运用倾向性评分匹配分析益气养精方对Ⅰ～ⅢA期肺腺癌术后患者生存预后的影响

汪宇涵; 董昀; 杨轶; 崔清; 蔡霄月; 周亚宁; 张时; 张铭

doi:10.16305/j.1007-1334.2023.2301003

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运用倾向性评分匹配分析益气养精方对Ⅰ～ⅢA期肺腺癌术后患者生存预后的影响

中医药治疗优势病种与重大疾病研究：肿瘤疾病专题 | 更新时间：2023-06-16

- 运用倾向性评分匹配分析益气养精方对Ⅰ～ⅢA期肺腺癌术后患者生存预后的影响
- Propensity score matching analysis of the effect of the Yiqi Yangjing Prescription on the survival prognosis of patients with stage Ⅰ⁃ⅢA lung adenocarcinoma after surgery
- 上海中医药杂志 2023年57卷第6期页码：50-55
- 作者机构：
  
  1.上海交通大学医学院附属胸科医院中西医结合科（上海 200030）
  2.上海交通大学医学院附属胸科医院肿瘤科（上海 200030）
- 作者简介：
  
  汪宇涵，男，硕士，住院医师，主要从事中西医结合治疗胸部恶性肿瘤的临床研究工作
  张铭，主任医师，博士研究生导师； E-mail： gason2000@126.com
- 基金信息：
  
  国家自然科学基金项目(81873275);上海交通大学“交大之星”计划医工交叉研究基金项目(YG2019ZDA25)
- DOI：10.16305/j.1007-1334.2023.2301003
  中图分类号：
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汪宇涵,董昀,杨轶,等.运用倾向性评分匹配分析益气养精方对Ⅰ～ⅢA期肺腺癌术后患者生存预后的影响[J].上海中医药杂志,2023,57(6):50-55.

WANG Yuhan,DONG Yun,YANG Yi,et al.Propensity score matching analysis of the effect of the Yiqi Yangjing Prescription on the survival prognosis of patients with stage Ⅰ⁃ⅢA lung adenocarcinoma after surgery[J].Shanghai Journal of Traditional Chinese Medicine,2023,57(6):50-55.
汪宇涵,董昀,杨轶,等.运用倾向性评分匹配分析益气养精方对Ⅰ～ⅢA期肺腺癌术后患者生存预后的影响[J].上海中医药杂志,2023,57(6):50-55. DOI： 10.16305/j.1007-1334.2023.2301003.

WANG Yuhan,DONG Yun,YANG Yi,et al.Propensity score matching analysis of the effect of the Yiqi Yangjing Prescription on the survival prognosis of patients with stage Ⅰ⁃ⅢA lung adenocarcinoma after surgery[J].Shanghai Journal of Traditional Chinese Medicine,2023,57(6):50-55. DOI： 10.16305/j.1007-1334.2023.2301003.

摘要

目的,2,探析益气养精方对Ⅰ～ⅢA期肺腺癌根治术后患者生存预后的影响。,方法,2,以2012年1月1日至2015年12月31日上海交通大学医学院附属胸科医院中西医结合科收治的Ⅰ～ⅢA期肺腺癌根治术后患者为研究对象，根据是否接受过益气养精方为主的中药治疗，分为中药组和对照组；采用倾向性评分匹配（PSM）平衡组间混杂因素，Kaplan-Meier法分析比较两组总生存期（OS）和无病生存期（DFS），Cox回归模型分析预后风险因素。,结果,2,①共纳入357例Ⅰ～ⅢA期肺腺癌根治术后患者，按1∶1进行PSM后，成功匹配204例，中药组和对照组均为102例。②PSM前，中药组5年OS率高于对照组（79.7% vs 64.2%，,P,=0.001），且5年DFS率较对照组更高（60.6% vs 47.2%，,P,=0.005）；PSM后，中药组5年OS率高于对照组（68.6% vs 52.5%，,P,=0.038），5年DFS率较对照组高但差异无统计学意义（49.0% vs 43.1%，,P,=0.176）。③PSM后的Cox单因素分析显示，组织学亚型是否含有高危病理因素（,P,=0.009）和是否服用中药（,P,=0.046）与OS显著相关；组织学亚型是否含有高危病理因素（,P,=0.031）和TNM分期（,P,=0.002）与DFS显著相关。④Cox多因素分析显示，是否含有高危病理因素（,P,=0.002）和是否服用中药（,P,=0.030）是影响Ⅰ～ⅢA期肺腺癌根治术后患者OS的独立预后因素；而是否含有高危病理因素（,P,=0.027）和临床TNM分期（,P,=0.001）是影响Ⅰ～ⅢA期肺腺癌根治术后患者DFS的独立预后因素。,结论,2,Ⅰ～ⅢA期肺腺癌根治术后尤其是组织学亚型有高危病理因素的患者，在西医治疗基础上服用益气养精方为主的中药，可达到延长生存期的治疗效果。

Abstract

Objective,2,To retrospectively analyze the effect of the Yiqi Yangjing （benefiting qi and nourishing essence） Prescription on the survival prognosis of patients with stage Ⅰ-ⅢA lung adenocarcinoma after radical surgery.,Methods,2,We included patients with stage Ⅰ-ⅢA non-small cell lung adenocarcinoma after radical surgery who were admitted to the Department of Integrative Medicine， Shanghai Chest Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 1， 2012 to December 31， 2015， and these study subjects were divided into traditional Chinese medicine （TCM） and control groups depending on whether they had received Yiqi Yangjing Prescription-based TCM treatment. The propensity score matching （PSM） was used to exclude the confounding factors and bias， the Kaplan-Meier method was used to compare the overall survival （OS） and disease-free survival （DFS） between the two groups， and the Cox Proportional-Hazards Model was used to analyze the prognostic risk factors.,Results,2,①A total of 357 patients with stage Ⅰ-ⅢA lung adenocarcinoma after radical surgery were included. After conducting a 1∶1 propensity score matching procedure， we got 204 successfully matched cases， with 102 cases in each group. ②Before PSM analysis， the 5-year OS rate was higher in the TCM group than that in the control group （79.7% vs. 64.2%， ,P,=0.001）， and the 5-year DFS rate was higher than that in the control group （60.6% vs. 47.2%， ,P,=0.005）； after PSM analysis， the 5-year OS rate was higher in the TCM group than that in the control group （68.6% vs. 52.5%， ,P,=0.038）， and the 5-year DFS rate was higher than that in the control group， but the difference was not statistically significant （49.0% vs 43.1%， ,P,=0.176）. ③The Cox univariate analysis after PSM showed that the presence of high-risk pathological factors in histological subtypes （,P,=0.009） and the administration of TCM （,P,=0.046） were significantly associated with OS； and the presence of high-risk pathological factors in histological subtypes （,P,=0.031） and TNM stage （,P,=0.002） were significantly associated with DFS. ④The Cox multifactorial analysis showed that the presence of high-risk pathological factors （,P,=0.002） and the administration of TCM （,P,=0.030） were independent prognostic factors affecting OS in patients with stage Ⅰ-ⅢA lung adenocarcinoma after radical surgery； while the presence of high-risk pathological factors （,P,=0.027） and clinical TNM stage （,P,=0.001） were independent prognostic factors affecting DFS in patients with stage Ⅰ-ⅢA lung adenocarcinoma after radical surgery.,Conclusion,2,The treatment effect of prolonging survival can be achieved by using Yiqi Yangjing Prescription-based TCM treatment in addition to Western medicine conventional treatment in patients with stage Ⅰ-ⅢA lung adenocarcinoma after radical surgery， especially those with high-risk pathological factors in histological subtypes.

关键词

非小细胞肺癌中医药疗法倾向性评分匹配生存期预后

Keywords

non-small cell lung cancertraditional Chinese medicine therapypropensity score matching （PSM）survival periodprognosis

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