| Colorectal cancer is one of the most common malignancies.At present,the mainly treatment of colorectal cancer is surgery,and postoperative recurrence and metastasis is an important factor affecting the prognosis.Clinical studies have shown that traditional Chinese medicine can play an important role in preventing recurrence and metastasis of colorectal cancer after surgery.The early stage of the national"eleventh five-year plan" science and technology support plan project of international cooperation project integrated treatament of traditional Chinese medicine to improve the prospectie cohort study of postoperative colorectal cancer effect a radical cure rate,according to the results of more than one year of the dialectical argument one treatment can reduce the transfer of patients with stage ? and ? colorectal cancer after operation the recurrence rate,but for the different influence on the prognosis of time total duration of not further clear.Previous state "twelfth five-year" science and technology support plan project of international cooperation project helped the teachings(spleen and kidney method)to reduce ?,? period a cohort study on recurrence of postoperative colorectal cancer metastasis,the results showed that the use of TCM prescriptions was associated with longer disease-free survival and lower recurrence and metastasis rates.However,as only one year follow-up has been completed,no long-term observation of survival has been made.Through the middle of colorectal cancer early postoperative recurrence of resistance to transfer of traditional Chinese medicine research progress,and the application of qualitative research in the field of prevention and treatment of colorectal cancer were reviewed,found at present about traditional Chinese medicine treatment time,give play to the role of anti relapse metastasis and human factors affecting the prognosis(e.g.,lifestyle and psychological intervention,etc.)of related research is less.Based on the above results,the study on TCM intervention improve ? and ?colorectal cancer postoperative outcomes of quantitative and qualitative research,more in-depth to study the effect of anti relapse metastasis of traditional Chinese medicine,and other factors that influence the prognosis for clinical use of Chinese medicine in order to improve the prognosis of patients with stage II and III colorectal cancer after operation to provide the basis of a more fully.The first part of this article for the follow-up cohort study again,based on previous topics,the effects of traditional Chinese medicine to reduce ?,?period the post-operation relapse and metastasis of colorectal cancer,and to further explore Chinese medicine treatment time give play to the role of anti relapse metastasis.At the same time,in order to explore other factors contributing to the improvement of prognosis in addition to receiving TCM treatment,patients with good prognosis were selected for the second qualitative study.Qualitative interview is used to understand the influence of factors such as receiving TCM treatment,lifestyle change and psychological intervention on prognosis from the perspective of patients.Research 1:Under the intervention of traditional Chinese medicine to reduce ?,III period the post-operation relapse and metastasis of colorectal cancer cohort study and follow-upObjective:Observation of TCM intervention on reducing ?,? period the influence of the post-operation relapse and metastasis rate of colorectal cancer,to explore the time when Chinese traditional medicine plays its role in preventing recurrence and metastasis.Method:Using a prospective multicenter cohort study design,collection on August 20,2014 to August 14,2016 in China academy of Chinese Medical Science Xiyuan Hospital oncology department and Beijing Cancer Hospital of 100 cases of each stage? ? and radical surgery in patients with colorectal cancer.On the basis of conventional western medicine treatment,patients taking traditional Chinese medicine for up to 3 months after conventional treatment were considered as exposure factors.Patients taking traditional Chinese medicine for more than 3 months after conventional treatment were categorized as the Chinese and Western medicine cohort,while those taking Chinese medicine for less than 3 months were categorized as the Western medicine cohort.The follow-up period was up to mid-January 2020,and the recurrence and metastasis rate and disease-free survival rate at 1,2 and 3 years after surgery were analyzed retrospectively.Results:1 Enrollment and follow-up situationA total of 200 patients were enrolled,among which 100 patients were enrolled in xiyuan hospital from August 2014 to August 2016,6 cases were included by mistake and lost to follow-up because they did not meet the inclusion criteria,and the remaining 94 patients were all treated with traditional Chinese medicine on the basis of conventional western medicine.From February 2015 to August 2016,Peking University cancer hospital enrolled 100 patients,8 cases were included by mistake and lost to follow-up because they did not meet the inclusion criteria.Among the remaining 92 patients,17 received traditional Chinese medicine treatment on the basis of conventional western medicine,and 75 received only conventional western medicine.Taking traditional Chinese medicine for 3 months after routine treatment as the exposure factor,94 cases taking traditional Chinese medicine for more than 3 months after routine treatment were classified as the Chinese and Western medicine cohort,and 92 cases taking Chinese medicine for less than 3 months were classified as the Western medicine cohort.By the middle of January 2020,the median follow-up time was 50.8 months(47.3-56.6 months),a total of 5 cases were lost to follow-up,lost to follow-up rate was 2.68%,186 patients were done after 1 year follow-up,179 patients completed after 2 years of follow-up,except 5 cases were lost to follow-up and 6 cases without law review,cannot determine whether patients with recurrence,transfer,more than 175 patients completed after 3 years follow-up,complete 4 years of follow-up,127 patients completed in 29 cases of postoperative follow-up for five years.2 Baseline informationThere was no statistically significant difference between the two groups in gender,age,family history,disease location,degree of differentiation,stage,lymph node dissection,and postoperative radiotherapy and chemotherapy(P>0.05).3 Recurrence and metastasis in two cohortsBy the middle of January of the last follow-up,37 of the 186 patients had developed recurrence and metastasis,including 14 in the Chinese and western medicine cohort and 23 in the western medicine cohort.The rate of recurrence and metastasis in the Chinese and western medicine cohort was 3.19%(3/94),9.78%(9/92),12.36%(11/89);and 6.52%(6/92),21.84%(19/87),and 24.42%(21/86),respectively,in the Chinese and western medicine cohort at 1,2,and 3 years after surgery.There was no significant difference in the recurrence and metastasis between the two groups within 1 year after surgery(P>0.05),but there was significant difference in the recurrence and metastasis between the two groups within 2 and 3 years after surgery(P<0.05).In the Chinese and western medicine cohort,75 patients were followed up for 4 years after surgery,and a total of 13 patients had recurrence and metastasis within 4 years after surgery,26 patients were followed up for 5 years after surgery,and a total of 14 patients had recurrence and metastasis within 5 years after surgery.In the western medicine cohort,52 patients were followed up for 4 years after surgery,and a total of 23 patients showed recurrence and metastasis within 4 years after surgery,and 3 patients were followed up for 5 years after surgery,and a total of 23 patients showed recurrence and metastasis within 5 years after surgery.4 Disease-free survival of both cohortsAfter log-rank test,the difference of kaplan-meier survival curves between the two groups was statistically significant(P<0.05).After about 9 months,the survival curve of the two corets began to differ,and the decline trend of the survival rate of the Chinese and Western corets was slower than that of the Western corets.5 Analysis of prognostic factorsTo investigate the factors affecting postoperative prognosis of stage ? and ?colorectal cancer,a univariate analysis of 186 cases was performed using log-rank test.The results showed that disease stage,presence of positive lymph nodes,and the cumulative duration of medication(6 months and 12 months)had an impact on the prognosis(P<0.05).There was no significant difference in gender,age,site affiliation,degree of differentiation,and whether there were less than 12 lymph nodes dissected(P>0.05).Statistical significance was found in the results of single factor analysis of factors into the COX regression analysis of multiple factors,the result shows:After controlling the stage and the presence or absence of positive lymph nodes and other factors,the cumulative time of taking drugs(with 12 months as the limit)was still the factor that could independently influence the disease-free survival of patients with stage ? and ? colorectal cancer after surgery,the difference was statistically significant(P<0.05,HR=0.417(CI:0.188?0.923),and the medicine is to protect the factor,the longer the duration may be the better prognosis,when medication time more than 12 months,can significantly affect the prognosis,and disease stage,if there is a positive lymph nodes show no associated with colorectal cancer radical surgery prognosis significantly.Aiming at different time after total time for further analysis found that within two years after taking time to reach more than 18 months in patients with recurrent shifting risk significantly lower than the duration of patients less than 18 months,statistically significant difference(P<0.05,HR=0.126(CI:0.017?0.925),postoperative medication in three years time to reach more than 18 months in patients with recurrent shifting risk significantly lower than the duration of patients less than 18 months,statistically significant difference(P<0.05,HR=0.146(CI:(0.035?0.611)),compared with the two groups,the HR value of taking the drug for 18 months within two years after surgery was smaller,indicating that taking the drug for more than 18 months within two years after surgery had a more protective effect on reducing recurrence and metastasis and prolonging disease-free survival.Conclusion:1.After conventional treatment of traditional Chinese medicine treatment more than 3 months can reduce ?,? period the post-operation relapse and metastasis rate of colorectal cancer,prolong disease-free survival.2.After the operation,Chinese medicine was taken for about 9 months(that is,up to 3 months after the conventional treatment),and the Chinese medicine treatment began to take effect,However,when taking Chinese medicine continuously for 18 months within 2 years after the operation,it can obviously reduce the recurrence and metastasis rate.Reasearch 2:Second,the intervention of traditional Chinese medicine and improve ?,? period the prognosis of patients with colorectal cancer radical surgery of qualitative researchObjective:Using qualitative interview method,from the perspective of patients improve prognosis factor,to know about the postoperative colorectal cancer treated with comprehensive treatment of traditional Chinese medicine understanding of the cause of disease themselves,understanding of traditional Chinese medicine,and in the process of treatment to make lifestyle changes,in order to explore the relationship between the related factors and treatment outcome,and found that the deficiencies in the process of treatment,at the same time also can make patients carries on the summary and the reflection of our way of life,in order to better help patients improve prognosis,benefit from treatment.Methods:Objective Sampling method was adopted to select 13 patients with stage ?and ? colorectal cancer who had disease-free survival over 4 years in an integrated Chinese and Western medicine cohort.Conduct in-depth personal interviews with patients based on a pre-prepared interview outline,Transcribing audio recordings into transcripts,and using the framework analysis method to analyze,repeatedly read the manuscript,identify and code.Subject and sub-subject are generated by induction,and qualitative analysis software is used for auxiliary analysis.Results:The patients mentioned more factors that were helpful to the improvement of postoperative prognosis,mainly including three aspects:Lifestyle,attitude and acceptance of Chinese medicine.Most of the patients had a poor lifestyle before they got sick,which included diet,alcohol,cigarettes,exercise,work,mood,etc.After illness through self-reflection and family,friends,doctor's advice,can insist on changing part of the unhealthy lifestyle.At the same time,actively accept the treatment of traditional Chinese medicine,adhere to the use of traditional Chinese medicine,strengthen the constitution,but also enhance the patient's confidence in the face of disease,and coupled with the patient's optimistic attitude and the encouragement from family,friends and doctors,the patient can positively face the disease and maintain a positive attitude,which is conducive to the improvement of the prognosis of the disease.Conclusion:In clinical practice,it is necessary to pay attention to the previous lifestyle of the patients,so as to discover part of the causes and timely remind the patients to correct.At the same time,the doctor should take into account the phenomenon of low mentality caused by the insufficient cognition of the patient to the disease,timely help the patient and his family to correctly understand the disease,and actively cooperate with the treatment.The confidence brought by TCM treatment to patients is more from the good curative effect.By improving symptoms,objective indicators and physique,patients' confidence in adhering to TCM treatment and promoting disease recovery is enhanced. |
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