目的 分析晚期非小细胞肺癌（nonsmall cell lung cancer，NSCLC）患者生存期的影响因素，观察中医药干预对晚期NSCLC的疗效。方法 回顾性分析874例接受中医药治疗的晚期NSCLC患者的临床资料，分别采用KaplanMeier法和COX回归模型对晚期NSCLC患者生存期的影响因素进行单因素分析和多因素分析，并建立COX比例风险模型，并对接受靶向治疗的晚期NSCLC患者分别进行分层分析。结果 ①874例晚期NSCLC患者的中位生存期（median survival time，MST）为24.0个月，1年生存率为75.0%，2年生存率为49.0%，3年生存率为33.0%，5年生存率为16.0%。②单因素分析结果显示，患者的性别、确诊时的体力状态评分（performance status，PS）、年龄、病理类型、临床分期、吸烟史、化学治疗、放射治疗、靶向治疗、中医证型、中医特色外治法、口服中成药时间、中药静脉制剂疗程、干预措施为预后的影响因素（P＜0.05）。③多因素COX回归分析结果显示，性别、年龄、临床分期、放射治疗、病理类型、干预措施、口服中成药时间、中药静脉制剂疗程、PS、中医辨证分型是影响晚期NSCLC预后的独立危险因素。结论 ①中医药干预可延长晚期NSCLC患者的生存期。②晚期NSCLC患者中，女性、年轻、临床分期早、肺腺癌、PS低、脾肾两虚的患者生存期优于其他患者。③接受放射治疗、使用口服中成药、长期接受中药静脉制剂治疗且长期接受中医辨证治疗，可以延长晚期NSCLC肺癌的生存期。
Objective To investigate the influencing factors for the survival of patients with advanced nonsmall cell lung cancer (NSCLC) and the clinical effect of traditional Chinese medicine (TCM) intervention on advanced NSCLC. Methods A retrospective analysis was performed for the clinical data of 874 patients with advanced NSCLC who underwent TCM treatment. The KaplanMeier method and the Cox regression model were used to perform univariate and multivariate analyses of the influencing factors for the survival of patients with advanced NSCLC. The Cox proportional hazards model was established, and a stratified analysis was performed for the patients with advanced NSCLC who received targeted therapy. Results The median survival time of 874 patients with advanced NSCLC was 24.0 months, and the 1, 2, 3, and 5year survival rates were 75.0%, 49.0%, 33.0%, and 16.0%, respectively. The univariate analysis showed that sex, performance status (PS) score at diagnosis, age, pathological type, clinical stage, smoking history, chemotherapy, radiotherapy, targeted therapy, TCM syndrome type, TCM external treatment, duration of oral administration of Chinese patent drug, course of treatment with TCM intravenous preparations, and intervention measures were influencing factors for prognosis (all P<0.05). The multivariate Cox regression analysis showed that sex, age, clinical stage, radiotherapy, pathological type, intervention measures, duration of oral administration of Chinese patent drug, course of treatment with TCM intravenous preparations, PS score, and TCM syndrome type were independent influencing factors for the prognosis of advanced NSCLC. Conclusion TCM intervention can prolong the survival of patients with advanced NSCLC. Among the patients with advanced NSCLC, those with female sex, young age, early clinical stage, lung adenocarcinoma, a low PS score, and deficiency of spleen and kidney tend to have a longer survival time than others. Radiotherapy, oral administration of Chinese patent drug, longterm administration of TCM intravenous preparations, and longterm TCM treatment based on syndrome differentiation can prolong the survival of patients with advanced NSCLC.
封佳莉,李和根,周晓辉,徐蔚杰,周 蕾,朱丽华,侯宛昕,肖 凌.中医药干预874例晚期非小细胞肺癌的生存分析[J].安徽中医药大学学报,2019,38(6):10-15复制