摘要
目的:评价并比较扶正、祛邪、扶正祛邪治则(通过这3种治则指导的中医治疗来反映,即扶正治疗、祛邪治疗、扶正祛邪治疗)对结直肠癌术后复发转移的影响.方法:基于采用非干预性临床研究的方法收集数据;采用寿命表法、Wilcoxon(Gehan)检验、Cox比例风险模型等统计学方法分析并比较扶正、祛邪、扶正祛邪三种不同中医治疗对结直肠癌术后复发转移的影响.结果:寿命表法和Wilcoxon(Gehan)检验的结果显示,TNM分期(P=0.000)、年龄(P=0.045)、组织分化程度(P=0.000)、放疗(P=0.000)、中药治疗(P=0.001)在累积无病生存率上的差异有统计学意义.不同中药治疗按扶正、祛邪、扶正祛邪区别并分别与对照组比较,差异均有统计学意义(P=0.000,P=0.005,P=0.019).Cox比例风险模型的多因素分析显示,TNM分期、年龄、组织分化程度、放疗、中药治疗是结直肠癌术后复发转移的独立影响因素,其中中药治疗是保护性因素.Wilcoxon(Gehan)检验对扶正、祛邪、扶正祛邪治疗进行两两比较,三者在术后无病生存上的差异均无统计学意义(P>0.05).扶正治疗在3年、5年的年累计无病生存率(year accumulative disease free survival rate,YDFSR)上与祛邪、扶正祛邪治疗无明显差别,但在10年Y D F S R上明显高于后两者(47.00%、33.00%、32.00%),在中位无病生存期方面,也明显长于后两者(91.28 mo、44.84 mo、52.45mo).结论:扶正、祛邪、扶正祛邪治则指导的中医治疗均能有效抑制结直肠癌术后复发转移;在预防结直肠癌术后复发转移的中医药治疗上,不必过于囿于扶正、祛邪、扶正祛邪治疗的任何一种,具体治则和治法仍应突出辨证论治的重要性;患者在获得5年无病生存后,其治疗在辨证论治的基础上,适当考虑扶正中药的应用,可能能获得更好的远期无病生存率.
AIM： To analyze the effects of three different Chinese medicine treatments, Fuzheng, Quxie and Fuzhengquxie, on postoperative relapse and metastasis of colorectal cancer （CRC）. METHODS： The data were collected on the basis of non-interventional clinical research. Life-table, Wilcoxon （Gehan） test and Cox proportional hazard model （multivariate analysis） were used to reveal the effect of Chinese medicine treatments on relapse and metastasis of postoperative CRC. RESULTS： The results of life-table analysis and Wilcoxon （Gehan） test showed that there were significant correlations between DFS and TNM stage （P = 0.000）, age （P -0.045）, histopathologic differentiation （P = 0.000）, radiotherapy （P = 0.000） and Chinese medicine treatment （P = 0.001）. The differences between Fuzheng vs control, Quxie vs control and Fuzhengquxie vs control were all statistically significant （P = 0.000, 0.005, 0.019, respectively）. Cox multivariate analysis showed that TNM stage, age, histopathologic differentiation, radiotherapy and Chinese medicine treatment were all independent influencing factors, among which Chinese medicine treatment was a protective one. Pairwise comparisons of Fuzheng, Quxie and Fuzhengquxie revealed that there were no statistical differences （P 〉 0.05 for all） in the 3and 5-year accumulative survival rates （YDFSR）, however, the 10-YDFSR and median DFS were longer in the Quxie group than in the other two groups （47.00% vs 33.00%, 32.00%; 91.28 mo vs 44.84 mo, 52.45 mo; P 〈 0.05 for all）. CONCLUSION： The Chinese medicine treatments directed by therapeutic guidance of Fuzheng, Quxie and Fuzhengquxie can all inhibit postoperative relapse and metastasis of CRC. In the prevention of postoperative relapse and metastasis of CRC with Chinese medicine therapy, we do not have to limit to any of the three Chinese medicine treatments, but should focus on treatment based on syndrome differentiation. After patients achieve 5-year DFS, the appropriate application of F
出处
《世界华人消化杂志》
CAS
北大核心
2014年第13期1890-1896,共7页
World Chinese Journal of Digestology
基金
上海市卫生局科研基金资助项目
No.20134117
上海市卫生局重点项目基金资助项目
No.20124024~~
关键词
结直肠癌
术后复发转移
扶正
祛邪
扶正祛邪
Colorectal cancer
Postoperative re-lapse and metastasis
Fuzheng treatment
Quxietreatment
Fuzhengquxie treatment
