A Study On The Correlation Between Preoperative Types Of TCM Syndromes And Clinicopathological Factors In Stage Ⅰ-Ⅲ Colorectal Cancer

Objective:To observe the distribution differences of TCM syndrome types in stageⅠ-Ⅲ colorectal cancer patients before operation,to explore the correlation between preoperative types of TCM syndromes and clinicopathological factors of colorectal cancer,and to analyze its internal relationship,so as to provide modern molecular biological basis for the objectification of TCM syndrome differentiation and to guide clinical diagnosis and treatment.Methods:A total of 165 hospitalized patients with stage Ⅰ-Ⅲ colorectal cancer who meet the inclusion and exclusion criteria in the oncology and anorectal surgery departments of Nanjing Hospital of Traditional Chinese Medicine from January 2019 to January 2020 are collected.Clinical data are collected by consulting the outpatient and inpatient medical records of the 165 patients,consulting the patients themselves and their family members in person and asking the patients to do the relevant clinical questionnaire.And TCM syndrome types differentiation is conducted under the guidance of teachers.After the 165 patients undergo radical resection of colorectal cancer,the relevant surgical pathological data are collected.Finally,a database is established and the data are analyzed by SPSS software to summarize the correlation between TCM syndrome types and the clinicopathological factors such as gender,age,location of disease,pathological typing,tumor markers and gene expression of colorectal cancer,and draw a conclusion.Results:(1)Distribution of clinical data:Of the 165 patients with stage Ⅰ-Ⅲ colorectal cancer,95 are males and 70 are females,with a male to female ratio of approximately 1.36:1.The average age is 58.74±8.35 years,and patients aged 61-70 years are the most,accounting for 39.4%of the total number.Patients with smoking and drinking history account for 27.9%and 37.0%of the total,respectively.There are 93 patients with CEA level>5ug/L before operation,accounting for 56.4%of the total number.There are more patients with stageⅡA and ⅢB,accounting for 43.6%and 38.2%of the total number,respectively.The rectum is the most common disease location and rectal cancer patients account for 54.5%of the total number.In terms of pathological features,ulcerative type(72.1%),moderate differentiation(77.6%),and common adenocarcinoma(78.2%)are the main types.53.9%of patients have no local lymph node metastasis(N0).There are 11 patients with positive circumferential resection margin,accounting for 6.7%of the total number.Peripheral nerve invasion is positive in 82 patients,accounting for 49.7%of the total.There are 59 patients with positive lymphovascular invasion,accounting for 35.8%of the total number.There are 9 patients with mismatch repair gene deficient(dMMR)colorectal cancer,accounting for 5.5%of the total number.(2)Distribution of TCM syndrome types:Among the 165 patients,the proportion of the four types of TCM syndromes before surgery is as follows:dampness and heat accumulation syndrome(36.4%)>spleen and kidney yang deficiency syndrome(29.1%)>qi stagnation and blood stasis syndrome(19.4%)>qi and blood deficiency syndrome(15.2%).In general,there are more excess syndromes than deficiency syndromes.(3)Analysis of factors related to TCM syndrome types:1)There is no significant correlation between the distribution of TCM syndrome types of colorectal cancer and gender(P=0.699>0.05),age(P=0.819>0.05,P=0.512>0.05),history of smoking(P=0.704>0.05),CEA level before surgery(P=0.694>0.05),general traits of the tumor(P=0.766>0.05),histologic type(P=0.960>0.05),degree of tumor differentiation(P=0.1 11>0.05),circumferential resection margin(P=0.583>0.05),lymphovascular invasion(P=0.623>0.05),MMR expression(P=0.714>0.05).2)There is a significant correlation between the distribution of TCM syndrome types of colorectal cancer and drinking history(P=0.005<0.05).Thereinto,there is a certain relationship between drinking history and qi and blood deficiency syndrome(P=0.018<0.05),dampness and heat accumulation syndrome(P=0.001<0.05).Compared with patients with no drinking history,the proportion of patients with dampness and heat accumulation syndrome is higher in patients with drinking,while the proportion of patients with qi and blood deficiency syndrome is lower.3)There is a significant correlation between the distribution of TCM syndrome types of colorectal cancer and TNM staging(P=0.008<0.05).Thereinto,there is a significant difference in the distribution of TCM syndrome types between stage Ⅰ-Ⅱand stage Ⅲ colorectal cancer(P=0.020<0.05).There is a certain relationship between stage Ⅰ-Ⅱ,stage Ⅲ and qi stagnation and blood stasis syndrome(P=0.016<0.05),dampness and heat accumulation syndrome(P=0.011<0.05).Compared with both stage Ⅰ-Ⅱ and stage Ⅲ patients,the proportion of dampness and heat accumulation syndrome is higher in stage Ⅰ-Ⅱ patients,and the proportion of qi stagnation and blood stasis syndrome is higher in stage Ⅲ patients.4)There is a significant correlation between the distribution of TCM syndrome types of colorectal cancer and disease location(P=0.038<0.05).Thereinto,there is a significant difference in the distribution of TCM syndrome types between rectum and right colon(P=0.011<0.0167).There is a certain relationship between rectum,right colon and qi stagnation and blood stasis syndrome(P=0.003<0.05),dampness and heat accumulation syndrome(P=0.042<0.05).Compared with both rectal cancer and right colon cancer,the proportion of right colon cancer patients with qi stagnation and blood stasis syndrome is higher,and the proportion of rectal cancer patients with dampness and heat accumulation syndrome is higher.5)There is a significant correlation between the distribution of TCM syndrome types of colorectal cancer and local lymph node metastasis(P=0.026<0.05).Thereinto,there is a significant difference in the distribution of TCM syndrome types between NO(no local lymph node metastasis)and N2(number of regional lymph node metastases≥4)(P=0.005<0.0167).There is a certain relationship between NO,N2 and qi stagnation and blood stasis syndrome(P=0.030<0.05),dampness and heat accumulation syndrome(P=0.004<0.05).Compared with both NO and N2,the proportion of patients with qi stagnation and blood stasis type and qi and blood deficiency type is higher in N2 patients,and the proportion of patients with damp-heat accumulation type in NO patients is higher.6)There is a significant correlation between the distribution of TCM syndrome types of colorectal cancer and peripheral nerve invasion(P=0.043<0.05).There is a certain relationship between peripheral nerve invasion and qi stagnation and blood stasis syndrome(P=0.005<0.05),Compared with the negative peripheral nerve invasion,the proportion of the patients with qi stagnation and blood stasis syndrome is higher in the patients with positive peripheral nerve invasion.Conclusions:(1)Stage Ⅰ-Ⅲ colorectal cancer is most common in elderly patients,with more men than women.A certain percentage of patients have a history of smoking and drinking.Preoperative CEA is elevated in most the patients.TNM staging is mainly inⅡA and ⅢB stages.The rectum is the most common site of colorectal cancer Moderately differentiated ulcerative common adenocarcinoma is the main pathological type.More than half of the patients had no local lymph node metastasis.The patients with positive lymphovascular invasion and peripheral nerve invasion account for a certain proportion.There are fewer patients with positive circumferential resection margin and dMMR phenotype.(2)Preoperative TCM syndrome types in patients with stage Ⅰ-Ⅲ colorectal cancer have more excess syndromes than deficiency syndromes.Dampness and heat accumulation syndrome is the most common syndrome type,and qi stagnation and blood stasis syndrome is relatively rare(3)There is no significant correlation between the distribution of preoperative TCM syndrome types of stage Ⅰ-Ⅲ colorectal cancer and gender,age,smoking history,CEA level before surgery,general traits of the tumor,histologic types,degree of tumor differentiation,circumferential resection margin,lymphovascular invasion,MMR expression.(4)There is a significant correlation between the distribution of preoperative TCM syndrome types of stage Ⅰ-Ⅲ colorectal cancer and drinking history.Compared with patients without drinking history,dampness and heat accumulation syndrome is more common in drinking patients,while qi and blood deficiency syndrome is rare.(5)There is a significant correlation between the distribution of preoperative TCM syndrome types of stage Ⅰ-Ⅲ colorectal cancer and TNM staging.Compared with both stage Ⅰ-Ⅱ and stage Ⅲ patients,dampness and heat accumulation syndrome is more common in stage Ⅰ-Ⅱ patients,while qi stagnation and blood stasis syndrome is more common in stage Ⅲ patients.(6)There is a significant correlation between the distribution of preoperative TCM syndrome types of stage Ⅰ-Ⅲ colorectal cancer and disease Iocation.Compared with both rectal cancer and right colon cancer,dampness and heat accumulation syndrome is more common in rectal cancer,while qi stagnation and blood stasis syndrome is more common in right colon cancer.(7)There is a significant correlation between the distribution of preoperative TCM syndrome types of stage Ⅰ-Ⅲ colorectal cancer and local lymph node metastasis.Compared with both NO and N2,qi stagnation and blood stasis syndrome and qi and blood deficiency syndrome are more common in N2,while dampness and heat accumulation syndrome is more common in NO(8)There is a significant correlation between the distribution of preoperative TCM syndrome types of stage Ⅰ-Ⅲ colorectal cancer and peripheral nerve invasion Compared with the negative peripheral nerve invasion,qi stagnation and blood stasis syndrome is more common in the patients with positive peripheral nerve invasion.