| BACKGROUND:Lung cancer is one of the most common malignant tumors in China.Because the initial performance is not obvious,most patients were diagnosed as advanced stage at the first visit and lost the opportunity of radical surgery,and the survival rate is low.Among many pathological types,non-small cell lung cancer(N SCLC)is the most common one.At present,modern medicine has made great progress in the treatment of advanced NSCLC through targeted therapy for patients with advanced non-small cell lung cancer who cannot be operated on.However,for advanced non-small cell lung cancer patients without driver gene,t two-drug combination containing platinum-containing drugs is often adopted,but the therapeutic effect is still limited,and the level of clinical treatment needs to be improved.As a unique way of diagnosis and treatment method in China,traditional Chinese medicine(TCM)plays an irreplaceable and important role in coping with the serious health challenges facing contemporary society.Traditional Chinese medicine(TCM)originated in the era of empirical medicine,which emphasized the holistic concept and the differentiation of symptoms.Traditional Chinese medicine emphasizes the interrelationship between the whole and multiple factors,emphasizes"syndrome differentiation",focuses on treating"sick people"and pays attention to the overall effect.Therefore,how to prolong the tum or-bearing survival of patients with advanced NSCLC is the key to the treatment of advanced NSCLC with traditional Chinese medicine.At present,the benefit population of TCM treatment is lack of systematic research on TCM characteristics,which has a certain impact on the accuracy of TCM treatment of lung cancer,thus affecting the clinical behavior of clinical front-line doctors and the clinical efficacy of TCM treatment.Therefore,it is necessary to conduct a screening study based on evidence-based medicine about the dominant groups of patients with advanced lung cancer treated by TCM.We need to carry out more research which is based on the syndrome difference of patients,and study on TCM treatment behavior of lung cancer at different levels.PURPOSE:Based on the early clinical research about treatment of NSCLC by traditional Chinese medicine,this study intends to construct an information management platform including patients with lung cancer who are treated by TCM.This research systematically collate and analyze the efficacy of TCM in prolonging the survival time of advanced NSCLC patients by retrospective analysis,so as to find out the benefit population in TCM aspects.Striving to start with the differences of TCM syndromes,this research is aimed at finding out the risk factors affecting the prognosis of lung cancer and classifying the benefit population according to their functional status,so as to determine the clinical orientation of traditional Chinese medicine in the comprehensive treatment of lung cancer and further improve the clinical efficacy of traditional Chinese medicine for lung cancer METHOD:This study included patients with NSCLC diagnosed by pathology and treated by traditional Chinese medicine for more than 3 months.The patients'gender,age,past medical history,history of tobacco and alcohol,allergy history,clinical stage,pathological grade,pathological type,complications,metastases,intervention measures of traditional Chinese medicine,traditional Chinese medicine syndrome and intervention time of traditional Chinese medicine were retrospectively analyzed.According to the therapeutic effect of traditional Chinese medicine,the differences and similarities among different patients were compared and analyzed.The benefit population of traditional Chinese medicine treatment of advanced non-small cell lung cancer was summarized.In addition,the common characteristics of lung cancer patients who benefit from TCM can provide classification basis and guidance for further screening the advantageous population of lung cancer treatment with traditional Chinese medicine.RESULT:95 patients with advanced stage ?-? non-small cell lung cancer(NSCLC)from January 1,2006 to December 31,2018 were selected from Guang'anmen Hospital,Chinese Academy of Traditional Chinese Medicine in this study.(1)General data:This study included 66 males and 29 females,and the ratio of male to female is 2.28:1.The age range is 37-84 years old,median age is 69 years old,average age 67.74± 9.79 years old.The peak is 60-79 years,accounting for 76.84%.There are 58 cases with smoking history and 25 cases with drinking history.There are 22 cases with family history of malignant tumors and 75 cases with past medical history,accounting for 78.95%The lesions are distributed in both left and right lobes,of which the right lung is more than the left lung.The number of central and peripheral lung cancer is the same in anatomical type.The pathological type of adenocarcinorna and squamous cell carcinoma are the main types,and the number of them is slightly higher than that of squamous cell carcinoma.In the study,the majority of the patients in the study are stage IV patients,accounting for 79.95%.Generally,there are 1 to 4 metastatic lesions,among which the single metastatic lesions are the most and the proportion of lymph node metastasis was the highest.(2)Survival analysis:The average OS is 40.09±4.88 months and the median OS is 27.00±2.13 months.The average OS of women(61.90±10.13 months)is significantly higher than that of men(29.63±3.94 months).The average OS of smokers(24.74±2.66 months)is significantly lower than that of non-smokers(58.23±8.68 months).The average OS of central lun g cancer patients(28.14±3.81 months)is lower than that of peripheral lung cancer patients(53.96±8.45 months).The average OS of adenocarcinoma patients(50.37±7.10 months)is higher than that of squamous cell carcinoma patients(25.08±3.44 months).Lymph node metastasis and bone metastasis have an effect on the average OS.The average OS in patients without the above two types of metastasis was significantly higher,The number is 46.63±6.69(VS 34.33±5.60)and 44.51±5.48(VS 19.97±5.66)months.The average OS in patients with complications is 31.31±4.97(VS 48.22±7.43)months.The average OS in patients without lung-spleen deficiency syndrome(47.09±6.99)months are higher than those with lung-spleen deficiency syndrome(29.40±5.73 months).(3)Syndrome differences:?Initial diagnosis:Most of the initial symptoms in the group have 2-6 symptoms at the same time,mainly concentrated in cough and expectoration..The first symptoms are pale,red,dark tongue,moss white,and the pulse is chord,slippery and fine veins.The first symptoms are mainly 2-3 concurrent syndromes,mainly concentrated in phlegm-dampness syndrome,Qi deficiency syndrome and blood stasis syndrome.The first symptoms are mostly single or two,phlegm-dampness-stasis syndrome is the most common type of the fi rst diagnosis.? Analysis of the situation after treatment:The population in this study chose one or more traditional Chinese medicine intervention methods,mostly traditional Chinese medicine decoction,supplemented by oral Chinese patent medicine or traditional Chinese medicine injection;most of the symptoms of reexamination had 3-6 symptoms at the same time,and the symptoms were still mainly concentrated in cough and expectoration.However,the proportion of other symptoms has changed,such as fatigue,insomnia,frequent nocturnal urination and diarrhea,chest tightness,blood in sputum,dry mouth and throat,chest pain,spontaneous sweating and night sweating,fear of cold limbs and fever.After the treatment of traditional Chinese medicine,the main symptoms of re-diagnosis are red tongue,dark,white coating,and the main pulse is still chord,slippery and fine veins.To appear in 1-2 concurrent syndromes,syndrome elements mainly concentrate on Qi deficiency,phlegm-dampness and Yin deficiency syndrome.Most of the re-diagnosis syndromes are single syndromes,and lung-spleen Qi deficiency is the most common one.After treatment,phlegm-dampness syndrome,blood stasis syndrome,heat-toxin syndrome,Qi deficiency syndrome and other syndromes have decreased,while the proportion of Yin deficiency syndrome has increased.The proportion of phlegm-dampness stagnation syndrome,heat-toxin obstructing lung syndrome,lung-spleen Qi deficiency has decreased.The proportion of Qi-Yin deficiency syndrome and spleen deficiency dampness-heat syndrome have increased.(4)Subgroup analysis:95 patients with OS = 18 months were divided into two groups.OS?18 months is the dominant group and OS<18 months is the control group.?Baseline comparison:The basic information of the two groups was compared,P>0.05.The baseline level of the two groups was basically consistent and comparable.However,the number of lymph node metastasis and bone metastasis in the control group was higher than that in the dominant group(P<0.05),the difference was statistically significant.?The influence of TCM intervention:By comparing the changes of symptoms,syndrome elements and syndromes before and after treatment,it was found that both groups had changes before and after treatment,but P>0.05,there was no significant difference?Cox multivariate regression analysis:The related factors of TCM before and after treatment were analyzed by multivariate analysis.The symptoms of blood in sputum and Yin deficiency syndrome appeared at the first diagnosis,and heat toxin syndrome element P<0.05 appeared at the second consultation,and the regression coefficient was positive,which was an independent risk factor affecting the prognosis of patients.CONCLUSION:(1)This study showed that in patients with advanced non-small cell lung cancer(NSCLC),gender,smoking history,anatomical site type,pathological type,lymph node or bone metastasis and complications were associated with survival.Among them,women,patients without smoking history,peripheral adenocarcinoma,lymph node and bone metastasis,and patients without complications had more advantages in survival time.(2)In terms of the characteristics of TCM,the patients without lung-spleen deficiency syndrome at the first diagnosis have more advantages in survival time,and the symptoms of expectoration with blood,Yin deficiency syndrome elements at the first diagnosis,and heat toxin syndrome elements after treatment are not conducive to the prognosis of patients. |
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