| objectiveTo explore the characteristics and advantages of traditional Chinese medicine(TCM)in the treatment of advanced lung adenocareinoma through the real world study of TCM in the treatment of stage ?B and IV lung adenocarcinoma,and to explore the best time for the treatment of lung adenocarcinoma with traditional Chinese medicine,so as to provide clinical reference for the treatment of lung adenocarcinoma with the combination of'TCM and Western medicine.MethodsThe medical records of the Department of Oncology,the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine,from January 1,2015 to December 31,2017 were retrieved.According to the inclusion and exclusion criteria,a total of 190 clinical cases were screened.Data related to case data were collected,including patient gender,age,smoking history,drinking history,family history of cancer,first symptom,previous basic disease,chest imaging findings at diagnosis,primary site of lesion,metastatic site,clinical stage,and tissue differentiation status,genetic mutation types,TCM syndrome differentiation,KPS score at admission,progression-free survival time and overall survival time.According to the time when patients began to use traditional Chinese medicine regularly,they were divided into the first-line treatment group of integrated traditional Chinese and Western medicine and the non-first-line treatment group of integrated traditional Chinese and Western medicine.The first-line treatment group of integrated Chinese and Western medicine began to use Chinese medicine regularly in the first-line treatment,while the non-first-line treatment group began to use Chinese medicine regularly in the non-first-line treatment.The regular use of traditional Chinese medicine is defined as:oral Chinese medicine decoction or Chinese patent medicine every day,the interval should not be more than one week.The median overall survival ti,e(mOS)and median progression-free survival time(mPFS)were calculated by Kaplan-Meier method.The main factors affecting survival were analyzed by single factor survival analysis and COX proportional hazard regression model.Result1.Basic clinical features:?A total of 190 qualified cases were screened,and the ratio of male to female was about 1.47:1.The average age is 60.21 years old.Most people are old patients.?There were 59 smokers and 131 non-smokers.Among them,53 were male smokers and 6 were female smokers.The majority of smokers were male.?The most common concomitant disease was primary hypertension,followed by type 2 diabetes.The most common first symptom of a patient is cough,chest or back pain.2.Diagnosis:?The most common chest imaging manifestations at diagnosis were lung masses in 149 cases(78,42%),scattered nodules in 59 cases(31.05%),obstructive pneumonia in 57 cases(30.00%),and pleural effusion in 49 cases(27.22%).Primary tumor lesion was located in left lung in 72 cases,right lung in 111 cases,and right lung in most cases.?There were 107 patients with EGFR and ALK mutations,and the mutation rate was 57.71%.There were 57 males and 50 females,and there were more cases of genetic mutations among female patients than males.And all the mutation patients have a history of targeted drug therapy.Statistical tests showed that there were significant differences in gene mutation between men and women(x 2=3.910,P=0.048).Tissue differentiation is dominated by moderate differentiation and poor differentiation.The most common metastases in this study were bone metastasis,followed by brain metastasis,mediastinal lymph node metastasis and bilateral lung metastasis.?Among the TCM syndrome differentiation types,the most common ones are lung and spleen qi deficiency syndrome(41.58%)and phlegm-heat obstructing the lung syndrome(36.84%),qi stagnation and blood stasis syndrome,qi and yin deficiency syndrome,and lung yin deficiency syndrome are rare.It is suggested that the main TCM syndromes of advanced lung adenocarcinoma are lung and spleen qi deficiency syndrome and phlegm-heat obstructing the lung syndrome.3.Survival time:?According to K-M statistical analysis,the average survival time of the patients was 33.88±1.98 months(95%Cl:30.00-37.76),the median survival time was 27.67±1.78 months(95%Cl:24.19-31.15),the one-year survival rate was 85%,the two-year survival rate was 59%,and the three-year survival rate was 35%.The mean progression-free survival time was 13.82+0.81 months(95%Cl:12.23-15.41),and the median progression-free survival time was 11.53±0.52 months(95%Cl:10.51-12.55).?The median survival time of the first-line treatment group was 29.43±2.10 months(95%Cl:25.31-33.55),and the median survival time of the non-first-line treatment group was 23.93 ± 2.15(95%Cl:19.72-28.14),P=0.012<0.05,suggesting that there was a significant difference between the two groups.Comparing the 1-year,2-year and 3-year survival rates of the two groups,the first-line group was better than the non-first-line group.It is suggested that the first-line treatment combined with Chinese and Western medicine can significantly prolong the survival time,improve the survival rate and have survival benefit.However,there was no statistically significant difference in median progression-free survival between the two groups.?Stratified analysis was conducted according to the age,genetic mutation and gender of patients.Among elderly patients and female patients,the survival time of first-line treatment with integrated Chinese and Western medicine was significantly better than that of non-first-line treatment,with statistically significant differences.There was no statistically significant difference in survival time between first-line treatment and non-first-line treatment for young and middle-aged patients,positive gene mutation,negative gene mutation and male patients,but the survival time of first-line treatment was longer than that of non-first-line treatment,and 1-year,2-year and 3-year survival rates were beneficial.Further stratified analysis of patients with brain metastasis,liver metastasis,bone metastasis and adrenal metastasis showed that the survival time of patients without metastasis treated with first-line integrated traditional Chinese and Western medicine was significantly better than that of non-first-line patients.?K-M single factor analysis showed that gender,smoking history,drinking history,syndrome differentiation,brain metastasis and gene mutation had influence on survival time.?According to COX proportional risk regression model,integrated Chinese and Western medicine treatment,gene mutation and syndrome differentiation are independent factors affecting the prognosis of advanced lung adenocarcinoma.First-line treatment combined with Chinese and Western medicine and gene mutation positive' s patients has a long survival period and a good prognosis.Among the TCM dialectical types,lung and spleen qi deficiency syndrome and phlegm-heat obstructing the lung syndrome had the best survival period,while qi stagnation and blood stasis syndrome had the worst survival period.Conclusion1.In this study,patients with stage ?B and ? lung adenocarcinoma were more common in elderly males.Among young and middle-aged people,women are more common.Non-smoking patients were the main group.The most common previous disease was primary hypertension.The most common types of syndrome differentiation are lung and spleen qi deficiency syndrome and phlegm-heat obstructing the lung syndrome.2.The first-line treatment of integrated Chinese and Western medicine can significantly prolong the survival time compared with non-first-line treatment,and the difference is statistically significant.The first-line treatment of integrated traditional Chinese and Western medicine in elderly patients,female patients and patients without brain,liver,bone and adrenal metastasis was significantly longer than non-first-line treatment,the difference was statistically significant.3.K-M single factor analysis model showed that gender,smoking history,drinking history,syndrome differentiation,brain metastasis and gene mutation had an impact on survival time.4.COX multivariate regression model showed that the integrated Chinese and Western medicine,gene mutation,syndrome differentiation and typing were independent factors affecting the prognosis of stage ?B and IV lung adenocarcinoma. |
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