Analysis Of TCM Syndrome Characteristics And Clinical Efficacy Of 78 Patients With Advanced Gastric Cancer

PurposeGastric cancer is one of the high-grade malignant tumors in developing countries,and 70%of gastric cancer patients are already advanced at the time of initial diagnosis.Traditional Chinese medicine has the advantages of prolonging the survival period and improving the quality of life in the treatment of advanced gastric cancer.This study describes the features of dominant populations and the characteristics of TCM diagnosis and treatment in patients with advanced gastric cancer undergoing Chinese Medicine treatment.The single factor and multivariate analysis are used to summarize the prognostic factors,which provides a preliminary clinical basis for TCM treatment of advanced gastric cancer.MethodsSelected the patients with gastric cancer who received comprehensive treatment of traditional Chinese medicine oral treatment in Dongzhimen Hospital of Beijing University of Traditional Chinese Medicine,Beijing Huanxing Cancer Hospital,or Beijing Sanhuan Cancer Hospital from December 1,2016 to March 31,2018 and meet the standards.Collect standard cases'western medicine treatment programs,TCM diagnosis and treatment elements such as traditional Chinese medicine syndromes,principles of treatment,core prescriptions and other basic medical history and suggested them continue on Chinese medicine oral treatment in the TCM professional doctors according to syndrome differentiation,treatment time of not less than 4 months.The patient survival time was obtained through a 2-month follow-up.The observation period was at least 12 months.ResultsIn this study,82 patients with advanced gastric cancer were included in the study,and 4 of them were shedding cases.The cause of shedding was two consecutive loss of follow-up.78 patients were included in the statistics,and 26 patients had reached the death endpoint.1.General situation:The age range is from 23 to 94 years old,the average age of onset is 59.26± 13.15 years,the median age is 60 years old,and the peak age range is 51-70 years;54 males and 24 females,male to female 2.25:1.There were more tumors originating in the stomach or the stomach body,accounting for 62.82%,followed by cardia and gastric antrum.The KPS score ranged from 60 to 90 points,with 80 points accounting for 64.10%and 70 points accounting for 23.08%;Adenocarcinoma patients were the most pathological type,accounting for 97.44%,followed by adenosquamous carcinoma and squamous cell carcinoma;Lauren's classification showed more diffuse type,accounting for 20.51%,followed by intestinal type,mixed type;The proportion of distant lymph nodes metastasis was 51.28%.There were 27 cases of liver metastases,followed by peritoneal metastasis,lung metastasis,adnexal metastasis,bone metastasis.Previous history of chronic gastritis accounted for 19.23%,followed by history of gastric surgery and history of gastric polyps.Symptoms:Fatigue accounted for 91.03%,poor appetite accounted for 74.36%,abdominal distension accounted for 64.10%,followed by aversion to cold,cold gas,acid reflux,nausea and vomiting,noisy stomach,epigastric pain,etc.;Tongue:Dark red tongue accounting for 26.92%,pale tongue accounted for 17.95%,tongue fat or tooth marks accounted for 15.38%,followed by tongue lean or crack,dark purple tongue or petechiae;Tongue coating:Thin white tongue coating accounted for 23.08%,white thick or white and greasy tongue coating accounted for 20.51%,followed by yellow thick or yellow greasy moss,yellow thin moss,savory moss,no moss;Pulse:Fine veins accounted for 41.03%,xianmai accounted for 34.62%,followed by chenmai,huamai,astringency;TCM syndromes:Qi deficiency accounted for 93.59%,yin deficiency syndrome accounted for 24.36%,dampness syndrome accounted for 60.26%,and blood stasis syndrome accounted for 42.31%,followed by yang deficiency syndrome and qi stagnation syndrome.2.Western medicine treatment:Treatment plan:The first-line treatment of patients is the most,accounting for 46.15%,followed by traditional Chinese medicine treatment,second-line chemotherapy,third-line treatment;Chemotherapy program containing taxanes most programs,accounting for 43.59%,followed by SOX program,single-agent thioferoline regimen,XELOX regimen,FOLFOX regimen,etc.;Targeted treatment regimen has the largest number of patients taking apatinib(14.10%),followed by trastuzumab,nimotuzumab,and bevacizumab monoclonal antibody.3.Chinese medicine treatment:Treatment principles:strengthening the spleen and stomach accounted for 84.62%,phlegm and dehumidification accounted for 41.03%,and soothing liver and spleen accounted for 20.51%,followed by promoting blood circulation,replenishing kidney qi,nourishing yin and drying counteracting phlegm and warming up the coke;Oral core recipe of decoction is sijunzitang accounted for 23.08%,liujunzitang accounted for 19.23%,erchentang accounted for 10.26%,followed by shiquan dabu tang and banxia xiexin tang,chaihu shugan powder,fuzi lizhong pills,buzhong yiqi decoction,gexiazhuyu decoction,etc.;The use of intravenous injections of xiaoaiping injection accounted for 23.08%,shenqi fuzheng injection accounted for 20.51%,and kanglaite injection.The ratio of liquid to 12.82%,followed by compound matrine injection,brucea oil injection,aidi injection,kangai injection and so on.4.Survival analysis:As of March 31,2018,a total of 26 patients died,the survival time of stage ? ranged from 1.7 months to 28.9 months,and the average stage IV survival time was 10.3±7.68 months.The median stage IV The survival time was 7.3(95%CI:4.560-10.040)months;the half-year survival rate was 61.54%(16/26),the 12-month survival rate was 30.77%(8/26),and the 18-month survival rate was 19.23.%(5/26),24 months survival rate was 7.69%(2/26);univariate and multivariate survival analysis showed that age stratification,surgical treatment and palliative chemotherapy had an impact on survival time.5.Characteristics of dominant populations:Age range 48-80 years old,mean age 67±11.9 years,median age 70 years;4 males and 4 females;Average KPS score was 75 points;Poorly differentiated adenocarcinoma in 3 cases,moderate differentiation adenocarcinoma in 3 cases;radical resection in 6 cases,2 cases without surgery;treatment mode selected traditional Chinese medicine in 4 cases,traditional Chinese medicine + second-line treatment in 2 cases,traditional Chinese medicine + first-line treatment in 2 cases;TCM syndrome:Qi-deficiency syndrome in 6 cases.Yin-deficiency syndrome in 3 cases,6 cases of blood stasis syndrome and 4 cases of dampness syndrome.Tongue images:3 cases of dark tongue,2 cases of tongue ecchymosis,2 cases of pale tongue,4 cases of thin white tongue coating,and 2 cases of thick yellow tongue coating.Pulses:7 in fine veins,4 in Xuan mai,and 2 in Huamai.Conclusions1.Syndrome characteristicsBased on the results of this study,we summarized the characteristics of pathogenesis of advanced gastric cancer with "hypoxic,phlegm,and convulsion" inclusions;Deficiency of TCM syndromes was mainly due to deficiency of qi and yin deficiency;Excess syndrome was mainly based on phlegm and blood stasis;Poor,abdominal distension as the main clinical manifestations;Dark red,dark,fat or teeth tongue,thin white,thick white or greasy,thick yellow or greasy moss as the main tongue image;Fine veins,xianmai,chenmai is the main pulse.2.Prognostic factorsThe results of this study indicate that age ? 65 years,surgical treatment,and palliative chemotherapy are favorable factors for the prognosis of advanced gastric cancer.3.Characteristics of dominant populationThe TOGA study showed that the survival time of patients with stage IV gastric cancer was 11.1 to 13.8 months.According to experts from the research group,patients with a survival time of ?13.8 months were initially defined as dominant populations.According to this standard,8 dominant populations were selected.Summarizes that the characteristics of dominant populations for advanced gastric cancer are average age of 67± 11.9 years,median age of 70 years,poorly differentiated or moderately differentiated adenocarcinoma,received radical treatment,TCM syndrome is qi deficiency or blood stasis,purple dark tongue,thin whitish coating,thready pulse.