Study On The Relationship Between Postoperative Recurrence Risk Factors And TCM Syndrome Factors In Stage Ⅱb/Ⅲ Colon Cancer

ObjectiveBased on the cross-sectional research method,to observe the distribution and changes of traditional Chinese medicine syndrome(TCM)factors and detect circulating tumor cells(CTC)counts before and after surgery in patients with stage ⅡB/Ⅲ colon cancer.Initially explore the correlation between TCM syndrome and prognostic factors of patients with stage ⅡB/Ⅲ colon cancer such as CTC.In order to preliminary probe the predictively prognostic value of TCM syndromes in stage ⅡB/Ⅲ colon cancer and provide a theoretical reference for the integrated treatment of traditional Chinese and western medicine.MethodsAccording to the inclusion and exclusion criteria,patients with colon cancer who planned to undergo RO resection were enrolled.Their TCM syndrome elements and the peripheral blood were collected.CTC was captured peripheral blood by microfluidic chip technology,and the captured cells were labeled with immunofluorescent reagents,and then the captured cells were identified with a fluorescence microscope to obtain the CTC count.Secondly,patients with postoperative pathological stage ⅡB/Ⅲ were dynamically followed up on the changes of TCM syndrome factors and peripheral blood CTC counts before the adjuvant chemotherapy.Finally,the frequency,composition ratio and rate were used to describe the distribution of TCM syndromes before and after surgery.Chi-square test and Fisher’ s exact test were used to compare the differences of 10 TCM syndrome elements between patients with different CTC levels and other prognostic predictors,and to analyze the correlation between TCM syndrome elements and CTC count and other prognostic factors for colon cancer.Results1.Baseline:From December 2017 to January 2020,a total of 102 patients with colon cancer diagnosed by the Guangdong Provincial Hospital of Traditional Chinese Medicine were included in this study,including 69 patients with stage ⅡB/Ⅲ colon cancer diagnosed postoperatively.Among them,35 were males and 34 were females,and the male-to-female ratio was 1.02:1.The age distribution of the patients was between 29-78 years old,78.3%of the patients were over 50 years old.Adenocarcinoma was the most common pathological type,with a total of 67 cases,accounting for 97%.In terms of degree of differentiation,61 cases were moderately differentiated,accounting for 88.4%,7 cases were poorly differentiated,and 1 case was moderately-lowly differentiated.In regard to primary site,there were 41 cases in the left colon and 28 cases in the right colon.On clinical high-risk factors 25 cases with the lymphatic vessel invasion,accounting for 36.2%,35 cases with peripheral nerve infiltration,accounting for 50.7%;12 cases with lymph node biopsy,accounting for 17.4%;Only 1 case of bowel obstruction;No positive margin and local perforation.2.Distribution of TCM syndrome factors:Among the 69 patients enrolled,the pre-operative TCM syndrome factors accounted for the top three in order was phlegm dampness(75.4%),spleen deficiency(73.9%),and Qi deficiency(68.1%);Qi deficiency(83.0%),Spleen deficiency(81.1%)and phlegm dampness(37.7%)were the forefront of 53 follow-up TCM syndromes cases.3.Comparison of 53 patients with TCM syndrome elements before and after operation:Postoperative patients with Qi deficiency and blood deficiency were increased while yin deficiency,yang deficiency,Qi stagnation,blood stasis and phlegm dampness were decreased after operation.The differences were statistically significant(P<0.05),the comparison of other syndrome elements was not statistically significant(P>0.05).4.CTC count:64 patients’ specimen were qualified.There were 40 cases with CTC-positive preoperatively(CTC counts>1),accounting for 62.5%.The maximum value of CTC count before operation was 172,the minimum value was 0,and the median was 2.Among he 39 patients with postoperative CTC detection,22 were CTC positive,accounting for 56.4%;the maximum value of postoperative CTC count was 34,the minimum value was 0,and the median was 1.There was no statistical difference in the age,sex,tumor location and other high-risk clinical factors of patients with different CTC count levels.5.Comparison of TCM syndrome elements among different relapse risk factors:Pre-operative patients with high CTC counts were more in yang deficiency and Qi stagnation syndrome elements,and the differences were statistically significant(yang deficiency:χ2=6.417,P=0.020;Qi stagnation:χ2=5.158,P=0.021);postoperatively,stagnation is more in patients with high CTC counts(P=0.010),the difference between other syndrome elements is not statistically significant(P>0.05).In terms of other recurrence risk factors,blood stasis syndrome elements are more common without lymphatic vessel invasion,while Qi deficiency syndrome elements in patients with peripheral nerve infiltration of tumors are more common.(P<0.05).6.Correlation of TCM syndrome elements and other preoperative factors with postoperative CTC count level:According to binary logistic regression analysis,the preoperative high CTC count level and postoperative Qi stagnation were positively correlated with postoperative high CTC count level(preoperative high CTC count level:χ2=7.871,P=0.005;postoperative Qi stagnation:χ2=7.669,P=0.006),suggesting that the above two may be risk factors for postoperative prognosis of colon cancer patients(preoperative high CTC count level OR=9.0,postoperative stagnation OR=8.4),Conclusion1:Qi deficiency,spleen deficiency and phlegm are common in pre-operative patients with colon cancer,suggesting that spleen Qi deficiency and phlegm may be an important etiology and pathogenesis of traditional Chinese medicine in CRC.Postoperative patients have less empirical syndrome factors and more deficiency syndrome factors indicating that strengthening body should be the main treatment principle in the perioperative period of CRC.2:There was no statistical difference in age,gender and tumor location between different CTC count levels before and after surgery.Patients with high CTC count level before surgery may be more prone to yang deficiency and stagnation syndrome,but the elements of Qi stagnation syndrome are more common after surgery,which provides some reference ideas for the clinical treatment of postoperative colorectal cancer patients with TCM syndrome differentiation.3:Preoperative high CTC count levels and postoperative Qi stagnation syndrome elements may be risk factors for postoperative high CTC count,which might indicate bad prognosis of stage ⅡB/Ⅲ colon cancer,suggesting that preoperative detection of CTC levels in colon cancer patients has certain reference value for its prognosis;Patients after colon cancer surgery should pay attention to emotional adjustment,and patients with elements of Qi stagnation may need more targeted treatment and follow-up.