中医治疗对不可根治肝癌生存时间及预后的影响  

Influence of Traditional Chinese Medicine Treatment on Overall Survival and Prognosis of Incurable Liver Cancer

作　　者：陈虹宇 黄海福 潘艳丽 甄宏德 周瑞生 唐莹[6] 周岱翰 CHEN Hong-yu;HUANG Hai-fu;PAN Yan-li;ZHEN Hong-de;ZHOU Rui-sheng;TANG Ying;ZHOU Dai-han(Shenzhen Futian Hospital of Guangzhou University of Chinese Medicine,Shenzhen 518034 Guangdong,China;Shenzhen Medical Center of TCM Oncology,Shenzhen 518034 Guangdong,China;Gusheng Tang TCM Chain Management Group,Guangzhou 518112 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)

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]固生堂中医连锁管理集团,广东广州518112 [4]广州中医药大学第一临床医学院,广东广州510405 [5]广州中医药大学第一附属医院,广东广州510405 [6]广州中医药大学中医肿瘤研究所,广东广州510405

出　　处：《中医肿瘤学杂志》2023年第6期1-6,共6页Journal of Oncology in Chinese Medicine

基　　金：深圳市“医疗卫生三名工程”广州中医药大学周岱翰国医大师中医肿瘤团队(编号:SZSM201802040);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：目的通过回顾性队列研究探讨中医辨证施治对不可根治肝癌生存时间的影响。方法纳入周岱翰教授2020年9月-2023年1月经治的符合纳排标准的不可根治肝癌患者,根据其确诊后有无规范的中医辨证施治,分为暴露组与非暴露组,比较两组患者的生存率及总生存时间(overall survival,OS),分析不可根治肝癌的预后因素,并探讨中医治疗对患者接受西医抗肿瘤治疗次数及体重变化的影响。结果纳入合格病例101例,暴露组(55例)与非暴露组(46例)基线均衡。生存分析显示,暴露组1年、2年、3年生存率对比非暴露组为70.0%、60.6%、41.9%对比48.3%、29.3%、9.8%,中位OS为27.3个月对比11.5个月,差异有统计学意义(χ^(2)=5.9,P=0.02),风险比(hazard ratio,HR)为0.50(95%CI 0.29~0.89,P=0.02)。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0.34(95%CI 0.16~0.72,P=0.04)。非暴露组接受肝动脉介入治疗、靶向治疗及PD-1/L1免疫治疗的占比均多于暴露组,且在肝动脉介入的例数与次数方面差异有统计学意义(W=1700,P<0.001)。所有患者病前及前三诊体重为(67.56±1.18)kg、(62.59±1.15)kg、(61.62±1.55)kg及(61.92±1.71)kg(P<0.001),初诊体重对比第二诊、第三诊差异无统计学意义,但第二诊对比第三诊(t=-2.95,P=0.006)差异有统计学意义。结论尽早、合理、规范的中医辨证施治可延长不可根治肝癌患者的总生存时间,减少西医抗肿瘤治疗次数,并具有维持体重的趋势。Objective A retrospective cohort was carried out to investigate the influence of traditional Chinese medicine(TCM)syndrome differentiation and treatment on the overall survival of patients with incurable liver cancer.Methods Patients with incurable liver cancer treated by Professor ZHOU Dai-han from September 2020 to January 2023 were continuously included.They were divided into exposed group and non-exposed group according to the performance of standardized TCM treatment after diagnosis.The survival rate and overall survival(OS)of the two groups were compared,the prognostic factors of untreatable liver cancer were analyzed,and the influence of TCM treatment on the frequency of anti-tumor western medicine therapy and the change of body weight was explored.Results A total of 101 eligible cases were included,with baseline balance between exposed group(55 cases)and non-exposed group(46 cases).Survival analysis showed that the one-year,2-year and 3-year survival rates in the exposed group were 70.0%,60.6%,41.9%versus 48.3%,29.3%and 9.8%in the nonexposed group,and the median OS was 27.3 months versus 11.5 months,the differences being statistically significant(χ^(2)=5.9,P=0.02).Hazard ratio(HR)was 0.50(95%CI 0.29~0.89,P=0.02).Multivariate Cox regression analysis showed that standardized TCM treatment was a protective factor for the prognosis,and the adjusted HR was 0.34(95%CI 0.16~0.72,P=0.04).The proportion of patients receiving transcatheter arterial intervention,targeted therapy and PD-1/L1 immunotherapy in the non-exposed group was higher than that in the exposed group,and there was significant difference in the number of cases and frequency of transcatheter arterial intervention(W=1700,P<0.001).The mean body weight of all patients before illness and at the previous three visits was(67.56±1.18)kg,(62.59±1.15)kg,(61.62±1.55)kg and(61.92±1.71)kg.The mean body weight at first visit did not differ from that at the second visit and at the third visit,but the mean body weight at the second visit differed from that a

关 键 词：原发性肝癌 生存时间 中医药 预后分析 

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