Retrospective cohort study on the postoperative survival rate enhancement of patients with colorectal cancer using three traditional Chinese medicine formulations: evidence from 1,361 cases

Abstract

Background: Prior studies have affirmed the safety and effectiveness of traditional Chinese medicine in treating colorectal cancer patients. However, definitive evidence regarding whether traditional Chinese medicine can significantly enhance the survival of colorectal cancer patients remains elusive. This study seeks to provide conclusive insights by examining the postoperative administration of Xihuang capsules, Pingxiao capsules, and Zilongjin tablets and its impact on the 5-year overall survival (OS) and disease-free survival (DFS) rates among colorectal cancer patients.
Methods: A retrospective study was conducted, involving 1,361 patients selected from the medical center. This retrospective study was carried out at a medical center in Tianjin, China. We assessed differences in postoperative OS and DFS between the control group and the medication group using Kaplan-Meier survival analysis and Cox proportional hazards modeling. Additionally, propensity score matching was used to mitigate imbalances in baseline characteristics among patients.
Results: Before propensity score matching, Xihuang capsules could prolong the 5-year OS (79.9% vs. 81.4%, Pβ=β0.0480) and 5-year DFS (74.9% vs. 79.5%, Pβ=β0.0046) of patients after surgery. Similar conclusions were obtained after propensity score matching: OS (74.8% vs. 78.3%, Pβ=β0.0084), DFS (72.7% vs. 78.9%, Pβ=β0.008). Patients taking Pingxiao capsules showed improved 5-year OS (77.2% vs. 84.0%, Pβ=β0.0383) and 5-year DFS (69.9% vs. 80.0%, Pβ=β0.0157) after propensity score matching. Patients taking Zilongjin tablets showed improvement in the 2-year OS (84.2% vs. 93.1%, Pβ=β0.0390) and 1-year DFS (88.2% vs. 92.0%, Pβ=β0.0320) after propensity score matching.
Conclusion: Xihuang capsules and Pingxiao capsules significantly improved the 5-year OS and DFS of patients with colorectal cancer after surgery. Zilongjin tablets showed improvement in the 2-year OS and 1-year DFS after surgery for patients.

Keywords

Colorectal cancer / Disease-free survival / Traditional Chinese medicine / Overall survival

Conflict of interest statement

The authors declare no conflict of interest.

Funding

This research was supported by the Key Research Project of Tianjin Science and Technology Support Program (19YFZCSY00420), Tianjin Natural Science Foundation (21JCZDJC00060, 21JCYBJC00180, and 21JCYBJC00340), Tianjin Key Medical Discipline Construction Project (TJYXZDXK-044A), and Hospital Management Research Project of Tianjin Hospital Association (2019ZZ07). Beijing-Tianjin-Hebei Basic Research Cooperation Project (23JCZXJC00390).

Author contributions

Kailong Zhao, Yi Zhang, Hongzhou Li, Leixin Jin conceived the project. Leixin Jin, Kailong Zhao, Qiurong Han, Tianyi Chen, Zhiqiang Feng, Yao Yao collected the data and researched Paper. Kailong Zhao, Weizheng Liang, Jun Xue, and Chunze Zhang analyzed the data. Wenke Zheng, Xipeng Zhang, and Qinghuai Zhang reviewed the article. Kailong Zhao wrote the manuscript with help from all of the authors. All authors read and approved the final manuscript.

Ethical approval of studies and informed consent

The study obtained approval from the Tianjin Union Medical Ethics Committee and was conducted in accordance with the principles of the Helsinki Declaration. Prior to the commencement of the study, participants provided informed consent by signing a consent form.

Acknowledgments

None.

Data availability

Due to restrictions on ethical approval involving patient data and anonymity, the datasets analyzed during the current study are not publicly available but can be obtained from the appropriate authors upon reasonable request. If you would like to obtain data from the study, please contact corresponding author Professor Chunze Zhang.

References

[1] Dekker E, Tanis PJ, Vleugels JLA, et al. Colorectal cancer. Lancet 2019;394(10207):1467-1480.

[2] Labianca R, Beretta GD, Kildani B, et al. Colon cancer. Crit Rev Oncol Hematol 2010;74(2):106-133.

[3] Zhang YZ, Yang JY, Wu RX, et al. Network pharmacology-based identification of key mechanisms of Xihuang pill in the treatment of triple-negative breast cancer stem cells. Front Pharmacol 2021;12:714628.

[4] Wang K, Chen Q, Shao Y, et al. Anticancer activities of TCM and their active components against tumor metastasis. Biomed Pharmacother 2021;133:111044.

[5] Cohen I, Tagliaferri M, Tripathy D. Traditional Chinese medicine in the treatment of breast cancer. Semin Oncol 2002;29(6):563-574.

[6] Zhou LY, Shan ZZ, You JL. Clinical observation on treatment of colonic cancer with combined treatment of chemotherapy and Chinese herbal medicine. Chin J Integr Med 2009;15(2):107-111.

[7] Liu X, Li M, Wang X, et al. Effects of adjuvant traditional Chinese medicine therapy on long-term survival in patients with hepatocellular carcinoma. Phytomedicine 2019;62:152930.

[8] Chen Z, Li Z, Yang S, et al. The prospect of Xihuang pill in the treatment of cancers. Heliyon 2023;9(4):e15490.

[9] Ge A, Yang K, Deng X, et al. The efficacy and safety of Xihuang pill/capsule in adjuvant treatment of breast cancer: a systematic review and meta-analysis of 26 randomized controlled trials. J Ethnopharmacol 2022;295:115357.

[10] Yu D, An GY. Clinical effects of Xihuang pill combined with chemotherapy in patients with advanced colorectal cancer. Evid Based Complement Alternat Med 2017;2017:5936086.

[11] Cao B, Wang S, Li R, et al. Xihuang pill enhances anticancer effect of anlotinib by regulating gut microbiota composition and tumor angiogenesis pathway. Biomed Pharmacother 2022;151:113081.

[12] Xu H, Tian G, Wu C, et al. Meta-analysis of the efficacy and safety of Xihuang pills/capsules in adjuvant treatment of uterine cervical neoplasms. Medicine (Baltim) 2023;102(34):e34846.

[13] Wu R, Zhou T, Xiong J, et al. Quercetin, the ingredient of Xihuang pills, inhibits hepatocellular carcinoma by regulating autophagy and macrophage polarization. Front Biosci (Landmark Ed) 2022;27(12):323.

[14] Wenjuan T, Yu HU, Man Z, et al. Pingxiao capsule inhibits lung metastasis of triple-negative breast cancer and sensitizes breast cancer to radiotherapy. J Tradit Chin Med 2023;43(5):897-905.

[15] Yuqing Y, Yuhuan C, Chunxiao LI, et al. Effectiveness and safety of Pingxiao capsule as adjuvant therapy in treatment of breast cancer: a systematic review and meta-analysis. J Tradit Chin Med 2023;43(5):851-859.

[16] Yu W, Lu C, Wang G, et al. Pharmacological mechanism of Pingxiao Formula against colorectal cancer. Evid Based Complement Alternat Med 2022;2022:7884740.

[17] Zhang P, Wang X, Xiong S, et al. Genome wide expression analysis of the effect of the Chinese patent medicine Zilongjin tablet on four human lung carcinoma cell lines. Phytother Res 2011;25(10):1472-1479.

[18] Tian ZH, Li ZF, Zhou SB, et al. Differentially expressed proteins of MCF-7 human breast cancer cells affected by Zilongjin, a complementary Chinese herbal medicine. Proteomics Clin Appl 2010;4(5):550-559.

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Acupuncture and Herbal Medicine