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Association between Chinese Medicine Therapy and Survival Outcomes in Postoperative Patients with NSCLC: A Multicenter, Prospective, Cohort Study

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Abstract

Objective

To evaluate the association between Chinese medicine (CM) therapy and disease-free survival (DFS) outcomes in postoperative patients with non-small cell lung cancer (NSCLC).

Methods

This multiple-center prospective cohort study was conducted in 13 medical centers in China. Patients with stage I, II, or IIIA NSCLC who had undergone radical resection and received conventional postoperative treatment according to the National Comprehensive Cancer Network (NCCN) guidelines were recruited. The recruited patients were divided into a CM treatment group and a control group according to their wishes. Patients in the CM treatment group received continuous CM therapy for more than 6 months or until disease progression. Patients in the control group received CM therapy for less than 1 month. Follow-up was conducted over 3 years. The primary outcome was DFS, with recurrence/metastasis rates as a secondary outcome.

Results

Between May 2013 and August 2016, 503 patients were enrolled into the cohort; 266 were classified in the CM treatment group and 237 in the control group. Adjusting for covariates, high exposure to CM was associated with better DFS [hazard ratio (HR) = 0.417, 95% confidential interval (CI): 0.307–0.567)]. A longer duration of CM therapy (6–12 months, 12–18 months, >24 months) was associated with lower recurrence and metastasis rates (HR = 0.225, 0.119 and 0.083, respectively). In a subgroup exploratory analysis, CM therapy was also a protective factor of cancer recurrence and metastasis in both stage I–IIIA (HR=0.50, 95% CI: 0.37–0.67) and stage IIIA NSCLC postoperative patients (HR = 0.48, 95% CI: 0.33–0.71), DFS was even longer among CM treatment group patients.

Conclusions

Longer duration of CM therapy could be considered a protective factor of cancer recurrence and metastasis. CM treatment is associated with improving survival outcomes of postoperative NSCLC patients in China. (Registration No. ChiCTR-OOC-14005398)

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Acknowledgments

The authors are indebted to all the patients whose participation made this study possible. We owe their gratitude to the following institutions: Guang’anmen Hospital, China Academy of Chinese Medical Sciences; The First Affiliated Hospital of Guangzhou University of Chinese Medicine; Hunan Academy of Traditional Chinese Medicine Affiliated Hospital; Cancer Hospital of Liaoning Province; Cancer Hospital of Shanxi Province; The Xinjiang Uygur Autonomous Region Traditional Chinese Medicine Hospital; Zhejiang Province Traditional Chinese Medicine Hospital; Anhui Provincial Hospital; Chongqing Cancer Hospital; Wuxi Hospital of Traditional Chinese Medicine; Dalian Hospital of Traditional Chinese Medicine; The Fourth Hospital of Qinhuangdao; and Shenzhen Baoan District Hospital of Traditional Chinese Medicine.

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Authors and Affiliations

  1. Department of Oncology, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China

    Xue-qian Wang, Ying Zhang, Wei Hou, Ying-tian Wang, Jia-bin Zheng, Jie Li, Jie Liu, Hui-ting Fan, Mei-ying Zhang & Hong-sheng Lin

  2. Department of Oncology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510000, China

    Li-zhu Lin

  3. Department of Oncology, Hunan Academy of Traditional Chinese Medicine Affiliated Hospital, Changsha, 410000, China

    Yi-lan Jiang

  4. Department of Integrated TCM & Western Medicine, Cancer Hospital of Liaoning Province, Shenyang, 110000, China

    Shen-yu Wang

  5. Department of Traditional Chinese Medicine, Cancer Hospital of Shanxi Province, Taiyuan, 030000, China

    Ying Xie

  6. Department of Oncology, The Xinjiang Uygur Autonomous Region Traditional Chinese Medicine Hospital, Urumqi, 830000, China

    Hong-liang Zhang

  7. Department of Oncology, Zhejiang Province Traditional Chinese Medicine Hospital, Hangzhou, 310000, China

    Qi-jin Shu

  8. Oncology Department of Traditional Chinese Medicine, Anhui Provincial Hospital, Hefei, 230000, China

    Ping Li

  9. Oncology Department of Traditional Chinese Medicine, Chongqing Cancer Hospital, Chongqing, 400000, China

    Wei Wang

  10. Department of Oncology, Wuxi Hospital of Traditional Chinese Medicine, Wuxi, Jiangsu Province, 214000, China

    Jian-liang You

  11. Department of Oncology, Dalian Hospital of Traditional Chinese Medicine, Dalian, Liaoning Province, 116000, China

    Ge Li

Authors
  1. Xue-qian Wang
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  2. Ying Zhang
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  3. Wei Hou
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  5. Jia-bin Zheng
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  6. Jie Li
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  7. Li-zhu Lin
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  8. Yi-lan Jiang
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  9. Shen-yu Wang
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  11. Hong-liang Zhang
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  12. Qi-jin Shu
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  13. Ping Li
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  14. Wei Wang
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  15. Jian-liang You
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  16. Ge Li
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  17. Jie Liu
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  18. Hui-ting Fan
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  19. Mei-ying Zhang
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  20. Hong-sheng Lin
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Contributions

LHS, HW and ZY are the main investigators regarding study data accrual and study design. WXQ and WYT contributed to data statistics and writing the article. WXQ and ZJB contributed to study monitoring and acquisition of data. LJ, LLZ, JYL, WSY, XY, ZHL, SQJ, LP, WW, YJL, LG, LJ, FHT and ZMY were responsible for data-processing support. All authors have read and approved the final version of the manuscript.

Corresponding author

Correspondence to Hong-sheng Lin.

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Conflict of interest

None to declare.

Supported by Special Funded Projects of the TCM Industry (No. 201307006), National Natural Science Foundation of China (No. 81473467) and Beijing Natural Science Fund (No. 7192181)

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Wang, Xq., Zhang, Y., Hou, W. et al. Association between Chinese Medicine Therapy and Survival Outcomes in Postoperative Patients with NSCLC: A Multicenter, Prospective, Cohort Study. Chin. J. Integr. Med. 25, 812–819 (2019). https://doi.org/10.1007/s11655-019-3168-6

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  • DOI: https://doi.org/10.1007/s11655-019-3168-6

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