中西医结合治疗对晚期结直肠癌患者生存影响的队列研究

张彤; 何文婷; 陈悦; 唐末; 孙凌云; 许云; 杨宇飞

doi:10.3969/j.issn.1006-2157.2023.03.015

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中西医结合治疗对晚期结直肠癌患者生存影响的队列研究

临床研究 | 更新时间：2023-04-07

- 中西医结合治疗对晚期结直肠癌患者生存影响的队列研究
- The effect of integrated of Chinese and Western medicine on the survival of patients with metastatic colorectal cancer: a cohort study
- 北京中医药大学学报 2023年46卷第3期页码：383-391
- 作者机构：
  
  1.中国中医科学院西苑医院　北京　100091
  2.新疆维吾尔自治区中医医院
  3.北京中医药大学第三附属医院
  4.北京大学肿瘤医院
- 作者简介：
  
  张彤，男，博士，副主任医师
  #杨宇飞，女，博士，教授，主任医师，博士生导师，主要研究方向：恶性肿瘤的中西医结合治疗，E-mail：yyf93@vip.sina.com
- 基金信息：
  
  国家自然科学基金项目(82174461);中国中医科学院科技创新工程项目(CI2021A01811)
- DOI：10.3969/j.issn.1006-2157.2023.03.015
  中图分类号： R273
- 收稿：2022-09-09，
  
  网络首发：2022-12-30，
  
  纸质出版：2023-03-30
- 稿件说明：
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张彤, 何文婷, 陈悦, 等. 中西医结合治疗对晚期结直肠癌患者生存影响的队列研究[J]. 北京中医药大学学报, 2023,46(3):383-391.

ZHANG Tong, HE Wenting, CHEN Yue, et al. The effect of integrated of Chinese and Western medicine on the survival of patients with metastatic colorectal cancer: a cohort study[J]. Journal of Beijing University of Traditional Chinese Medicine, 2023, 46(3): 383-391.
张彤, 何文婷, 陈悦, 等. 中西医结合治疗对晚期结直肠癌患者生存影响的队列研究[J]. 北京中医药大学学报, 2023,46(3):383-391. DOI： 10.3969/j.issn.1006-2157.2023.03.015.

ZHANG Tong, HE Wenting, CHEN Yue, et al. The effect of integrated of Chinese and Western medicine on the survival of patients with metastatic colorectal cancer: a cohort study[J]. Journal of Beijing University of Traditional Chinese Medicine, 2023, 46(3): 383-391. DOI： 10.3969/j.issn.1006-2157.2023.03.015.

摘要

目的

评价中西医结合治疗对晚期结直肠癌患者的临床疗效。

方法

收集2013年8月1日—2015年12月31日就诊于中国中医科学院西苑医院、北京大学肿瘤医院、新疆维吾尔自治区中医医院的晚期结直肠癌患者，共纳入733例。采用队列研究设计，将“是否连续接受≥3个月中医治疗”作为暴露因素，将符合此暴露因素的患者分入中西医治疗列队，不符合此暴露因素的患者分入西医治疗队列。比较2个队列的总生存期，以及第1、3、5年生存率。采用COX多因素风险比例回归模型探索影响晚期结直肠癌患者预后的因素。

结果

本研究最终共纳入335例晚期结直肠癌患者，中西医治疗队列129例，西医治疗队列206例。中西医治疗队列的中位生存期为28.0个月，西医治疗队列的中位生存期为20.3个月，差异具有统计学意义[

＝0.748，95%

(0.587～0.950)，

0.05]。中西医治疗队列第1、3、5年的累计生存率分别是96.0%(120/125)、36.8%(46/125)、10.4%(13/125)，西医治疗队列第1、3、5年的累计生存率分别是79.9%(159/199)、23.1%(46/199)、6.0%(12/199)，中西医治疗队列第1、3年累计生存率高于西医治疗队列，差异具有统计学意义(

0.01)。亚组分析显示：在女性、右半结肠、RAS基因突变、无靶向治疗、化学药物治疗(简称“化疗”)、无化疗的亚组中，中西医治疗队列较西医治疗队列的生存期延长，差异均具有统计学意义(

0.05，

0.01)。多因素分析显示：右半结肠、无化疗、RAS基因突变、低分化是晚期结直肠癌预后差的独立预后因素，中西医治疗队列为保护性因素[

＝0.529，95%

(0.386～0.714)，

0.01]，可以将晚期结直肠癌的死亡风险降低47.1%。

结论

中西医结合治疗可以延长晚期结直肠癌患者的生存期，在女性、右半结肠、RAS基因突变的人群中获益更加明显。中西医结合治疗可明显降低晚期结直肠癌患者的死亡风险。在西医治疗开始的同时，尽早联合中医治疗，可以为晚期结直肠癌患者带来更大的生存获益。

Abstract

Objective

We aimed to verify the efficacy of integrated Chinese and Western medicine in the treatment of patients with metastatic colorectal cancer (mCRC).

Methods

733 mCRC patients who visited Xiyuan Hospital of Chinese Academy of Chinese Medical Sciences

Beijing Cancer Hospital and Xinjiang Uygur Autonomous Region Hospital of Traditional Chinese Medicine between August 1

2013 and December 31

2015 were enrolled. A cohort study design was adopted

and "receiving continuous traditional Chinese medicine (TCM) for ≥3 months" was taken as the exposure factor. Patients who met this criterion were classified into the integrated Chinese and Western medicine cohort

and patients who did not meet this criterion were classified into the Western medicine cohort. Overall survival (OS) and the 1-

3- and 5-year survival rates were compared between the two cohorts. A multivariate risk proportional regression model was used to explore the factors affecting the prognosis of mCRC patients.

Results

A total of 335 patients with mCRC were included in this study

including 129 patients in Chinese and Western medicine cohort and 206 patients in Western medicine cohort. The median overall survival (mOS) in the Chinese and Western medicine cohort was 28.0 months and that of the Western medicine cohort was 20.3 months. The difference was statistically significant (

=0.748

95%

=0.587-0.950

0.05). The 1-

3- and 5-year survival rates of the Chinese and Western medicine cohort were 96.0% (120/125)

36.8% (46/125) and 10.4% (13/125)

respectively. The 1-

and 5-year survival rates of the Western medicine cohort were 79.9% (159/199)

23.1% (46/199) and 6.0% (12/199)

respectively. The 1-

3-year survival rates of Chinese and Western medicine cohort was higher than Western medicine cohort(

0.01). Subgroup analysis showed that there was a significant difference in mOS between the two cohorts in the female

right-side colon

RAS mutation

no targeted therapy

and non-chemotherapy subgroups (

0.05

0.01). Multivariate analysis showed that right-side colon

non-chemotherapy

RAS mutation

and low differentiation were independent prognostic factors for poor prognosis of mCRC and integrated of Chinese and Western medicine was a protective factor (

=0.529

95%

=0.386-0.714

0.01)

which reduced the risk of death by 47.1%.

Conclusion

Integrated of Chinese and Western medicine can prolong the OS of mCRC patients

and the benefits are more obvious in women and in patients with right-side colon cancer and RAS mutation. Integrated of Chinese and Western medicine can significantly reduce the risk of death in mCRC patients. At the beginning of Western medicine treatment

the early integrated of traditional Chinese medicine will bring greater survival benefits to mCRC patients.

关键词

Keywords

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