[1]沈倩芸,李和根.中西医结合治疗570例晚期非小细胞肺癌回顾性生存分析及队列研究[J].西部中医药,2025,38(11):134-139.[doi:10.12174/j.issn.2096-9600.2025.11.24]
　SHEN Qianyun,LI Hegen.Retrospective Survival Analysis and Cohort Studies on 570 Cases of Advanced NSCLC Treated with Integrative Traditional Chinese and Western Medicine[J].Western Journal of Traditional Chinese Medicine,2025,38(11):134-139.[doi:10.12174/j.issn.2096-9600.2025.11.24]
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中西医结合治疗570例晚期非小细胞肺癌回顾性生存分析及队列研究()

《西部中医药》[ISSN:2096-9600/CN:62-1204/R]

卷:
38
期数:
2025年11期
页码:
134-139
栏目:
衷中参西
出版日期:
2025-11-15

文章信息/Info

Title:
Retrospective Survival Analysis and Cohort Studies on 570 Cases of Advanced NSCLC Treated with Integrative Traditional Chinese and Western Medicine
作者:
沈倩芸, 李和根
上海中医药大学附属龙华医院，上海 200032
Author(s):
SHEN Qianyun, LI Hegen
Longhua Hospital Shanghai University of TCM, Shanghai 200032, China
关键词:
非小细胞肺癌; 中医; 生存分析; 进展速度; 免疫; 炎症因子
Keywords:
non-small cell lung cancer; TCM; survival analysis; the speed of progression; immunity; inflammatory factor
分类号:
R273
DOI:
10.12174/j.issn.2096-9600.2025.11.24
文献标志码:
B
摘要:
目的分析影响晚期非小细胞肺癌（non-small cell lung cancer，NSCLC）患者预后的危险因素与保护因素，通过与单纯西医治疗进行横向对比，明确中医治疗的优势。 方法采用回顾性队列研究设计，通过受试者工作特征曲线（receiver operating characteristic，ROC）确定炎症因子的最佳截断值并评价其预测价值；采用最小绝对收缩和选择算子回归（least absolute shrinkage and selection operator，LASSO）排除变量间多重共线性；采用 Kaplan-Meier法（KM法）绘制生存曲线并进行单因素生存分析，通过COX单因素比例风险回归分析筛选潜在预后因素；采用COX多因素比例风险回归分析构建预后模型并量化各因素影响；采用时间依赖性COX（Time-Dependent COX）回归分析排除时间相关因素的干扰。 结果1）接受中医治疗者队列生存期与生存率均高于单纯西医治疗者，分别为29.4个月和22.1个月，5年生存率为18.6%和6.3%。2）单纯中医维持治疗以时长＞4年者疗效更佳；3）患者在确诊晚期NSCLC后1年内出现疾病进展，全组中位首次无进展生存期约12个月；首次进展后中位第二次无进展生存期约6个月，尤其确诊晚期后7～8个月内出现新发转移的患者，后续进展风险更高；出现2次及以上进展的患者5年生存率仅为1.3%。4）C反应蛋白/白蛋白比值＜0.06的患者生存期更长，其对晚期NSCLC预后的预测价值较高。5）COX多因素回归分析显示，放疗、化疗、酪氨酸激酶抑制剂（tyrosine kinase inhibitors，TKI）治疗、间变性淋巴瘤激酶（anaplastic lymphoma kinase，ALK）抑制剂治疗、贝伐珠单抗治疗、免疫治疗、中医治疗为晚期NSCLC患者的独立保护因素；性别、健康状态评分、病理类型、肿瘤分期、CAR值为独立危险因素。 结论联合中医治疗的患者在中位生存期、5年生存率及无进展生存率上均高于未联用者；中医维持治疗与靶向维持治疗时长越长，患者生存期越佳，且不受时间依赖性混杂因素影响；确诊晚期NSCLC后7～8个月内出现新发转移的患者预后较差；晚期NSCLC患者中，除骨髓抑制外，白蛋白降低或C反应蛋白升高（即CAR值升高）者生存期更短。
Abstract:
ObjectiveTo analyze the risk and protective factors influencing the prognosis of advanced NSCLC, and to demonstrate the advantages of TCM therapy by conducting a direct comparison against Western medicine therapy. MethodsRetrospective Cohort study design was adopted to determine the optimal cutoff value for inflammatory factors and assess their predictive values using ROC; LASSO was applied to exclude multicollinearity between variables; KM method was used to draw survival curve and conduct single factor survival analysis; candidate prognostic factors were assessed using univariable Cox proportional hazards regression; the prognostic model was constructed using multivariable Cox proportional hazards regression and the influence of each factor was quantified; time-dependent COX regression analysis was used to exclude the interference of time-related factors. Results1) The survival period and survival rate of patients treated with TCM were higher than those treated with Western medicine alone, respectively 29.4 months and 22.1 months, five-year survival rates were 18.6% and 6.3%. 2) The effect of simple traditional Chinese medicine maintenance therapy was better in patients with a duration> 4 years; 3) The patient developed disease progression within one year after diagnosis of advanced NSCLC, the median first progression-free survival (PFS-1) in the entire cohort was approximately 12 months; the median second PFS-2 in the entire cohort was approximately 6 months after the first progression, particularly in patients who develop new metastases within 7 to 8 months after being diagnosed with advanced disease, the risks are higher in subsequent developments; five-year survival rate of patients with at least two episodes of progression was 1.3%. 4) patients with a C-reactive protein to albumin ratio < 0.06 had significantly longer survival times, and the ratio presents a high prognostic value for advanced NSCLC. 5) multivariable COX proportional hazards regression demonstrates that radiotherapy, chemotherapy, and TKI therapy, ALK inhibitor therapy, bevacizumab treatment, immunotherapy, and TCM therapy are the independent protective factors for patients with advanced NSCLC; gender, health state scores, pathological types, stages of tumor and CAR value are the independent risk factors. ConclusionPatients who received TCM combined therapy are higher than these without the combination therapy in median survival time, five-year survival rate and progression-free survival; the longer duratiosn of both TCM maintenance therapy and targeted maintenance therapy are associated with the better outcomes, and it is not affected by time-dependent confounding factors; the patients with new metastases within 7 to 8 months after diagnosis of advanced NSCLC have poor prognosis; among patients with advanced NSCLC, these with lower albumin levels or higher C-reactive protein levels have shorter survival compared to those with arrest of bone marrow.

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备注/Memo

备注/Memo:
国家中医药管理局高水平中医药重点学科建设项目（zyyzdxk-2023063）；上海市临床重点专科建设项目（中医肿瘤）［shsczdzk03701，ZY（2021-2023）-0302］；上海市浦东新区卫生健康委员会卫生计生科研项目计划任务（20191114134747096）；上海市中医肿瘤临床医学研究中心（21MC1930500）。沈倩芸（1995—），女，硕士学位。研究方向：中医药抗肿瘤的理论和机制研究。
更新日期/Last Update: 2025-11-15