| Objective:To analyze the distribution pattern of TCM syndromes in 373 patients with renal cell carcinoma in our hospital during the past fifteen years (2001?2015), so as to provide reference for clinical medication and further studies.Method:Retrospective study method was used. From the medical record room of Guanganmen Hospital of Chinese Academy of traditional Chinese medicine,the cases of renal carcinoma which meet the inclusion criteria were selected, and each medical record was recorded. The TCM syndrome differentiation type developing diagnostic standard of syndrome differentiation was mainly based on the standard of syndrome differentiation of kidney cancer in the Guideline of Cancer Diagnosis and Treatment of Traditional Chinese Medicine published by the Chinese Medical Association, At the same time, referred to Chinese Medicine Oncology( edited by Yu Rencun ),and Guide to the Diagnosis and Treatment of Malignant Tumors( edited by Lin Hongsheng), and Chinese Medicine Oncology( edited by Zhou Daihan), and the syndrome differentiation of kidney cancer in Internal Medicine (New Century Second Edition, edited by Zhou Zhongying). The classification of syndromes was based on the clinical symptoms and the tongue and vein in the admission records, medical record information was inputted into EXCEL database, the records included hospital numbers,name, gender, age, family history, length of hospital stay, type of Pathology, treatment modality, length of stay, KPS score, metastasis, stage of tumor, and Medical record for death or not. Software SPSS 20 was used for Analyzing data, and Chi - square test, Fisher exact probability test, Kruskal-Wallis H test were for test, When P < 0.05, the difference is statistically significant.Result:1.According to statistics, there were 245 males (65.7%) and 128 females (34.3%) in 373 cases, Male: female=1.9: 1, this result was consistent with the epidemiological investigation of renal cancer.The minimum age of admission was 23-year-old, and the maximum of admission was 90-year-old, the average age was 63.65-year-old, and the median age was 65-year-old. Among them,70?79 years old,60?69 years old,50?5 9 years old,the three age groups of patients are the most. There was no significant difference in sex distribution among the different age groups.2. Of the 373 patients with renal cell carcinoma, 12.6% had a family history of the tumor,87.4% were without family history or unknown. From 2001?2015, the number of hospitalized patients with renal cell carcinoma is increasing every year, especially in the past three years.The growth rate is particularly rapid, and there is no obvious seasonal difference. Among the different treatments, 75.1% were performed and 24.9% were not surgically treated; Biological immunotherapy accounted for 58.7% of the total, the 41.3% were without biological immunotherapy. There were 18.5% of chemotherapy history and 81.5% without chemotherapy history. For the distribution of different pathological types, clear cell carcinoma accounted for 59% (220 cases), papillary carcinoma accounted for 3.8%(14 cases),chromophobe cell carcinoma accounted for 0.5% (2 cases), collecting duct carcinoma accounted for 0.8% (3 cases), mixed type (also contains two or more than two kinds of pathological type) accounted for4.3% (16 cases), other types accounted for9.4% (35 cases),no pathological examination or unknown accounted for 22.3% (83 cases). The minimum length of stay was 1 days,the maximum length of stay was 95 days,the average length of stay was 26.44 days, and the median length of stay was 26 days. Among them, the largest number of inpatients for 15?28 days accounted for 48%; secondly, patients hospitalized for 29?42 days is up to 31.1%. Of 373 patients with renal cell carcinoma, 127 patients were missing KPS score, Of the 246 currently available, the lowest score was 30 points (1 cases), and the maximum score was 100 points (26 cases). The most common cases were 90 points (77 cases,31.3%), 80 points (65 cases, 26.4%), and 70 points (34 cases, 13.8%). Of the 373 patients,333 had metastasis (89.3%), lung metastasis (263 times, 70.5%), bone metastasis (102 times,27.3%), lymph nodes metastasis (90 times, 24.1%), and liver metastasis (84 times, 22.5%)were the most common.The distribution of different stages of renal cell carcinoma, I stage accounted for 2.7%, II phase accounted for 2.4%, III phase accounted for 3.8%, IV phase (the maximum) accounted for 96.5%, and 3.5% of patients were not staging. Of the 373 patients with renal cell carcinoma, 9.1% were dead medical records, and 90.9% were non -death medical record.3. In this study, the distribution of syndrome differentiation for 373 cases of renal cancer patients was as below: Deficiency of the spleen and kidney: 56.3%; Internal heat due to yin deficiency: 25.2%; Blood stasis internal resistance: 10.2%; Damp heat accumulating toxin:8.3%. By statistical analysis, there were significant differences among TCM syndromes,the highest proportion was the spleen and kidney two deficiency type, followed by Internal heat due to yin deficiency type.4. The purpose of this study was to investigate the correlation between these factors and each TCM classification by analyzing the gender, age, time of admission, pathological types and treatment methods of the patients. The results showed that there were significant differences in the distribution of syndrome types in different genders (chi, 2=9.559, P=0.023 <0.05). Both the spleen and kidney two deficiency type and Internal heat due to yin deficiency type are more common in both male and female. The types of blood stasis in female patients are more than those of damp heat and toxin type, while those of male patients are similar.There were significant differences in TCM Syndrome Types in different age groups (chi, 2=,18.751, P=0.017 < 0.05). The trend shows that, before the age of 40, the patients with Internal heat due to yin deficiency and blood stasis internal resistance accounted for more proportion,and after 40 years old, the patients with spleen and kidney two deficiency type patients increased proportion. After 80 years old, the proportion of spleen and kidney deficiency of two types decreased, while the proportion of yin deficiency and internal heat increased again.It may be related to the law of the growth and decline of yin and Yang in human body.Regardless of family history, there was no significant difference in the distribution of medical syndromes (chi, 2=, 0.792, P=0.851 > 0.05). There was no significant difference in the distribution of TCM syndromes at different admission times (chi, 2=5.368, P=0.801 > 0.05).And there was no significant difference in the distribution of TCM syndromes between clear cell carcinoma and non-clear cell carcinoma (chi, 2=, 5.312, P=0.504 > 0.05).The trend showed that the proportion of damp heat diarrhea type decreased in the patients treated with surgery, but no significant difference was found (chi, 2=2.028, P=0.567 > 0.05).After chemotherapy, the proportion of patients with Internal heat due to yin deficiency increased significantly, and the proportion of blood stasis internal heat and damp heat diarrhea type decreased. The proportion of patients with blood stasis and internal resistance increased significantly after biological immunotherapy, and both showed statistically significant difference (chi 2=10.742, P=0.014 < 0.05, Chi 2=21.842, P < 0.001).5. In the study of correlation between syndrome type and prognosis, there was no significant correlation between the length of hospital stay and the distribution of TCM syndromes (chi 2=0.526, P=0.913 > 0.05). There was no significant difference in the distribution of renal cancer syndromes between the different KPS scoring groups (chi, 2=,1.006, P=0.605 > 0.05). No matter whether it was transferred or not, there was no significant difference in the distribution of the syndrome types (chi, 2=6.847, P=0.077 > 0.05). The distribution of TCM syndromes in different stages was significantly different (chi, 2=9.925,P=0.019 < 0.05). There was no significant difference in the distribution of renal cancer syndromes between death and non-death patients (chi, 2=, 3.948, P=0.267 > 0.05).6. The trend shows that the deficiency is often more obvious for the patients with relatively poor prognosis, For the patients with poor prognosis, the proportion of spleen and kidney two deficiency type and Internal heat due to yin deficiency type is higher than that of patients with better prognosis. For the patients with good prognosis, excessive disease tended to be more obvious, the proportion of the blood stasis type and damp toxin type was slightly higher than that of patients with poor prognosis. For example, in patients hospitalized for longer than 42 days, the proportion of spleen and kidney two deficiency was higher than those patients hospitalized within 42 days. In the patients with metastasis, the proportion of spleen and kidney two deficiency type was higher than that of patients without metastasis. For the patients with KPS ? 40, the proportion of Internal heat due to yin deficiency increased significantly. In the case of death, the proportion of spleen and kidney two deficiency type and Internal heat due to yin deficiency type was higher than that of non-death patients, but there was no statistically significant difference.Conclusion:1. There are significant differences in the distribution of syndromes among patients with renal carcinoma: spleen and kidney two deficiency type > Internal heat due to yin deficiency > blood stasis internal resistance type > damp heat toxin type.2. Regardless of family history, there is no significant difference in the distribution of Medical Syndromes. There is no significant difference in the distribution of TCM syndromes type at different admission times. There is a significant difference in the distribution of TCM syndrome type of renal carcinoma among different treatment modalities.3. There was no significant difference in the distribution of TCM syndrome types between different pathological types, different length of hospital stay, different KPS and death or not.4. The trend shows that deficiency syndrome is often more pronounced for the patients with poorer prognosis,while the excessive disease is often more pronounced for the patients with better prognosis.5. The results suggest that kidney cancer is characterized by deficiency of vital Qi. In other words, Qi deficiency is the primary cause of Kidney cancer. Phlegm, dampness, heat,blood stasis and toxicity cemented together are the secondary cause. The pathogenesis is Asthenia of healthy qi and sthenia of pathogenic factors and deficiency complicated with excess. In the process of the pathological changes, sthenia of pathogenic factors is the main character in the early stages, and in the later period, deficiency of asthenia of healthy qi is the main character. Firstly, there is Yang Deficiency , which is followed by deficiency of both yin and yang, at last, there is divorce of yin-yang. |
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