Abstract
BACKGROUND: Non-small cell lung cancer (NSCLC) is a prevalent malignancy where adjuvant therapy is crucial. Astragalus polysaccharide injection (APS-I) has shown potential as an adjunct due to its immunomodulatory properties, but its impact on survival outcomes requires further validation. OBJECTIVE: This study employed propensity score matching (PSM) to evaluate the efficacy of APS-I combined with conventional therapy versus conventional therapy alone in the adjuvant treatment of NSCLC. METHODS: In this retrospective cohort study, NSCLC patients receiving adjuvant therapy between January 2018 and December 2024 were enrolled. After 1:1 PSM, 54 matched pairs were allocated to the APS-I + conventional therapy group or the conventional therapy alone group. Outcomes included objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS), overall survival (OS), immune function, quality of life (QoL), and adverse events. RESULTS: The APS-I group demonstrated significantly superior short-term efficacy, with higher ORR (77.8% vs 33.3%, P<0.001) and DCR (96.3% vs 70.4%, P<0.001). Survival outcomes were significantly improved: median PFS was 12.8 months versus 8.2 months (Hazard Ratio [HR]= 0.143, 95% CI: 0.082-0.250, P<0.001), and median OS was 23.3 months versus 17.0 months (HR= 0.249, 95% CI: 0.154-0.401, P<0.001). The APS-I group also showed a significantly higher Karnofsky Performance Status (KPS) improvement rate (60.5% vs 27.9%, P=0.003) and a lower incidence of adverse events (11.1% vs 33.3%, P=0.014). CONCLUSION: APS-I combined with conventional therapy shows promise in improving survival and quality of life, but multicenter RCTs are warranted to validate efficacy before clinical adoption.