中药联合PD-1/PD-L1抑制剂一线治疗老年非小细胞肺癌的临床疗效及核心处方分析OA

Objective To investigate the effect of Chinese medicine combined with first-line programmed death-1(PD-1)/programmed death-ligand 1(PD-L1)inhibitors on progression-free survival(PFS)in elderly patients with non-small cell lung cancer(NSCLC)based on real-world data,and to explore the core Chinese medicine prescription.Methods A retrospective analysis was conducted on the clinical data of 217 elderly NSCLC patients treated at China-Japan Friendship Hospital from January 2019 to December 2023.The Kaplan-Meier method was used to estimate the median PFS of each group and plot survival curves,and the Log-rank test was employed to compare the differences in median PFS between groups.Cox regression model was used to analyze independent factors influencing PFS prognosis in elderly NSCLC patients,and related adverse events were recorded and analyzed.Clinical records of 73 elderly NSCLC patients treated with Chinese medicine combined with first-line PD-1/PD-L1 inhibitors were collected to establish a Chinese medicine prescription database.Association rule analysis and cluster analysis were used to explore the clinical medication characteristics and principles of effective Chinese medicine compound formulas.Results(1)A total of 206 elderly NSCLC patients were finally included,with 133 cases(64.56%)in the western medicine group and 73 cases(35.44%)in the integrated Chinese medicine and western medicine group(shortened to intergrated group).The median PFS was 11.90 months in the western medicine group,with 1-,2-,and 3-year PFS rates of 52.7%,26.9%,and 21.5%,respectively;the median PFS was 18.83 months in the integrated group,with 1-,2-,and 3-year PFS rates of 59.7%,47.8%,and 40.1%,respectively.The difference in PFS between the two groups was statistically significant(P=0.013).(2)Univariate and multivariate Cox regression analyses showed that clinical stage and whether receiving Chinese medicine treatment were significantly correlated with PFS in elderly NSCLC patients(P＜0.05 or P＜0.01).(3)The Chinese medicine compound prescriptions involved a total of 296 herbs,with 19 herbs used more than 100 times.After cluster analysis,the high-frequency herbs were divided into six clusters,among which"Astragali Radix,Codonopsis Radix,Poria,Atractylodis Macrocephalae Rhizoma,Agrimoniae Herba"constituted the core prescription.Conclusion Chinese medicine combined with first-line PD-1/PD-L1 inhibitors significantly prolongs median PFS and reduces immune-related adverse events in elderly NSCLC patients.Clinical stage and whether receiving Chinese medicine treatment are independent prognostic factors for PFS.The core prescription represented by"Astragali Radix,Codonopsis Radix,Poria,Atractylodis Macrocephalae Rhizoma,Agrimoniae Herba"embodies the traditional Chinese medicine therapeutic principle of"strengthening vital qi and reinforcing deficiency".