The Analysis Of The Correlation Between Prognosis Of TCM Syndrome Types And MiR-21and MiR-181a Expressions Levels In Saliva Of Pancreatic Cancer Patients

Background:Currently surgical operations remain the mere effective way to cure pancreatic cancer. However, the surgical resection rate of pancreatic cancer is relatively low which only accounts for5%to10%and that means only very few patients who suffer from pancreatic cancer are able to make a full recovery. At present, the use of Gemcitabine as single drug is the standard scheme of advanced pancreatic cancer treatment. The median survival time of patients is about five to seven months and the survival rate in one year is around20%. In order to improve the efficacy, various chemotherapy drugs and moleculartargeteddrugs are combined with Gemcitabine to cure advance pancreatic cancer.But in the phase III clinical tests, only the combination of Gemcitabine and Erlotinib or the combination of Gemcitabine and Capecitabine edges out that of the use of Gemcitabine as single drug. The research which takes the Gemcitabine as comparison shows that the above combined treatment schemes can only promote the progression free survival time and total reaction rate of patients but not the overall survival period.Although certain improvements have been made recently regarding pancreatic cancer treatment, enormous challenges still exist and those are the remarkable treatment sensitivities and adverse reactions differences lie in different ethnic groups or individuals. The continuous development of Genomics technology enables the realization of analyzing the individual differences concerning diseases which exist in various patients via individual genome and meanwhile make use of these differences to guide the clinical treatments rationally. The study of genomics on the whole reflects the dynamic process of genes in various stages with the change of temporal and spatial variation. This resembles much like the distinction methods in traditional Chinese medicine of summarizing disease course via relevant syndromes. In traditional Chinese medicine there is individual syndrome differentiation treatment mode which indicates the cure of diseases should vary according to different ’person, place and time’ just in accordance with the features of gene polymorphism. From the view of traditional Chinese medicine, pancreatic cancer is a kind of systemic diseases while Western medicine regards it as the interaction of internal and external causes, various elements and procedures and they are meanwhile controlled by these procedures and various genes. Recent years, as the continuous development of genomics technology, the correlation studies of TCM syndrome and gene polymorphism have been hot spots of the studies of basic TCM theories.Relevant experiments on animals in early stages demonstrated that patterns ofsyndromes has certain impacts on the growth of pancreatic tumor and we deduce that the appearance of syndrome patterns may a protective reaction of various organic microenvironments to tumor. We then further verify that there exists certain relation between TCM syndrome and tumor microenvironment through studying correlativefactors that are related to tumor microenvironment such as relevant fibroblasts and macrophage of tumor, chemotacticfactors, etc. Via clinical data to analyze the correlation between TCM syndrome and prognosis of patients, we can see that the effective drug duration and overall survival time varies due to different syndrome pattern of patients and patients that are of damp-heat syndrome have more survival advantages and favorable prognosis.MicroRNA is a kind of small single non-coding RNA molecule whose length is usually equal to21-13nucleotides and there are more and more researches demonstrate that miRNA play a significant role in various physiological and pathological processes such as cellproliferation, differentiation and apoptosis, resistance to compressive forces etc. Multiple studies have shown that the effects of miRNA are something like oncogene or tumor suppressor gene in tumor and it controls the occurrence, development, transfer and the malignancy level of tumor via effecting relevant significant gene expressions of tumor. Pancreatic cancer shows as various clinical syndromes and signs externally while internally as various physiological and pathological changes as well as relevant various variations of genes. The patients who are with same clinical syndromes are likely to have comparatively consistent pathological changes and same gene variation. Therefore, TCM syndrome is probably related to miRNA in certain degree and it is very meaningful to explore the correlation between the two which will benefit a lot to the essential study of TCM.Objectives:To Analyze the prognostic relevance of TCM syndrome in tumor to patients and explaining the effects of syndrome that on patients’prognostic mechanism will provide a new research idea and approach to the TCM syndrome.Methods:We analyze retrospectively the195clinical cases of patients who have been diagnosed as pancreatic cancer in hospital from the year2007to2012. All the patients are without operative treatments and are at least accepted two cycles of Gemcitabine chemotherapy, gathering relevant syndrome information via syndrome scale. We use SPSS to calculate and analyze the correlation between the PFS, OS of patients and TCM syndrome, meanwhile collecting saliva samples of relevant syndrome patients, detecting the differences of relevant pancreatic cancer miRNA expressions in various syndromes via laboratory facilities such as RT-PCR to explore the correlation between TCM syndrome and miRNAin pancreatic cancer.Results:1. A total of195patients, We found a significant difference among the three ZHENGs for OS (P=0.003),but the median progression-free survivalwas of no statistical significance (P=0.063).The overall survival of the Shi-Re ZHENG was201days,95%confidence interval (CI),171-231;2. The expression levels of miR-21and miR-181a are the lowest in damp-heat syndrome group than any other three groups,while the levels of syndrome-free group are the highest.Conclusion:1. There are certain differences on the whole between the three syndromes andoveral survival (OS). Damp-heat syndrome have slight advantages concerning the overall survival time of those enrolled patients compared with that of spleen-deficiency syndrome and blood stasis syndrome.As to the pancreatic cancer patients that are before taking chemotherapy, TCM syndrome can prompt the prognosis of pancreatic cancer to some extent the results that the prognosis of damp-heat syndrome show the best, spleen-deficiency syndrome the second and blood stasis syndrome the worst.2. The expression of miR-21and miR-181a is lowest in damp-heat syndrome compared withspleen-deficiency syndrome-compared with that of syndrome-free group. Hence we are able to infer that the dissociative miRNA in the loop may have different expressions in various TCM syndromes and the miRNA in saliva may be regarded as the index for inspecting the prognosis of pancreatic cancer.