健脾解毒方对晚期大肠癌同时性和异时性转移患者生存时间影响的回顾性分析  

Effect of Jianpi Jiedu Formula(健脾解毒方)on Survival Time in Advanced Colorectal Cancer Patients with Synchronous and Metachronous Metastases:A Retrospective Analysis

作　　者：杜美璐 侯风刚[1] 石齐[1] 韩苏苏 杨伊 贾嘉柠 刘星[1] 石川 殷晓聆[1] DU Meilu;HOU Fenggang;SHI Qi;HAN Susu;YANG Yi;JIA Jianing;LIU Xing;SHI Chuan;YIN Xiaoling(Shanghai Municipal Hospital of Traditional Chinese Medicine,Shanghai University of Traditional Chinese Medicine,Shanghai,200071)

机构地区：[1]上海中医药大学附属市中医医院,上海市200071

出　　处：《中医杂志》2023年第8期820-826,共7页Journal of Traditional Chinese Medicine

基　　金：上海市2020年度科技创新行动计划医学创新研究专项(20Y21902700)。

摘　　要：目的观察健脾解毒方对晚期大肠癌同时性转移和异时性转移患者生存情况的影响。方法回顾性收集确诊的晚期大肠癌患者的一般资料及病理类型、组织分化、转移部位、既往治疗史、既往病史、确诊时间、复发转移时间、死亡时间,确诊6个月内出现转移为同时性转移,确诊6个月后出现转移为异时性转移。根据是否服用健脾解毒方将入组患者分为健脾解毒方组和对照组,同时性转移患者分为健脾解毒方1组和对照1组两个亚组;异时性转移患者分为健脾解毒方2组和对照2组两个亚组。采用倾向性评分匹配平衡组间协变量,以生存时间为主要结局指标。采用Kaplan-Meier曲线分析比较健脾解毒方组和对照组患者生存时间及亚组患者生存时间,Cox比例风险回归模型分析协变量(年龄、性别、肿瘤原发部位、分化级别、病理类型、转移部位、手术史、化疗史、合并症)对晚期大肠癌患者的生存时间的影响。结果匹配前共纳入874例患者,匹配后纳入770例,其中同时性转移患者290例(健脾解毒方1组130例,对照1组160例),异时性转移患者480例(健脾解毒方2组262例,对照2组218例)。健脾解毒方组患者中位生存时间为38个月,对照组为30个月,死亡风险比HR为0.77(95%CI:0.67~0.89,P<0.001)。健脾解毒方1组的中位生存时间为20个月,对照1组为14个月,两组比较差异有统计学意义(P<0.05),死亡风险比HR为0.80(95%CI:0.63~1.01);健脾解毒方2组中位生存时间为49个月,对照2组为37个月,两组比较差异有统计学意义(P<0.01),死亡风险比HR为0.79(95%CI:0.66~0.95)。同时性转移和异时性转移患者中位生存时间分别为16个月和42个月,死亡风险比HR为2.23(95%CI:1.92~2.59,P<0.001)。结论健脾解毒方可以延长晚期大肠癌异时性转移患者生存时间,降低同时性转移患者死亡风险,且异时性转移患者从健脾解毒方中获益更多。Objective To explore the effect of Jianpi Jiedu Formula(健脾解毒方,JJF)on survival time in advanced colorectal cancer with synchronous and metachronous metastases.Methods Data were collected from the clinical records of patients with advanced colorectal cancer,including the general information and pathological type,tissue differentiation,metastatic site,previous treatment history,past medical history,diagnosis time,recurrence and metastasis time,and death time.Patients were divided into the synchronous and metachronous metastasis,with synchronous disease defined as distant metastases occurring within,and metachronous disease beyond 6 months of the primary diagnosis.According to whether or not JJF was taken,patients were divided into JJF group and control group(without JJF),and further JJF group1 and control group1 in patients with synchronous metastasis,and JJF group2 and control group2 in patients with metachronous metastasis.Propensity score matching(PSM)was used to further balance the covariates between groups.Survival time was the primary outcome.In addition,we used Kaplan-Meier curve to compare the survival time between JJF and control groups,as well as the Cox proportional hazards regression model to analyze the influence of covariates including age,gender,primary tumor site,differentiation grade,pathological type,metastatic site,operation history,chemotherapy history,and comorbidities on the overall survival in advanced colorectal cancer.Results A total of 874 patients were included before matching,and 770 patients remained after PSM including 290 patients with synchronous metastases(130 cases in the JJF group1 and 160 cases in the control group1)and 480 patients with metachronous metastases(262 cases in the JJF group2 and 218 cases in the control group2).The medium survival time for patients in the JJF group was 38 months,while that in the control group was 30 months,with the hazard ratio(HR)of 0.77(95%CI 0.67-0.89,P<0.001).The medium survival time in the JJF group1 and control group1 was 20 months a

关 键 词：大肠癌 同时性转移 异时性转移 健脾解毒方 生存时间 

分 类 号：R273[医药卫生—中西医结合]