Analysing The Efficacy And Prognosis In The Treatment Of Primary Hepatic Carcinoma By Integration Of Chinese And Western Medicine With Typical Medicinal Cases Of Discrimination

ObjectiveAnalysing the efficacy and prognosis in the treatment of primary hepatic carcinoma by integration of chinese and western medicine, providing further evidence based medicine in therapy and reference to the typical medicinal cases. Furthermore, Professor Lin Li-zhu's cogitations and experiences were summarized particularly in the treatment of primary hepatic carcinoma.MethodsThe research was based on the retrospective study of 101 primary hepatic carcinoma cases which were treated by the integration of chinese and western medicine in affiliated hospital during the period in January 2011 to mid-December 2013. The Kaplan-Meier analysis was adopted to examine the difference in tumor stages, PS score and variance of survival in difference TCM syndromes. The observations were included the efficacy of the integration of chinese and western medicine in term of recent effects, distribution pattern of various TCM syndromes and liver functions. The data was analysed by Cox's regression model via selected 11 factors which were related to prognosis of hepatic carcinoma in order to screen risk factors and protective factors. The typical hepatic carcinoma cases, which were treated by Professor Lin Li-zhu, were selected to study her cogitations and experiences.ResultsThe patients with different tumor stages, the median survival period of ?a stage was 1,821 days (95% CI:847.97 to 2794.03), Ib stage was 1,231 days (95% CI:627.65 to 1834.35), ?a stage was 578 days (95% CI:350.63 to 805.37), ?b stage was 567 days (95% CI:404.52 to 729.48), ?a stage was 232 days (95% CI:103.63 to 360.37), ?b stage was 123 days (95% CI:30.62 to 215.39). There was statistically variance in survival rate of different stages (P= 0.000).In patients with different TCM syndromes, the median survival period of liver depression and spleen deficiency was 584 days (95% CI:415.99 to 752.01), liver-gallbladder with damp heat was 193 days (95% CI:190.43 to 195.57), liver heat with blood stagnation was 578 days (95% CI:162.76 to 993.25), spleen deficiency with damp was 574 days (95% CI:11.97 to 1136.03), liver and kidney with yin deficiency was 80 days (95% CI:9.19 to 150.82). There was statistically variance in survival rates of different TCM syndromes(P= 0.000).In patients with different PS score, the median survival period of PS 0-1 was 758 days (95% CI:442.59 795.41) and PS 2-3 was 496.39 days (95% CI:56.77 to 359.23). There was statistically variance of survival rate in different PS score (P=0.018).The efficacy was revealed that the tumor at stable status was 74.3%. The effective clinical symptom score was 84.2%. The PS score at stable status or improvement was 85.2%. The overall efficacy was 72.3% for stable status. The effective portion was 15.8%. The total effective rate was up to 88.1%.In patients between the ?a stage to ?a stage, liver depression and spleen deficiency was about 50%-83.33%, followed by liver heat with blood stagnation. While in ?b stage patients, the major portion was liver and kidney with yin deficiency and about 44.44%. There was statistically variance in distribution of each stage in different TCM syndromes(P=0.000). There was statistically variance between various TCM syndromes under classification by Child-Pugh score. Patients with liver depression and spleen deficiency had better liver function. But patients with liver and kidney with yin deficiency had the worst liver function(P=0.006). In the numerous factors including PS score, alpha-fetoprotein(AFP), Alanine transaminase(ALT), ?-Glutamyl Transferase (GGT), serum albumin, total bilirubin, total bile acid, Child-Pugh score, there were no statistically variance except symptom score and GGT. The variation and trend of data was shown that liver function was deteriorated faster and worse prognosis in patients with liver and kidney with yin deficiency.In Cox's regression model analysis, those factors probably affecting the hepatic carcinoma prognosis were included hepatitis B history, cirrhosis history, tumor size,tumor stage, portal vein thrombosis, AFP, Child-Pugh score, TCM syndrome, medical treatment, chinese medicine treatment time and minimally Invasive therapy.The results revealed that the hepatic carcinoma prognosis was depended on the chinese medicine treatment time, tumor size, tumor stage, portal vein thrombosis and Child-Pugh score. Five typical cases was analysed and was treated by the individualized integration of chinese and western medicine satisfactorily.Conclusion1. The advanced hepatic carcinoma patients can prolong their median survival period by treatment of integration of chinese and western medicine. Also, there are more advantages in stable tumor, improving clinical symptoms and maintain physical condition.2. In accordance with the State Administration of Traditional Chinese Medicine of the People's Republic of China, the patients are classified into various TCM syndromes under the guidance of chinese clinical medicine practice and chinese diagnosis and treatment program. The difference of TCM syndromes are shown various median survival periods. The patients with liver depression and spleen deficiency, liver heat with blood stagnation, liver and spleen deficiency with damp have better median survival period. The patients with TCM syndrome of liver-gallbladder with damp heat and liver and kidney with yin deficiency have worse median survival period. Among all TCM syndrome types, the liver and kidney with yin deficiency is the shortest median survival period and the worst prognosis. The distribution of various TCM syndromes is different. The liver depression and spleen deficiency is the most common TCM syndrome in the ?a and ?a stages. The patients of ?b stage appear the most common TCM syndrome of liver and kidney with yin deficiency. Among patients with various TCM syndromes shows different in functional hepatic reserve but the liver depression and spleen deficiency is better than others. The liver and kidney with yin deficiency is the worst. Among improvement rate of patients with various TCM syndromes related to clinical index, the liver and kidney with yin deficiency is the worst.3. There are difference in survival rate due to variation in PS score and tumor stage. The PS score was inversely correlated to median survival period.4. Multivariate analysis of prognostic shows that the protective factor is result from the use of chinese medicine treatment time, risk factors for the tumor size, tumor stage, portal vein thrombosis and Child-Pugh score.5. The treatment of primary hepatic carcinoma can be reduced the tumor resurrection and metastasis after surgery by the individualized integration of chinese and western medicine and TCM syndrome differentiation. Also, it can improve the clinical symptoms, quality of life and prolongation survival period.