Retrospective Cohort Study And Survival Analysis Of 315 Patients With Stage IV Non-small Cell Lung Cancer

Research purposes:By grouping comparison of TCM treatment of stage ? NSCLC patients' overall survival time and progression-free survival time,screening the factors effecting the prognosis of patients with stage ? NSCLC.Methods:Clinical information of patients with stage ? non-small cell lung cancer treated in Cancer Hospital of Chinese Academy of Medical Sciences from 01 January 2017 to 31 December 2017 was collected.The final survival status was obtained through outpatient and telephone follow-up until December 31,2020.The treatment of Traditional Chinese Medicine as an exposure factor was divided into three cohorts:high exposure,low exposure and no exposure.The main research indicators were total survival time(OS)and progression-free survival time(PFS).The main variables analyzed included sex,age,body mass index(BMI),smoking history,family history,TNM staging(International Association for the Study of Lung Cancer,IASLC version 8),location of metastasis at diagnosis,location of primary lung cancer,pathological type,and treatment methods such as surgery,radiotherapy,chemotherapy,targeted therapy and immunotherapy.Kaplan-Meier method was used for univariate survival analysis,and the difference was statistically significant by Log-rank test and Breslow test.Then,according to the results of univariate analysis,Cox multivariate regression analysis was used to obtain significant variables related to prognosis,so as to screen out independent risk factors and protective factors.Results:1.A total of 315 cases of stage ? non-small cell lung cancer were included.By the end of follow-up,a total of 230 cases died and 85 cases survived.The average OS was 30.521 ±1.032 months,and the median OS was 29.7(95%CI:26.068,33.332)months.The 1-year survival rate was 81.0%,the 2-year survival rate was 56.8%,the 3-year survival rate was 39.4%,and the 4-year survival rate was 5.1%.By the end of the follow-up,there were 311 cases of progress and 4 cases of no progress.The median PFS was 10.1(95%CI:8.572,11.628)months.Among them,the 1-year non-progress rate is 45.4%,the 2-year no-progress rate is 14.6%,and the 3-year non-progress rate is 4.4%.2.According to the degree of TCM exposure,the patients were divided into three groups:high exposure group(n=96),low exposure group(n=75)and non-exposure group(n=150).The baselines of the three groups are the same.After Log-rank test and Breslow test,it was found that OS and PFS,in high exposure group were significantly longer than those in low exposure group and non-exposure group(P<0.05),but there was no significant difference between low exposure group and non-exposure group(P>0.05).3.Kaplan-Meier univariate analysis showed that initial bone metastasis,initial liver metastasis and initial adrenal metastasis,gene mutation,lung surgery,targeted therapy,traditional Chinese medicine treatment,syndrome differentiation decoction treatment,traditional Chinese medicine combined with targeted therapy all affected OS and PFS of stage ? NSCLC,sex,smoking history,pathological type,primary location,immunotherapy,traditional Chinese medicine combined with chemotherapy,traditional Chinese medicine combined with chemotherapy and targeted therapy only affected the survival time of stage ?NSCLC,while chemotherapy only affected the progression-free survival time of stage ?NSCLC.4.Multivariate analysis showed that the independent factors affecting OS of stage ?non-small cell lung cancer were staging IVC[HR=1.605(95%CI:1.092,2.359),P=0.016],history of smoking[HR=1.626(95%CI:1.153,2.293),P=0.006],and targeted therapy[HR=0.468(95%CI:0.345,0.634),P=0.000].Syndrome differentiation decoction for treatment lasting 3-6m(HR=0.510(95%CI:0.350,0.743),P=0.000),lasting? 6m(HR=0.263(95%CI:0.173,0.399),P=0.000).5.Multivariate analysis showed that the independent factors affecting the PFS of stage? non-small cell lung cancer were pulmonary surgery[HR=0.517(95%CI:0.365,0.730),P=0.000],initial liver metastasis[HR=1.973(95%CI:1.322,2.945),P=0.001],targeted therapy[HR=0.593(95%CI:0.434,0.809),P=0.001].Syndrome differentiation decoction for treatment lasting 3-6m[HR=0.358(95%CI:0.249,0.498),P=0.000],lasting? 6m[HR=0.352(95%CI:0.365,0.730),P=0.000].Conclusion:High exposure traditional Chinese medicine treatment has a certain effect on improving OS and PFS of stage ? non-small cell lung cancer,and syndrome differentiation decoction combined with targeted therapy is more effective in improving prognosis.