Chen Shu-Ling, Lin Wei-Chun, Chen Yu-Chun, Chen Jiun-Liang, Wu Yi-Hong, Yang Sien-Hung, Chen Hsing-Yu
Division of Chinese Internal and Pediatric Medicine, Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Taoyuan Branch, Taoyuan, Taiwan.
Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.
Front Pharmacol. 2022 Oct 6;13:1018281. doi: 10.3389/fphar.2022.1018281. eCollection 2022.
Esophageal cancer (EC) remains a leading cause of death worldwide and in Taiwan. The prognosis of advanced-stage EC is notably poor, and the treatment options are limited. Chinese herbal medicine (CHM) has been widely used as a complementary treatment for cancer, yet the long-term effect of CHM in stage IV EC remains unclear. The multi-institutional cohort obtained from the Chang Gung research database (CGRD) was used to study the long-term outcome of CHM use among incident stage IV EC patients from 1 January 2002, to 31 December 2018. All patients were followed up to 5 years or the occurrence of death. The overall survival (OS) and disease-specific survival rates were conducted using Kaplan-Meier estimation. Overlap weighing and landmark analysis were used to eliminate confounding and immortal time biases. Furthermore, we demonstrated the core CHMs for stage IV EC by using the Chinese herbal medicine network (CMN) analysis on prescriptions. Nine hundred eighty-five stage IV EC patients were analyzed, including 74 CHM users and 911 non-CHM users. We found the use of CHM was associated with a higher 5-year overall survival rate than CHM nonusers (the cumulative probability: 19.52% versus 6.04%, log-rank test: < 0.001, and the < 0.001 with overlap weighting). In addition, the overall median survival time was about 7 months longer among CHM users. Moreover, the lower 1-, 3-, 5-year disease-specific survival rates were higher among CHM users. Additionally, the risk of all-cause mortality was lower among CHM users when considering accessible demographic covariates (adjusted hazard ratio: 0.59, 95%CI: 0.39, 0.89, = 0.011). Furthermore, the CMN analysis revealed that CHMs improved health while relieving tumor burden. For example, was the core CHM with an anti-cancer effect, while Miq and Rochebrune were used together to relieve cancer-related gastrointestinal discomfort. The use of CHM seems safe and possibly beneficial among stage IV EC patients with a higher 5-year OS. Further clinical trials on CHM were guaranteed to explore the role of CHM in managing stage IV EC patients.
食管癌（EC）在全球及台湾地区仍是主要的致死原因。晚期食管癌的预后明显较差，治疗选择有限。中药已被广泛用作癌症的辅助治疗方法，但中药对IV期食管癌的长期疗效仍不明确。本研究使用从长庚研究数据库（CGRD）获取的多机构队列，来研究2002年1月1日至2018年12月31日期间新诊断的IV期食管癌患者使用中药的长期结局。所有患者均随访至5年或死亡。采用Kaplan-Meier估计法计算总生存率（OS）和疾病特异性生存率。使用重叠加权法和标志性分析来消除混杂因素和不朽时间偏倚。此外，我们通过对处方进行中药网络（CMN）分析，确定了IV期食管癌的核心中药。共分析了985例IV期食管癌患者，其中74例使用中药，911例未使用中药。我们发现，与未使用中药的患者相比，使用中药的患者5年总生存率更高（累积概率：19.52%对6.04%，对数秩检验：<0.001，重叠加权后<0.001）。此外，使用中药的患者总体中位生存时间长约7个月。而且，使用中药的患者1年、3年、5年疾病特异性生存率更高。此外，在考虑可获得的人口统计学协变量时，使用中药的患者全因死亡率风险更低（调整后风险比：0.59，95%CI：(0.39, 0.89)，P = 0.011）。此外，CMN分析显示，中药在减轻肿瘤负担的同时改善了健康状况。例如， 是具有抗癌作用的核心中药，而 米契和 罗氏布鲁内一起使用可缓解癌症相关的胃肠道不适。在IV期食管癌患者中，使用中药似乎是安全的，且可能有益，5年总生存率更高。有必要开展进一步的中药临床试验，以探索中药在IV期食管癌患者管理中的作用。
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