLC中的临床意义。方法按照治疗方案不同将73例晚期NSCLC患者分为益肺消积颗粒+EGFR-TKIs一线组26例、益肺消积颗粒+EGFR-TKIs二/三线组22例和EGFR-TKIs单药组25例。按照中医证型将73例晚期NSCLC患者分为脾虚痰湿型13例、气滞血瘀湿阻型5例、阴虚内热型19例和气阴两虚型36例。观察患者治疗后临床疗效[中医证候改善情况、ECOG评分、客观反应率(ORR)、疾病控制率(DCR)]和生存情况[总生存期(OS)、无进展生存期(PFS)、中位生存期(MST)和18个月生存率]。结果73例患者中,28例(38.4%)获中医证候显著改善,27例(37.0%)获部分改善,18例(24.7%)无明显改善;24例(32.9%)ECOG评分降低≥1分,28例(38.4%)稳定,21例(28.8%)增高≥1分;ORR为56.2%(41/73),DCR为72.6%(53/73),MST为17.7个月,OS为17.7个月(7.8~25.7个月),PFS为12.7个月(5.6~18.8个月),18个月生存率为45.2%(33/73)。不同治疗方案组间ORR、OS、PFS比较差异均有统计学意义(P均<0.05),益肺消积颗粒+EGFR-TKIs一线组ORR更高,OS和PFS更长,而中医证候改善、ECOG评分和DCR比较差异均无统计学意义(P均>0.05)。不同中医证型之间患者的证候改善、ORR、DCR、OS和PFS比较差异均有统计学意义(P均<0.05),ECOG评分比较差异无统计学意义(P>0.05)。结论益肺消积颗粒能够提高EGFR-TKIs一线治疗晚期NSCLC的临床疗效,延长生存期,改善生活质量,但不同中医证型间疗效有明显差异,临床应辨证施治。Objective It is to observe the efficacy of Yifei Xiaoji granules combined with epidermal growth factor receptor-tyrosine kinase inhibitors(EGFR-TKIs)in the first-line and second/third-line treatment of advanced non-small cell lung cancer(NSCLC),and explore the clinical significance of TCM syndrome differentiation and treatment in the treatment of advanced NSCLC with integrated TCM and western medicine.Methods According to different treatment plans,73 patients with advanced NSCLC were divided into Yifei Xiaoji granules+EGFR-TKIs first-line group of 26 cases,Yifei Xiaoji granules+EGFR-TKIs second/third line group of 22 cases and single EGFR-TKIs group of 25 cases.According to TCM syndrome,73 patients with advanced NSCLC were divided into 13 cases of spleen deficiency and phlegm-dampness type,5 cases of Qi stagnation,blood stasis and dampness obstruction type,19 cases of Yin deficiency and internal heat type,and 36 cases of Qi and Yin deficiency type.The clinical efficacy[improvement of TCM syndromes,ECOG score,objective response rate(ORR),disease control rate(DCR)]and survival status[overall survival(OS),progression-free survival(PFS),medium survival time(MST)and 18-month survival rate]of patients after treatment were observed.Results Among 73 patients,28 patients(38.4%)received significant improvement in TCM syndromes,27 patients(37.0%)received partial improvement,18 patients(24.7%)had no significant improvement;24 patients(32.9%)had an ECOG score reduction of≥1 point,28 cases(38.4%)were stable,21 cases(28.8%)had an increase of≥1 point;ORR was 56.2%(41/73),DCR was 72.6%(53/73),MST was 17.7 months,and OS was 17.7 Months(7.8-25.7 months),PFS was 12.7 months(5.6-18.8 months),and the 18-month survival rate was 45.2%(33/73).There were significant differences in ORR,OS,PFS among these treatment regimens(P>0.05).The ORR of Yifei Xiaoji granules+EGFR-TKIs first-line group was significantly higher than that of the other groups(both P<0.05),OS and PFS were significantly longer than those of the other groups(both P<0.05)

关 键 词：益肺消积颗粒 表皮生长因子受体-酪氨酸激酶抑制剂 非小细胞肺癌 辨证施治 

分 类 号：R734.2[医药卫生—肿瘤]