| ObjectiveFollow the elemental principles of evidence-based medicine,develop investigation on formulating?Guideline of TCM-WM diagnosis and treatment of Advanced prostate cancer?,thus to raise the level of TCM-WM clinical diagnosis and treatment of advanced prostate cancer and to explore the idea and method of practice TCM-WM.Methods1.On the basis of extensive research based on "advanced prostate cancer diagnosis and treatment of Chinese and Western medicine" as the starting point,selected "advanced prostate cancer diagnosis and treatment guidelines" as a research topic.2.To set up a guideline writing team,to train the members of the group,to make the search term,to search the life,to search the literature,and to search the foreign language literatures by searching the Chinese ancient literature..CNKI,Wanfang,Cochrane library,Pubmed,UpTodate and other ancient and modern Chinese and foreign databases were searched by means of manual-search,computer search and web search.3.The results of the first screening were as follows:Vip 40,Wanfang 709,CNKI1301,35 references,45 articles,4755 ancient articles and 19 famous TCM experiences.Secondary screening results:Vip 17,Wanfang 61,CNKI53,the ancient provisions of 125.4.Thirty-one randomized controlled trials with JADAD score of 3 were selected,10 randomized controlled trials with a JADAD score of 3 or less,15 non-randomized controlled studies,19 expert experiences,11 in Chinese medicine,24 in traditional Chinese medicine,6 in English,21 in traditional Chinese medicine,125 in ancient Chinese and 19 in Chinese medicine.5.The JADDA scoring system.did not meet the requirements of randomized controlled trials,and the 31 randomized controlled trials further analyzed the effects of TCM on TPSA,CD3 +,CD4 +,CD8 +,NK cells in advanced prostate cancer,IPSS,QOL,survival time,response rate.and the possible mechanism of metastatic foci.Non-randomized controlled trials were used to evaluate and evaluate the quality of the literature.6.According to the level of the Evidence Rating System,the evidence was graded according to the TCM Clinical Practice Guideline Rating System proposedby Professor Wang Shouchuan of Nanjing University of Traditional Chinese Medicine.The quality of the randomized and non-randomized control literatures was graded.Classification.7.Combined with expert consensus,GRADE grading standards in accordance with the formation of recommendations,the development of preliminary guidance guidelines to write the first draft guide.Results.1.Set up and spread the differentiation and treatment strategy on different stage of prostate cancer:The radical treatment of early prostate cancer,"dispelling evil" based,perioperative Chinese medicine,"supporting right" supplement,to promote rapid rehabilitation of the best treatment strategy.Endocrine therapy for hormone-dependent prostate cancer and Chinese medicine synergistic combination of a comprehensive treatment program to delay the conversion of castration to resist prostate cancer time.For the current lack of effective Western medicine and treatment of castration resistance of prostate cancer,the main Chinese medicine tonificate vitality strongly for the law to improve clinical symptoms and prolong survival for.the purpose.2.Further clarify the etiology,pathogenesis and pathological features of advanced prostate cancer:The deficiency of the deficiency of the Qi and Yin or the deficiency of the spleen and kidney is more common.The disease is located in the lower coke,which is closely related to the lung,spleen and kidney.Endocrine therapy in advanced stage of prostate cancer in the sensitive period to more common Qi and Yin Deficiency,refractory prostate cancer with spleen and kidney deficiency more common,castrated resistance to prostate cancer pathogenesis mainly kidney Yang deficiency,Yin depletion.3.TCM-WM treatment of advanced prostate carcinoma reflects the advantages of TCM-WM diagnostic and treatment:The advantages of Western medicine are in diagnosis and surgery,the advantages of Chinese medicine are in combining the disease and syndrome,TCM and WM is not contradictory,but should learn from the director,especially for advanced prostate cancer,we take treatment strategy of combination of "supporting right and dispelling evil",endocrine therapy for hormone-sensitive prostate cancer combined with TCM synergistic combination of treatment programs to improve quality of life,delayed conversion to castration-resistant type of prostate cancer time,and even achieve the purpose of clinical cure.For the current lack of effective western medicine and treatment of castration-resistant prostate cancer,symptomatic treatment on the basis of the main tonificate vitality strongly and supporting right to restrain cancer of TCM for the law to improve clinical symptoms and prolong survival,while fully informed consent and with the ability to pay on the basis of the appropriate choice of radiotherapy and chemotherapy or biological targeting treatment.4.To carry out advanced prostate cancer follow-up and chronic disease management without delay:There is no unit system to carry out advanced prostate cancer follow-up and chronic disease management,research data is unknown,the level of published research evidence is low,it is necessary to carry out chronic disease management,establish a comprehensive electronic database and chronic disease management team,and carry out chronic disease out-patient,long-term follow-up,thus establish big data of advanced prostate cancer.5.Through the comprehensive search,screening and analysis of the relevant literatures on the diagnosis and treatment of advanced prostate cancer with TCM-WM,the literature was graded and assessed.The ability of literature search,analysis and evaluation was well mastered.And the implementation and summary of expert consensus are familiar.6.The quality of Chinese and Western medicine in the treatment of advanced prostate cancer is not high:analysis found that there are heterogeneity differences and biases in TCM literature,the literature generally lack of rigorous research methodology and case reports,retrospective study are on the high side,really meet the requirements of the RCT is rare,published journals mainly for non-core journals.The level of evidence is generally low,while lack of high-level evidence,the quality of Chinese medicine research papers are to be improved.Conclusion1.It is necessary to carry out research on the guideline' s formulation of TCM-WM diagnosis and treatment of Advanced prostate cancer,through the development,promotion and application of guidelines of advanced prostate cancer is conducive to further clarify the pathogenesis,etiology and pathogenesis characteristics,thus through the combination of disease and syndrome,the combination of Chinese and Western medicine,to develop the best treatment plan,selected the exact effect of herbs,practice of TCM-WM diagnostic and treatment strategy.2.Through the formulation of guidelines,can improve the level of diagnosis and treatment,standardize the clinical medical behavior,saving medical resources,more accurately reflect the advantages of clinical efficacy of traditional Chinese and Western medicine and explore the practice of TCM-WM ideas and methods.3.As soon as possible to carry out the management of prostate cancer,establish prostate cancer database,follow-up work to establish a large data on prostate cancer.4.Speed up the construction and training of the guide team,multi-disciplinary experts to participate in the establishment of a professional compilingteam.5.For the general lack of high-level evidence of Chinese medicine research status,I hope in the future more reasonable design,reliable operation,the data is true,large sample,multi-center clinical randomized controlled study in the prevention and treatment of prostate cancer in high-level Evidence of medical research. |
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