中医治疗对原发性肝癌术后复发及生存时间的影响  

Influence of Traditional Chinese Medicine Treatment on Postoperative Recurrence and Survival Time in Patients with Primary Liver Cancer

作　　者：陈虹宇 甄宏德 周瑞生 唐莹[5] 潘艳丽 黄海福 周岱翰 CHEN Hong-yu;ZHEN Hong-de;ZHOU Rui-sheng;TANG Ying;PAN Yan-li;HUANG Hai-fu;ZHOU Dai-han(Shenzhen Hospital of Guangzhou University of Chinese Medicine,Shenzhen 518034 Guangdong,China;Shenzhen Medical Center of TCM Oncology,Shenzhen 518034 Guangdong,China;The First Clinical Medical School of Guangzhou University of Chinese Medicine,Guangzhou 510405 Guangdong,China;The First Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510405 Guangdong,China;Institute of TCM Oncology of Guangzhou University of Chinese Medicine,Guangzhou 510405 Guangdong,China;Gushengtang TCM Chain Management Group,Guangzhou 518112 Guangdong,China)

机构地区：[1]广州中医药大学深圳医院(福田),广东深圳518034 [2]深圳市中医肿瘤医学中心,广东深圳518034 [3]广州中医药大学第一临床医学院,广东广州510405 [4]广州中医药大学第一附属医院,广东广州510405 [5]广州中医药大学中医肿瘤研究所,广东广州510405 [6]固生堂中医连锁管理集团,广东广州518112

出　　处：《中医肿瘤学杂志》2023年第5期18-24,共7页Journal of Oncology in Chinese Medicine

基　　金：广州中医药大学“双一流”与高水平大学学科协同创新团队项目(编号:2021XK23)。

摘　　要：目的本研究通过回顾性队列分析,探究中医辨证施治对原发性肝癌术后复发及生存时间的影响。方法选取国医大师周岱翰教授2020年9月至2023年1月经治的符合纳排标准的肝癌术后患者,根据术后有无规范的中医辨证施治分为暴露组与非暴露组,比较两组的复发率及至复发时间(time to recurrence,TTR),分析肝癌术后的预后因素,并探讨中医治疗对患者体重及生存时间的影响。结果纳入合格病例119例,暴露组(60例)与非暴露组(59例)基线不齐,前者病理为肝内胆管细胞癌(intrahepatic cholangiocarcinoma,ICC)及混合细胞癌占25.0%,BCLC C期占16.7%,而后者仅占8.5%与1.7%,有显著性差异(P<0.05)。通过倾向性评分匹配(propensity score matching,PSM)使两组基线均衡。生存分析显示,暴露组的1年、2年、3年、5年复发率对比非暴露组为10.4%、16.6%、29.5%、58.7%与55.8%、75%、81.5%、89.5%,中位TTR为53.8个月对比10.3个月,有显著性差异(χ^(2)=32.5,P<0.001),HR为0.20(95%CI 0.11-0.37,P<0.001)。多因素Cox回归显示,规范的中医辨证施治为预后保护因素,调整后HR为0.16(95%CI 0.08-0.30,P<0.001)。患者病前及前三诊的体重分别为(64.05±1.19)kg、(63.90±0.98)kg、(65.44±1.21)kg与(67.50±1.21)kg,两两对比均有显著性差异(P<0.05)。两组的中位生存时间尚未达到,但暴露组的生存曲线已与非暴露组明显分开(χ^(2)=5.0,P=0.03),HR为0.27(95%CI 0.08-0.94,P=0.02)。结论尽早、合理、规律的中医治疗可延缓肝癌术后复发、促进术后体质恢复,并具有延长总生存时间的潜力。Objective To investigate the influence of TCM syndrome differentiation and treatment on the recurrence and survival time in patients with primary liver cancer after radical treatment through a retrospective cohort analysis.Methods Postoperative patients with primary liver cancer who met the inclusion and exclusion criteria and were treated by the renowned TCM master Zhou Dai-han from September 2020 to January 2023 were enrolled into the analysis.The patients were divided into an exposed group and a non-exposed group with reference to the performance of standardized TCM syndrome differentiation and treatment after radical treatment.The recurrence rate and time to recurrence(TTR)in the two groups were compared,prognostic factors for postoperative of liver cancer were analyzed,and the impact of TCM therapy on the body weight and survival time of the patients was explored.Results A total of 119 qualified patients were included.The baseline of the exposed group(60 cases)and the non-exposure group(59 patients)was uneven,with intrahepatic cholangiocarcinoma(ICC)and hepatic mixed cell carcinoma accounting for 25.0%and BCLC stage C accounting for 16.7%in the exposed group,while only 8.5%and 1.7%in the non-exposure group(P<0.05).After propensity score matching(PSM),the baseline equilibrium of the two groups was achieved,and then the survival analysis results showed that the 1-year,2-year,3-year,and 5-year recurrence rates in the exposed group were 10.4%,16.6%,29.5%,and 58.7%,respectively,compared to 55.8%,75.0%,81.5%,and 89.5%in the non-exposed group.The median TTR was 53.8 months in the exposed group compared to 10.3 months in the non-exposed group,showing a significant difference(χ^(2)=32.5,P<0.001),with a hazard ratio(HR)of 0.20(95%CI being 0.11-0.37,P<0.001).Multivariate Cox regression analysis revealed that standardized TCM syndrome differentiation and treatment was the protective factor for prognosis,with an adjusted HR of 0.16(95%CI 0.08-0.30,P<0.001).The body weight of the patients before illness and at the first

关 键 词：原发性肝癌术后 复发时间 生存时间 中医药 队列研究 

分 类 号：R273[医药卫生—中西医结合] R735.7[医药卫生—中医肿瘤科]