Effective Influence Of Traditional Chinese Medicine(TCM) On Inflammatory Microenviroment And Retrospective Study Of Involvement Of TCM In Treating Advanced Colorectal Cancer (IVA、IVB)

The morbidity and mortality of lung and colon cancers are among the top of all malignant cancers. It is estimated that, the number of medicines on it will be more in the world than before. However,a lot of medicines didn’t play an important role in the treatment of them,So a lot of people are searching for new treatment of them. TCM plays an very important role in the treatment of lung and Colon cancer in China. In fact, in the treatment of tumor,TCM emphasizes on determination of treatment based in pathogenesis obtained through different symptoms and signs. Parenteral solution Chinese patent medicine and medicinal broth, can be used for treatment of lung and Colon cancer according to the patient’s syndrome and stage of disease.It is sad to say that, most studies assessed effect of single drug or treatment because of limitation of randomized controlled trial. Characteristic of TCM treatment based in pathogenesis obtained through differentiation of symptoms and signs,has not been displayed. This study focused on tow feilds, one is effective influence of Traditional Chinese Medicine (TCM) on inflammatory microenviroment, another is the retrospective study of involvement of TCM in treating advanced colorectal cancer (IVA、IVB).We further investigated the molecular mechanism of inflammatory microenviroment and the effective influence of Traditional Chinese Medicine (TCM) on it.And we also attempted to reveal the trends of TCM treatment of advanced colorectal cancer as well as to provid the useful information on standardization of clinical treatment and improvement the curative effect.Part Ⅰ Experimental aspects1Experiment study in vivoObject To observe the the major pathway of TNF-α-NF-κ B-Snail of inflammatory microenvironment’s reaction of Fei Liu Ping sirupu and study its molecular mechanism.Method To observe the inhibition of Feiliuping sirupu、CTX and Feiliuping sirupu+CTX function on Lewis lung cancer transplantation tumor. The expression of E-cadherin、N-cadherin protein, NF-KB of tumor tissue was detected by immunohistochemical method, and the expression of IL-1β、IL-6and TNF-α was measured by ELISA.Result1. Feiliuping sirupu obviously inhibited the growth of the transplantation tumor of Lewis lung cancer.The inhibitory rate of Feiliuping sirupu+CTX、CTX and Feiliuping sirupu were83.25%,64.10%and38.83%.2. E-cadherin:The expression of E-cadherin in tunmor that treated by feiliuping sirupu and feiliuping sirupu+CTX increased more significantly than that in model, feiliuping sirupu+CTX vs model (P<0.01), feiliuping sirupu+CTX vs model (P<0.05),and there was no significant difference in the three treatment groups*,however, there was a stronger trend in feiliuping sirupu+CTX group (P>0.0083)*.3. N-cadherin:The expression of N-cadherin in tunmor that treated by feiliuping sirupu and feiliuping sirupu+CTX decreased more significantly than that in model (P<0.01). There was no significant difference between each other (P>0.0083)4. NF-KB:The expression of NF-KB in tumor that treated by feiliuping sirupu CTX and feiliuping sirupu+CTX decreased more significantly than that in model, feiliuping sirupu+CTX vs model (P<0.01),feiliuping sirupu vs model (P<0.01)、CTX vs model (P<0.05).There was no significant difference in the three treatment groups*.However there was a stronger trend in feiliuping simpu+CTX group (P>0.0083)5. IL-1β:The expression of IL-1β in blood that treated by feiliuping sirupu CTX and feiliuping sirupu+CTX decreased more significantly than that in model (P<0.05).And it was with no significant difference compared with each other*, but there was a stronger trend in feiliuping sirupu+CTX group (P>0.05)6. IL-6:The expression of IL-6in blood that treated by feiliuping sirupu、CTX and feiliuping sirupu+CTX decreased more significantly than that in models (P<0.05).And there was no significant difference compared with each other*,but eiliuping sirupu+CTX might be better (P>0.05)7. TNF-α:The expression of TNF-a in blood that treated by feiliuping sirupu、CTX and feiliuping sirupu+CTX decreased more significantly than that in models (P<0.05).And there was no significant difference compared with each other*, but eiliuping sirupu+CTX might be better (P>0.05)Part Ⅱ Clinical researchPurpose This study attempts to recall advanced CRC (IVA、IVB) patient medical records participated in the treatment of TCM in our department of Oncology in the last decade (2000.1.1-2011.12.31). So We can provide reliable clinical data for formulating better therapeutic regimen of advanced CRC.Method This study wants to analyze medical records in the basic situation of case treatment program, short-term and long-term effect, and changes in economic indicators, between in the past six years (2006-2011) and the first six years (2000-2005), between TCM treatment and integrated traditional chinese and western medicine treatment. This study also attempts to reveal the trends of TCM treatment of advanced CRC, as well as to provide the useful information on standardization of clinical treatment and improvement the curative effect.Result1.In the past six years, the treatment of advanced colorectal cancer patients had a higher efficiency,and the response rate was35.14%, while in the first six years, the patients had a higher stable disease rate of49.02%(P<0.05). However, both group’s disease control rate had no significant difference (P>0.05). The Karnofsky scores of patients in the past six years with improvement were higher than the patients in first six years,29.63%vs28.00%(P<0.05), in the first six years, the patients’Karnofsky stable rate was significantly higher than the past six years,60.00%vs36.11%(P<0.05). Patients’weight increase rate was higher than the patients in the first six years35.63%vs22.37%(P<0.05). In the fiest six years,the weight stable rates was higher than the past six years,47.37%vs45.98%(P<0.05). The median survival time of past six years compared with the first six years has no significant difference,23.5VS19months(P>0.05). The1,2and3year survival rate of patients in the first6years were75.81%,43.55%and19.35%, while in the past six years were84.61%,52.56%and20.51%, but there are no significant difference (P>0.05). The time to progress was6months in the first6years while11months in the past years, and there is a significant difference (P<0.05), indicating that the median TTP is significantly improved in the past6years. The cost-effectiveness ratio of past six years is better than that of the first6years.2. The integrated treatment group’s response rate and disease control rate were significantly higher than the TCM group,41.46%vs6.67%,76.42%vs62.22%(P <0.05). The stable rates of Chinese Medicine group were higher than that of integrated treatment group,55.56%vs34.96%(P<0.05). The integrated treatment group’s Karnofsky improve rate and stable rate were significantly higher than the TCM group,33.61%vs22.09,51.64%vs41.86%(P<0.05). The integrated treatment group’s weight increase rate and stable rate were higher than the TCM group,37.50%vs15.52%,47.12%vs45.76%,(P<0.05).The median OS of integrated treatment group compared with the TCM group had no significant difference,24VS19months(P>0.05),and the tow groups’1year,2years,3-year survival rate was no difference either,83.95%vs76.27%50.61%vs40.68%,19.75vs16.95%. The time to progress of integrated treatment group was10months while the TCM group was6months, and there was a significant difference (P<0.05),TCM group with an average length of stay was shorter(P<0.05), but the cost-effectiveness ratio of integrative medicine group was better.3. The COX regression analysis showed that the liver metastases was poor prognostic factors, The risk of death of patients with liver metastasis was1.473times more than patients with no liver metastasis (HR=1.473);integrated treatment was good prognostic factors for TTP, and the risk of progression of integrated treatment group was lower than the TCM group.Conclusion1. In the tumor treatment of Traditional Chinese Medicine, the function is outstanding, one of its inherent function mechanism may change the major pathway of TNF-α-NF-κ B-Snail of inflammatory microenviroment in tumor patients.2. This study demonstrates that the Feiliuping sirupu may inhibit the major pathway of TNF-α-NF-κ B-Snail of tumor inflammatory microenvironment of IL-6, IL-1β, TNF-α and other inflammatory factors, increase E-cadherin, down N-cadherin and NF-KBprevention of EMT occurrence, and thus indirectly play a role in its anti-tumor recurrence and metastasis.3. Feiliuping sirupu can inhibit tumor growth, reduce the side effects of chemotherapy, and improve the quality of life.4. These effects in integrated treatment group (Feiliuping sirupu+CTX) have a stronger role in the trend.5. The cases of colorectal cancer is broadly in line with the epidemiological trends. Yang deficiency of spleen and kidney is the most common type of dialectical of TCM.The Chinese treatment rate is100%.The COX regression analysis showed that the liver metastases is poor prognostic factors, and the integrated treatment is good prognostic factors for TTP.6.Grouped according to treatment time, the past six years group has more TCM treatments and chemotherapy to achieve a better clinical benefit trend and higher quality of life improved rate、longer TTP, less hospital stay、costs、better cost-effectiveness ratio. But the first six year group has better stable disease rates, and the same OS.7.Grouping according to the way of treatment, the integrated treatment group achieved better efficiency and clinical benefit rate, longer TTP and better cost-effectiveness ratio. At the same time simple Chinese medicine treatment group has a wealth of traditional Chinese medicine treatment, stable disease rates, fewer hospital days, and the same OS.