中医及中西医结合治疗晚期非小细胞肺癌的回顾性队列研究  

Traditional Chinese Medicine and Integrative Medicine in Treatment of Advanced Non-small Cell Lung Cancer:A Retrospective Cohort Study

作　　者：管懋莹 周蕾[1] 徐蔚杰[1] 朱丽华[1] 封佳莉 黄弦歌 张任 沈倩芸 杨昕 李和根[1] GUAN Maoying;ZHOU Lei;XU Weijie;ZHU Lihua;FENG Jiali;HUANG Xiange;ZHANG REN;SHEN Qianyun;YANG Xin;LI Hegen(Department of Oncology,Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200032,China)

机构地区：[1]上海中医药大学附属龙华医院肿瘤科,上海200032

出　　处：《世界中医药》2024年第17期2641-2646,共6页World Chinese Medicine

基　　金：国家自然科学基金面上项目(82374532)——正得康阻断FoxM1-PCK2-AMPK促进铁死亡抑制非小细胞肺癌转移的机制研究;国家自然科学基金青年科学基金项目(82205214)——金复康通过mTOR促进自噬下调GPX4诱导铁死亡治疗非小细胞肺癌的分子机制研究;上海市中医肿瘤临床医学研究中心项目(21MC1930500);上海市临床重点专科(中医肿瘤)建设项目(shslczdzk03701);李和根上海市名老中医学术经验研究工作室项目(SHGZS-202215);国家中医药管理局高水平中医药重点学科(中医肿瘤病学)建设项目(zyyzdxk-2023063)。

摘　　要：目的:评价中医及中西医结合治疗晚期非小细胞肺癌(NSCLC)的远近期疗效及安全性。方法:选取2012—2020年上海中医药大学附属龙华医院肿瘤科收治的晚期NSCLC患者201例作为研究对象,根据治疗措施不同分为中医组(n=94)和中西医结合组(n=107)。对资料进行生存分析以评估远期疗效,并对治疗前后实体瘤疗效、免疫功能、血清肿瘤学标志物进行分析以评价其近期疗效,同时观测肝肾功能以评估治疗的安全性。结果:中医组及中西医结合组患者的中位生存期分别为53个月、33个月,无进展生存期分别为17个月、12个月。中医组患者疾病控制率(DCR)高于中西医结合组,中西医结合组患者客观缓解率(ORR)高于中医组(P<0.05)。2组患者CD3^(+)T淋巴细胞、CD4^(+)T淋巴细胞变化的有效率和稳定率均高于无效率(P<0.05)。2组患者治疗后鳞癌抗原(SCC)、神经元特异性烯醇化酶(NSE)、糖类抗原125(CA125)均呈下降趋势(P<0.05)。中医组患者肝肾功能异常发生率低于中西医结合组,2组均未发生3~4级的肝功能异常及2级以上肾功能异常。结论:中医药无论是单独维持治疗,还是结合西医治疗,均能够延长晚期NSCLC患者生存期,改善远期疗效,控制局部病灶,稳定免疫功能、降低血清肿瘤标志物,提高近期疗效,同时具有良好的安全性。Objective:To evaluate the long-term and short-term efficacy and safety of traditional Chinese medicine(TCM)and integrative TCM and Western medicine in the treatment of advanced non-small cell lung cancer(NSCLC).Methods:A total of 201 patients with advanced NSCLC admitted to the Oncology Department of Longhua Hospital affiliated with Shanghai University of Traditional Chinese Medicine between 2012 and 2020 were enrolled.According to different treatment measures,they were divided into the TCM group(n=94)and the integrative TCM and Western medicine group(n=107).Survival analysis of medical data was conducted to assess long-term efficacy.The short-term efficacy was evaluated by analyzing solid tumor response,immune function,and serum tumor markers before and after treatment.Liver and kidney functions were also monitored to assess safety.Results:The median survival time for the TCM group and the integrative medicine group was 53 months and 33 months,respectively,and the progression-free survival(PFS)was 17 months and 12 months,respectively.The disease control rate(DCR)in the TCM group was higher than that in the integrative medicine group,while the objective response rate(ORR)in the integrative medicine group was higher than that in the TCM group(P<0.05).In both groups,the effective and stable rates of CD3^(+)T lymphocytes and CD4^(+)T lymphocytes were significantly higher than the ineffective rates(P<0.05).After treatment,squamous cell carcinoma antigen(SCC),neuron-specific enolase(NSE),and carbohydrate antigen 125(CA125)showed a downward trend in both groups(P<0.05).The incidence of liver and kidney function abnormalities was lower in the TCM group than in the integrative medicine group.No grade 3 to 4 liver dysfunction or grade 2 or higher kidney dysfunction was observed in either group.Conclusion:TCM,whether used alone for maintenance or in combination with Western medicine,can extend the survival time of patients with advanced NSCLC,improve long-term efficacy,control local lesions,stabilize immune function,reduce

关 键 词：非小细胞肺癌 晚期 回顾性队列研究 生存期 近期疗效 远期疗效 安全性 中西医结合治疗 中医治疗 

分 类 号：R273[医药卫生—中西医结合]