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      The Effect of Long-Term Traditional Chinese Medicine Treatment on Survival Time of Colorectal Cancer Based on propensity Score Matching: A Retrospective Cohort Study

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          Abstract

          Objective

          To explore the effect of long-term traditional Chinese medicine (TCM) treatment on survival time of colorectal cancer (hereinafter referred to as CRC).

          Methods

          Our clinical study included patients who were diagnosed with CRC clinically or pathologically. Patients were divided into TCM treatment group and control group according to whether the modified Anti-cancer Decoction II Formula was applied for more than six months. Propensity score matching (hereinafter referred to as PSM) was used to further balance the covariates between groups. One-year to six-year progression-free survival rates of the two groups and the median progression-free survival (mPFS), median overall survival (mOS) of the two groups before and after PSM were calculated respectively. Furthermore, 15 factors that may affect the mPFS in CRC were included in COX multivariate regression analysis to explore the prognostic factors related to CRC as well as to analyze the risk ratio of different subgroups.

          Results

          A total of 529 CRC patients were included in our study, 285 patients were in the TCM treatment group and 244 patients were in the control group. Before PSM, the mPFS and mOS in the TCM treatment group were 68 months and 75 months respectively, while mPFS and mOS in the control group were 40 months and 65 months respectively. After PSM, mPFS and mOS in the TCM treatment group were both 75 months, while mPFS and mOS in the control group were 28 months and 44 months respectively. One-year to six-year progression-free survival rates were 94.0%, 76.1%, 64.7%, 57.9%, 52.0%, 44.1% respectively in the TCM treatment group, and 78.6%, 61.4%, 51.7%, 40.8%, 33.0%, 29.1% respectively in the control group ( p < 0.01) . COX multivariate regression analysis indicated that surgery, chemotherapy and taking Chinese herbal decoction were protective factors for CRC recurrence and metastasis, while combining with intestinal obstruction, drinking history and family history were independent factors for CRC recurrence and metastasis. The results of subgroup analysis showed that the decoction of TCM could reduce the risk of recurrence and metastasis in each subgroup ( p < 0.01) . COX multivariate regression analysis indicated that surgery, chemotherapy and taking Chinese herbal decoction were protective factors for CRC recurrence and metastasis, while combining with intestinal obstruction, drinking history and family history were independent factors for CRC recurrence and metastasis. The results of subgroup analysis showed that the decoction of TCM could reduce the risk of recurrence and metastasis in each subgroup (

          Conclusions

          Long-term TCM treatment by the usage of the modified Anti-cancer Decoction II Formula not only has a positive effect on the survival time of CRC patients, but also helps reduce the risk of recurrence and metastasis of CRC, which can be flexibly applied in the whole process of CRC treatment.

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          Association of Adjuvant Chemotherapy With Overall Survival in Patients With Rectal Cancer and Pathologic Complete Response Following Neoadjuvant Chemotherapy and Resection

          Michael Choti, Sergio Huerta, Patricio Polanco … (2018)
          Question Does adjuvant chemotherapy provide a survival benefit in patients with rectal cancer with pathologic complete response following neoadjuvant chemoradiotherapy and resection? Findings In this propensity score matching analysis of a cohort from a large national data set, adjuvant chemotherapy was associated with significantly improved 5-year survival in patients with rectal cancer who achieved a complete pathologic response following neoadjuvant chemoradiotherapy and resection compared with those who did not receive adjuvant chemotherapy. Patients with clinical stage T3/T4 and node-positive disease benefited most from adjuvant chemotherapy. Meaning Adjuvant chemotherapy was associated with improved overall survival in patients with a complete pathologic response after neoadjuvant chemoradiotherapy for locally advanced rectal cancer following surgery. This propensity score matching cohort analysis compares the overall survival between adjuvant chemotherapy and postoperative observation in patients with rectal cancer with pathologic complete response following neoadjuvant chemoradiotherapy and resection. Importance Adjuvant chemotherapy (AC) in patients with rectal cancer with pathologic complete response following neoadjuvant chemoradiotherapy (nCRT) and resection is recommended by treatment guidelines. However, its role in this setting is equivocal because data supporting benefits are lacking. Objective To compare the overall survival (OS) between AC and postoperative observation (OB) in patients with rectal cancer with pathologic complete response following nCRT and resection. Design, Setting, and Participants We identified a cohort of patients with rectal cancer and a complete pathological response (ypT0N0) after nCRT in the National Cancer Database between 2006 and 2012. Patients who received AC were compared with OB patients by propensity score matching. Overall survival was compared using the stratified log-rank test and stratified Cox regression model. The outcomes after AC vs OB were also evaluated in patient subgroups. The data analysis was completed in June 2017. Exposures Adjuvant chemotherapy and OB. Main Outcomes and Measures Overall survival. Results We identified 2764 patients (mean [SD] age, 60.0 [12.3] years; 40% female) with clinical stage II or III resected adenocarcinoma of the rectum who had received nCRT and were complete responders (ypT0N0M0). Of this cohort, 741 patients in the AC group were matched by propensity score to 741 patients who underwent OB. The AC cohort had better OS compared with the OB cohort (hazard ratio, 0.50; 95% CI, 0.32-0.79). The 1-, 3-, and 5-year OS rates were 99.7%, 97.1%, and 94.7% for the AC group and 99.2%, 93.6%, and 88.4% for the OB group ( P  = .005). In subgroup analysis, patients with clinical stage T3/T4 and node-positive disease benefited most from AC (hazard ratio, 0.47; 95% CI, 0.25-0.91). Conclusions and Relevance Adjuvant chemotherapy was associated with improved OS in patients with pathologic complete response after nCRT for resected locally advanced rectal cancer. This study supports the use of AC in this setting where there is currently paucity of data.
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            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

            Yun Xu, Jun Mao, Lingyun Sun … (2017)
            Background Chinese cancer patients often use Traditional Chinese Medicine (TCM) herbal medicine during or after active cancer treatments. However, little is known about how TCM herbal medicine impacts cancer outcomes. This study aimed to evaluate the association between TCM herbal therapy and survival outcomes in patients with stage II or III colorectal cancer. Methods We conducted an eight-center prospective cohort study in China among patients who had undergone radical resection for stage II and III colorectal cancer. All patients received comprehensive conventional treatments according to National Comprehensive Cancer Network (NCCN) guidelines, and follow-up visits were conducted over five years. We defined high exposure as a patient’s use of TCM individualized herbs for more than one year, ascertained via clinical interviews. The primary outcome was disease-free survival (DFS), with overall survival (OS) as a secondary outcome. Results Between April 2007 and February 2009, we enrolled 312 patients into the cohort; 166 (53.2%) met the definition of high exposure to TCM herbs. Adjusting for covariates, high exposure to TCM was associated with both better DFS (hazard ratio [HR] = 0.62, 95% confidence interval [CI] = 0.39 to 0.98) and OS (HR = 0.31, 95% CI = 0.14 to 0.68). In subgroup exploratory analysis, the effects demonstrated that the differences in outcomes were statistically significant in patients who had received chemotherapy. Conclusion Longer duration of TCM herbal use is associated with improved survival outcomes in stage II and III colorectal cancer patients in China. More research is needed to evaluate the effects and underlying mechanisms of herbal medicine on colorectal cancer outcomes.
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              Mortality Trends in Colorectal Cancer in China During 2000–2015: A Joinpoint Regression and Age-Period-Cohort Analysis

              Wenyuan Yu, Junfeng Jiang, Lingling Xie … (2018)
              Introduction As lifestyles have increasingly become westernized in China, public health strategies have increasingly focused on cancer prevention. The objective of this study was to describe trends in colorectal cancer (CRC) mortality and the age, period, and cohort effects of CRC mortality in urban and rural China from 2000 to 2015. Methods We collected CRC mortality data from the China Health Statistics Yearbook. We used joinpoint regression analysis to estimate the slope of mortality trends. We then used the age-period-cohort (APC) model with intrinsic estimator to estimate the age, period, and cohort effects of CRC mortality. Results CRC mortality was higher in urban areas than in rural areas, and the average annual percentage change was also larger in urban areas (4.1%) than in rural areas (3.7%). CRC mortality risk was higher among older adults than among adults aged 20 to 24: the relative risk among adults aged 60 to 64 was 31.09 times higher in urban China and 11.46 times higher in rural China. CRC mortality risk increased with period: compared with period 2000, the relative risk was 1.01 in period 2005, 1.36 in period 2010, and 1.42 in period 2015 in urban China and 1.12 in period 2005, 1.24 in period 2010, and 1.69 in period 2015 in rural China. More recent cohorts had lower CRC mortality risk: compared with the cohort born during 1920–1924, the relative risk of cohort 1950–1954 was 0.70 in urban China and 0.69 in rural China. Conclusion More interventions to reduce the burden of CRC should be conducted, and it is more necessary for older people and urban residents to adopt a healthy lifestyle in China.
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                Author and article information

                Contributors
                Yan Li:
                ORCID: https://orcid.org/0000-0001-6574-1502
                Journal
                Journal ID (nlm-ta): Evid Based Complement Alternat Med
                Journal ID (iso-abbrev): Evid Based Complement Alternat Med
                Journal ID (publisher-id): ECAM
                Title: Evidence-based Complementary and Alternative Medicine : eCAM
                Publisher: Hindawi
                ISSN (Print): 1741-427X
                ISSN (Electronic): 1741-4288
                Publication date Collection: 2020
                Publication date (Electronic): 31 January 2020
                Publication date PMC-release: 31 January 2020
                Volume: 2020
                Electronic Location Identifier: 7023420
                Affiliations
                1Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
                2Ganquan Street Community Hospital of Shanghai Putuo District, Shanghai, China
                3Shanghai Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
                4Shanghai Putuo District Central Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
                Author notes

                Academic Editor: Oliver Micke

                Author information
                https://orcid.org/0000-0003-1462-460X
                https://orcid.org/0000-0003-1577-9179
                https://orcid.org/0000-0001-6574-1502
                Article
                DOI: 10.1155/2020/7023420
                PMC ID: 7013320
                PubMed ID: 32089727
                SO-VID: c438a28c-ab85-4dbf-9c38-4b356200b261
                Copyright © Copyright © 2020 Yuli Wang et al.
                License:

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 21 February 2019
                Date revision received : 9 July 2019
                Date accepted : 1 August 2019
                Funding
                Funded by: National Natural Science Foundation of China
                Award ID: 81673947
                Funded by: Youth Program of Chinese National Nature Science Fund
                Award ID: 81603590
                Funded by: Science and Technology Commission of Shanghai Municipality
                Award ID: 17401933500
                Funded by: Shanghai Further Accelerate the Project of the Three-year Action Plan For the Development of TCM
                Award ID: ZY(2018-2020)-CCCX-4001-01
                Funded by: Health and Family Planning Commission of Sichuan Province
                Award ID: 20154Y0060
                Award ID: 20164Y0004
                Categories
                Subject: Research Article

                ScienceOpen disciplines: Complementary & Alternative medicine
                Data availability:
                ScienceOpen disciplines: Complementary & Alternative medicine

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