Please wait a minute...
1Traditional Medicine Research  2019, Vol. 4 Issue (2): 91-98    DOI: 10.12032/TMR20190225099
Article     
The effect of long-term traditional Chinese medicine treatment on disease-free survival of postoperative stage I-III lung cancer patients: a retrospective cohort study
Su-Tong Liu1, Su-Fang Zhang1,2, Kai-Qi Su3, Ying-Bin Luo1, Zhi-Hong Fang1, Yuan Fang1, Jing Xu1, Jian-Chun Wu1,*(), Yan Li1,*()
1 Department of Oncology, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
2 Department of Traditional Chinese and Western Medicine, Shanghai Pulmonary Hospital of Tongji University School of Medicine, Shanghai, China.
3 Shanghai University of Traditional Chinese Medicine, Shanghai, China.
Download: HTML     PDF(616KB)
Export: BibTeX | EndNote (RIS)      

Highlights

This retrospective cohort study showed that long-term traditional Chinese medicine as an adjuvant therapy can improve disease-free survival of postoperative lung cancer patients, especially in patients with stage I and II disease.

Traditionality

This study provided sufficient evidence that long-term traditional Chinese medicine treatment is associated with 5-year disease-free survival in postoperative lung cancer patients, especially in patients with stage I and II disease.

Abstract

Objective: Traditional Chinese medicine (TCM) has been extensively used as one of popular alternative therapies for several cancers. However, it remains unclear whether TCM treatment is associated with longer survival in lung cancer patients. In this study, we explored the effect of long-term TCM treatment on patients with different stages of lung cancer. Methods: All information of lung cancer patients with stage I-III disease from January 2007 to September 2015 was collected for this retrospective cohort study. Those who were treated with TCM after surgery were divided into TCM group and the others were into the non-TCM group (control group). All patients were regularly followed up by clinic appointment or phone, and all survival data were collected from databases after the last follow-up in October 2017. Results: A total of 575 patients were included in this study, with 299 patients in the TCM group and 276 in the control group. For all patients, 5-year disease-free survival (DFS) was 62.2% in TCM group and 42.1% in the control group, and 6-year DFSs were 51.8% and 35.4%, respectively (HR = 0.51, 95% CI: 0.40 to 0.66, log-rank P ≤ 0.001). For patients with stage I, 5-year DFSs were 83.7% (TCM group) and 57.5% (control group) and 6-year DFSs were 73.7% and 51.9%, respectively (HR = 0.30, 95% CI: 0.18 to 0.50, log-rank P ≤ 0.001). For patients with stage II in the TCM group and the control group, 5-year DFSs were 59.4% and 17.6% and 6-year DFSs were 44.7% and 17.6%, respectively (HR = 0.31, 95% CI: 0.19 to 0.52, log-rank P ≤ 0.001), and for patients with stage III, 5-year and 6-year DFSs in the TCM group were 18.7% and 12.5% compared with 28.4% and 20.3% in the control group (HR = 1.06, 95% CI: 0.72 to 1.56, log-rank P = 0.76). Conclusions: This study demonstrated that long-term TCM treatment as an adjuvant therapy is able to improve the DFS of postoperative stage I-III lung cancer patients, especially in patients with stage I and II disease. However, these observational findings need being validated by large sample randomized controlled trials.



Key wordsTraditional Chinese medicine      Lung cancer      Disease-free survival      Retrospective study      Cohort study     
Received: 25 November 2018      Published: 05 March 2019
Fund:  This work was supported by the Nation Natural Science Foundation of China (No.814737627, No.81673947), the Science and Technology Commission of Shanghai Municipality (No.17401933500) and the Shanghai Municipal Population and Family Planning Commission (No.201740059).
Corresponding Authors: Wu Jian-Chun,Li Yan     E-mail: eq219@126.com.;yanxiaotian@shutcm.edu.cn
Cite this article:

Su-Tong Liu, Su-Fang Zhang, Kai-Qi Su, Ying-Bin Luo, Zhi-Hong Fang, Yuan Fang, Jing Xu, Jian-Chun Wu, Yan Li. The effect of long-term traditional Chinese medicine treatment on disease-free survival of postoperative stage I-III lung cancer patients: a retrospective cohort study. 1Traditional Medicine Research, 2019, 4(2): 91-98. doi: 10.12032/TMR20190225099

URL:

https://www.tmrjournals.com/tmr/EN/10.12032/TMR20190225099     OR     https://www.tmrjournals.com/tmr/EN/Y2019/V4/I2/91

Figure 1 The flow chart of patients selection and censoring for this study
DFS, Disease-free survival.
Figure 2 1-6 year disease-free survival in the TCM and control group
Figure 3 Disease-free survival curves for all patients before (A) and after (B) propensity scoring
Figure 4 Disease-free survival curves for patients with stage I (A), II (B) and III (C) disease
Group Before PSM After PSM
TCM
(n = 299)
Control
(n = 276)
P value TCM
(n = 233)
Control
(n = 233)
P value
Gender
Male 169 177 0.073 144 145 0.924
Female 130 99 89 88
Age (year)
<60 143 143 0.359 114 115 0.926
>=60 156 133 119 118
Pathology type
Adenocarcinoma 177 167 0.009* 153 145 0.620
Squamous carcinoma 55 71 50 51
Unknown 67 38 30 37
Stage
169 148 0.757 125 127 0.709
59 56 42 47
71 72 66 59
Histodifferentiation
Poor 24 17 0.054 20 14 0.583
Moderate 126 140 115 114
Well 13 19 12 17
Unknown 136 100 86 88
Chemotherapy
Yes 229 231 0.037* 188 191 0.721
No 70 45 45 42
Radiotherapy
Yes 20 24 0.433 19 16 0.598
No 279 252 214 217
Comorbidities
Yes 162 127 0.050 118 120 0.853
No 137 149 115 113
Table 1 The baseline characteristics and clinical features in the TCM group and control group.
1.   Gadgeel SM, Ramalingam SS, Kalemkerian GP.Treatment of lung cancer. Radiol Clin North Am 2012, 50: 961-974.
doi: 10.1016/j.rcl.2012.06.003
2.   Torre LA, Bray F, Siegel RL, et al. Global cancer statistics, 2012. CA Cancer J Clin 2015, 65: 87-108.
doi: 10.3322/caac.21262
3.   Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015. CA Cancer J Clin 2016, 66: 115-132.
doi: 10.3322/caac.21338 pmid: 26808342
4.   Ferrara R, Mezquita L, Besse B.Progress in the management of advanced thoracic malignancies in 2017. J Thorac Oncol 2018, 13: 301-322.
doi: 10.1016/j.jtho.2018.01.002 pmid: 29331646
5.   Wakelee H, Kelly K, Edelman MJ.50 years of progress in the systemic therapy of non-small cell lung cancer. Am Soc Clin Oncol Educ Book 2014, 34: 177-189.
doi: 10.14694/EdBook_AM.2014.34.177 pmid: 24857075
6.   Eadens MJ, Robinson SI, Price KA.Effectiveness of maintenance treatments for nonsmall cell lung cancer. Lung Cancer (Auckl) 2011, 2: 29-39.
doi: 10.2147/LCTT.S12507
7.   Salgia R.Diagnostic challenges in non-small-cell lung cancer: an integrated medicine approach. Future Oncol 2015, 11: 489-500.
doi: 10.2217/fon.14.275 pmid: 25675128
8.   Liu J, Lin HS, Hou W, et al. Comprehensive treatment with Chinese medicine in patients with advanced non-small cell lung cancer: A multicenter, prospective, cohort study. Chin J Integr Med 2017, 23: 733-739.
doi: 10.1007/s11655-016-2737-1 pmid: 27796823
9.   Ling CQ, Wang LN, Wang Y, et al. The roles of traditional Chinese medicine in gene therapy. J Integr Med 2014, 12: 67-75.
doi: 10.1016/S2095-4964(14)60019-4 pmid: 24666672
10.   Ling CQ, Yue XQ, Ling C.Three advantages of using traditional Chinese medicine to prevent and treat tumor. J Integr Med 2014, 12: 331-335.
doi: 10.1016/S2095-4964(14)60038-8 pmid: 25074882
11.   Xu L, Li H, Xu Z, et al. Multi-center randomized double-blind controlled clinical study of chemotherapy combined with or without traditional Chinese medicine on quality of life of postoperative non-small cell lung cancer patients. BMC Complement Altern Med 2012, 12: 112.
doi: 10.1186/1472-6882-12-S1-P112 pmid: 3373485
12.   Zhao Z, Liao H, Ju Y.Effect of compound Kushen injection on T-cell subgroups and natural killer cells in patients with locally advanced non-small-cell lung cancer treated with concomitant radiochemotherapy. J Tradit Chin Med 2016, 36: 14-18.
doi: 10.1016/S0254-6272(16)30002-4 pmid: 26946613
13.   Tang WR, Yang SH, Yu CT, et al. Long-Term effectiveness of combined treatment with traditional Chinese medicine and western medicine on the prognosis of patients with lung cancer. J Altern Complement Med 2016, 22: 212-222.
doi: 10.1089/acm.2015.0214 pmid: 26986673
14.   Liu JM, Lin PH, Hsu RJ, et al. Complementary traditional Chinese medicine therapy improves survival in patients with metastatic prostate cancer. Medicine 2016, 95: e4475.
doi: 10.1016/j.urols.2016.05.199 pmid: 4979842
15.   Huang Y, Cai T, Xia X, et al. Research advances in the intervention of inflammation and cancer by active ingredients of traditional Chinese medicine. J Pharm Pharm Sci 2016, 19: 114-126.
doi: 10.18433/J3SG7K pmid: 27096696
16.   Xu Y, Mao JJ, Sun L, et al. Association between use of Traditional Chinese Medicine herbal therapy and survival outcomes in patients with stage II and III colorectal cancer: a multicenter prospective cohort study. J Natl Cancer Inst Monogr 2017, 2017: 19-25.
doi: 10.1093/jncimonographs/lgx015 pmid: 29140496
17.   Xu Y, Zhao AG, Li ZY, et al. Survival benefit of traditional Chinese herbal medicine (a herbal formula for invigorating spleen) for patients with advanced gastric cancer. Integr Cancer Ther 2013, 12: 414-422.
doi: 10.1177/1534735412450512 pmid: 22781545
18.   Jiang Y, Liu LS, Shen LP, et al. Traditional Chinese medicine treatment as maintenance therapy in advanced non-small-cell lung cancer: a randomized controlled trial. Complement Ther Med 2016, 24: 55-62.
doi: 10.1016/j.ctim.2015.12.006 pmid: 26860802
19.   Wang XQ, Liu J, Lin HS, et al. A multicenter randomized controlled open-label trial to assess the efficacy of compound kushen injection in combination with single-agent chemotherapy in treatment of elderly patients with advanced non-small cell lung cancer: study protocol for a randomized controlled trial. Trials 2016, 17: 124.
doi: 10.1186/s13063-016-1231-6
20.   Chan KK, Yao TJ, Jones B, et al. The use of Chinese herbal medicine to improve quality of life in women undergoing chemotherapy for ovarian cancer: a double-blind placebo-controlled randomized trial with immunological monitoring. Ann Oncol 2011, 22: 2241-2249.
doi: 10.1093/annonc/mdq749 pmid: 21355071
21.   Liao YH, Lin CC, Lai HC, et al. Adjunctive traditional Chinese medicine therapy improves survival of liver cancer patients. Liver Int 2015, 35: 2595-2602.
doi: 10.1111/liv.12847 pmid: 25875878
22.   Fei B, Dai W, Zhao S.Efficacy, safety, and cost of therapy of the traditional Chinese medicine, catalpol, in patients following surgical resection for locally advanced colon cancer. Med Sci Monit 2018, 24: 3184-3192.
doi: 10.12659/MSM.907569 pmid: 29763415
23.   Ezeome ER, Anarado AN.Use of complementary and alternative medicine by cancer patients at the University of Nigeria Teaching Hospital, Enugu, Nigeria. BMC Complement Altern Med 2007, 7: 28.
doi: 10.1186/1472-6882-7-28 pmid: 17850665
24.   Hyodo I, Amano N, Eguchi K, et al. Nationwide survey on complementary and alternative medicine in cancer patients in Japan. J Clin Oncol 2005, 23: 2645-2654.
doi: 10.1200/JCO.2005.04.126 pmid: 15728227
25.   Chen YZ, Feng XB, Li ZD, et al. Clinical study on long-term overall survival of advanced non-small-cell lung cancer patients treated with Chinese medicine and Western medicine. Chin J Integr Med 2014, 20: 179-183.
doi: 10.1007/s11655-014-1770-6 pmid: 24615210
26.   Li SG, Chen HY, Ou-Yang CS, et al. The efficacy of Chinese herbal medicine as an adjunctive therapy for advanced non-small cell lung cancer: a systematic review and meta-analysis. PLoS One 2013, 8: e57604.
doi: 10.1371/journal.pone.0057604 pmid: 23469033
27.   Xu ZY, Jin CJ, Zhou CC, et al. Treatment of advanced non-small-cell lung cancer with Chinese herbal medicine by stages combined with chemotherapy. J Cancer Res Clin Oncol 2011, 137: 1117-1122.
doi: 10.1007/s00432-011-0975-3 pmid: 21298288
28.   Liao YH, Li CI, Lin CC, et al. Traditional Chinese medicine as adjunctive therapy improves the long-term survival of lung cancer patients. J Cancer Res Clin Oncol 2017, 143: 2425-2435.
doi: 10.1007/s00432-017-2491-6 pmid: 28803328
[1] Wei-Jie Xie, Yu-Mei Wu, Shuai-Shuai Chen, Jian Xu, Fang-Fang Yang, Yong-Ping Zhang, Xiao-Bo Sun. In vitro evaluation of transdermal permeation effects of Fu’s cupping therapy via six diffusion kinetics models[J]. 1Traditional Medicine Research, 2019, 4(1): 42-53.
[2] Jian Hao, Shi-Jun Li. Recent advances in network pharmacology applications in Chinese herbal medicine[J]. 1Traditional Medicine Research, 2018, 3(6): 260-272.
[3] Liang-Jun Yang, Dao-Rui Hou, Ya Li, Zhi-Peng Hu, Yong Zhang. A network pharmacology approach to investigate the mechanisms of Si-Jun-Zi decoction in the treatment of gastric precancerous lesions[J]. 1Traditional Medicine Research, 2018, 3(6): 273-285.
[4] Yan-Lan Hu, Shao-Hui Wang, Cui-Wei He, Tong-Xiang Liu. Research progress on anti-tumor properties of Marsdenia tenacissima[J]. 1Traditional Medicine Research, 2018, 3(4): 202-213.
[5] Yue Ji, Jun-Chen Li, Jing-Yan Meng, Xue-Rou Yan, Jian-ang Li, Qing-Yun Zhao, Kang Yang, Chun- Liu. Study of dual-directional regulatory effect of Banxia (Pinellia ternata) and Huanglian (Coptis chinensis) drug pair on gastrointestinal movement of mice[J]. 1Traditional Medicine Research, 2018, 3(3): 148-156.
[6] Li-Lin Yang, Jie Gao, Hai-Wang Wu, Song-Ping Luo. History of recurrent miscarriage in traditional Chinese medicine literature[J]. 1Traditional Medicine Research, 2018, 3(2): 62-69.
[7] Wen-Qi Huang, Zhu Yang, Dong-Xin Tang, Feng-Xi Long, Li Luo, Bing Yang, Juan Li, Jie Chen. Pharmacological intervention of traditional Chinese medicine for the quality of life in patients with colorectal cancer: a systematic review and meta-analysis[J]. 1Traditional Medicine Research, 2018, 3(2): 95-105.
[8] Dong-Mei Jiang, Feng-Wei Wang, Li-Juan Zhang, Long Zhang, Tai Zhang, Wen-Hua Zhang. Gemcitabine and cisplatin combined with the Chinese herbal medicine compound Fuzhenggubenfang improve quality of life and progression-free survival in patients with advanced non-small cell lung cancer[J]. 1Traditional Medicine Research, 2018, 3(1): 40-51.
[9] Tian Ran, Dai Liang, Shang Hong-Cai, Li You-Ping, Bian Zhao-Xiang. How to establish precise proprietary Chinese medicine in post-marketing reappraisal?[J]. 1Traditional Medicine Research, 2017, 2(4): 155-160.
[10] Yang Xue, Wu Xiong-Zhi. The combination of disease and Zheng (syndrome) on the basic of differentiation of six channels: a new pattern of disease diagnosis and treatment of traditional Chinese medicine[J]. 1Traditional Medicine Research, 2017, 2(2): 100-104.
[11] Zhai Jing-Bo, Li Jiang, Chen Jing. The applications of Bayesian models in real-world studies of traditional Chinese medicine: a primer[J]. 1Traditional Medicine Research, 2017, 2(2): 88-93.
[12] Xu Wei, Chai Ni, Cheng Yue-Lei, Yang Qiong, Zhu Hui-Rong. Analysis on the principles of differentiation and prescription of traditional Chinese medicine in the treatment of cancerous fever[J]. 1Traditional Medicine Research, 2017, 2(1): 41-50.
[13] Que Zu-Jun, Bi Ling, Zhou Zhi-Yi, Zhou Lei, Wang Qing, Luo Bin, Liu Jian-Wen, Li He-Gen, Tian Jian-Hui. Feiji Recipe Reverses Lung Cancer Immune Escape by Inhibiting the Expression of IDO[J]. 1Traditional Medicine Research, 2016, 1(3): 149-155.
[14] Liu Li-Juan, Zhou Chao, Song Fu-Cheng, Zhang Sen-Sen, Teng Wen-Jing, Zhuang Jing, Sun Chang-Gang, Si Hong-Zong. Molecular docking study on the molecular mechanism of rhaponticin for treatment of chronic myelocytic leukemia[J]. 1Traditional Medicine Research, 2016, 1(3): 122-127.
[15] Shang Hong-Cai, Wu Xiong-Zhi, Qiu Rui-Jin, Wang Ya-Han, Wang Yong-Yan. Traditional Chinese medicine should not be ignored during the development of precision medicine with Chinese characteristics[J]. 1Traditional Medicine Research, 2016, 1(3): 105-114.