To Study The Correlation Between TCM Syndrome Type And Prognosis Of Advanced Colorectal Cancer Based On The Change Of Blood Coagulation Index

In recent years,the incidence and mortality of colorectal cancer in China have been increasing year by year,posing a serious threat to human health,especially for advanced patients.Most of them lose the opportunity for surgery,and the efficacy of chemo radiotherapy is not significant.A large number of clinical studies have shown that TCM treatment can significantly improve the quality of life and prolong the survival time of patients.In clinical practice,we also observed the different prognosis of patients with advanced colorectal cancer with different TCM syndromes.In order to further clarify the existence of the association,the correlation between TCM syndrome type and prognosis was explored through retrospective study,and a theoretical discussion on the mechanism of coagulation was expected.This study is divided into two parts,which are summarized as follows:Part I:Objective: To investigate the correlation between TCM syndrome type and prognosis of advanced colorectal cancer.Methods: This study cases collected from January 2013 to January 2019 the first affiliated hospital of Tianjin university of TCM oncology outpatient and ward of advanced colorectal cancer deaths in 85 cases,collecting information database is established.Through retrospective case-control analysis and referring to international studies,46 patients with a survival time ?18 months were selected as the observation group and 39 patients with a survival time>18 months were selected as the control group.The correlation between TCM syndrome and prognosis was analyzed from TCM syndrome type and TCM treatment time.Results: Among the 85 patients with advanced death,the age of onset was mainly between61 and 80 years old.There was no statistically significant difference in age distribution between the two groups(P>0.05).There was no statistically significant difference in sex,location of onset and cause of first diagnosis(P>0.05).In terms of TCM syndrome type,spleen deficiency and qi stagnation syndrome accounted for a higher proportion in the observation group(P<0.001),while liver and kidney Yin deficiency syndrome accounted for a higher proportion in the control group(P < 0.05).The difference of survival time betweenthe two groups was statistically significant in less than 12 months and more than 12 months after TCM treatment(P <0.05).It indicates that the prognosis of patients who have taken Chinese medicine for more than 1 year is better than those who have taken Chinese medicine for less than 1 year.According to Cox survival analysis,the time of TCM treatment and the syndrome of spleen deficiency and qi stagnation were the important factors affecting the survival time of patients respectively(P<0.01).Conclusion: there is a correlation between TCM syndromes and prognosis,and the syndrome of spleen deficiency and qi stagnation has a poor prognosis compared with other syndromes.Long-term TCM treatment may have the effect of prolonging the survival time of patients with advanced colorectal cancer.Part II:Objective: To explore the relationship between TCM syndrome types and coagulation indexes at different stages of advanced colorectal cancer,and to expounding the intrinsic relationship between TCM syndrome types and prognosis from the perspective of coagulation function.Methods: the study cases collected from January 2013 to January 2019 the first affiliated hospital of Tianjin university of TCM oncology outpatient and ward,343 cases of patients with advanced colorectal cancer,according to weed out and fall off standard,excluding 15 cases.Eventually into statistical database of 328 cases collected information database is established.According to RECIST standard,the treatment effect of solid tumor can be divided into progressive stage and stable stage.In the progressive stage,the sum of the longest diameter of solid tumor increases by ?20% compared with the former;In the stable stage,the sum of the longest diameters of solid tumors did not increase or increased by less than 20%.According to ?Chinese society of traditional Chinese medicine standard · guidelines for the diagnosis and treatment of tumor in traditional Chinese medicine? released by the Chinese society of traditional Chinese medicine,the standard for syndrome differentiation and classification of colorectal cancer was formulated,which can be divided into six syndrome types: deficiency of qi and blood,deficiency of spleen and kidney Yang,deficiency of liver and kidney Yin,stasis of poison,dampness and heat accumulation and syndrome of spleen and qi stagnation.Six commonly used laboratory indicators representing coagulation functionwere tested and their correlation was analyzed by statistical methods.Results: Among the 328 patients with advanced colorectal cancer included in this study,the ratio of male to female was about 1.624:1,with the age distribution ranging from 23 to 91 years old,and the age range of high incidence ranging from 61 to 80 years old.The primary site was mostly the rectum,the metastatic site was mostly the liver and lung,the pathological type was mostly the adenocarcinoma.Middle differentiation accounted for the highest proportion in the degree of differentiation.In the stable stage of the disease,the FIB level of patients with qi and blood deficiency syndrome was higher than the normal level(P=0.005<0.01).The level of APTT in patients with spleen-kidney Yang deficiency syndrome was lower than the normal level(P=0.026 < 0.05).The level of FIB in patients with internal stasis syndrome was higher than normal(P=0.043<0.05),which was statistically significant.At the stage of disease progression,the APTT of patients with qi and blood deficiency syndrome was higher than normal(P=0.049<0.05).The APTT of patients with internal stasis syndrome was lower than the normal level(P=0.028<0.05).The level of FIB in patients with damp-heat syndrome was higher than normal(P=0.022 < 0.05),which was statistically significant.Decreased PLT level was positively correlated with disease progression(OR=4.235,P=0.003< 0.01).APTT prolonging was positively correlated with disease progression(OR=3.894,P=0.027 < 0.05).Increased FIB level was negatively correlated with disease progression(OR=0.362,P=0.002 < 0.01).Increased D-D level was positively correlated with disease progression(OR=19.596,P=0.005 < 0.01).There was a positive correlation between thromboembolic diseases and disease progression(OR=2.147,P=0.039<0.05).All of which were statistically significant.PLT was positively correlated with deficiency of qi and blood(OR=1.004,P=0.011<0.05).FIB was negatively correlated with deficiency of qi and blood(OR=0.588,P=0.002 < 0.01).PLT was positively correlated with liver and kidney Yin deficiency syndrome(OR=1.003,P=0.030<0.05).There was a negative correlation between PLT and internal stasis syndrome(OR=0.996,P=0.019 < 0.05).APTT was negatively correlated with internal stasis syndrome(OR=0.934,P=0.039<0.05).There was a positive correlation between FIB and internal stasis syndrome(OR=1.307,P=0.042<0.05).There was a positive correlation between FIB and damp-heat accumulation syndrome(OR=1.251,P=0.038 < 0.05).All of which were statistically significant.Conclusion:1.The changes of coagulation function in patients with advanced colorectal cancer were significant,which were manifested as hypercoagulability,bleeding tendency,which were consistent with the literature reports.2.Reduced PLT,prolonged APTT,elevated d-d and thromboembolic diseases in patients with advanced colorectal cancer are risk factors for disease progression,respectively.3.Advanced colorectal cancer has a tendency of bleeding,and the increased FIB level may be the result of the body's self-protection feedback,which is speculated to be the protective factor for maintaining a relatively stable state of the disease.4.In the stable period of advanced colorectal cancer,the damp-heat syndrome was the most common,and it was positively correlated with the increase of FIB,which was speculated to be the internal factor for the relative stability of patients with this syndrome.5.Spleen deficiency and qi stagnation syndrome was the most common syndrome in the advanced stage of colorectal cancer.However,this study has not yet concluded that spleen deficiency and qi stagnation syndrome were associated with a certain coagulation index,which may be caused by a small sample size or the incompleteness of the included laboratory indexes for the evaluation of coagulation function.Looking forward to further in-depth study will find it.6.For other TCM syndromes,when PLT is increased,the probability of deficiency of qi and blood or deficiency of liver and kidney Yin is higher;When FIB is elevated,the probability is higher for the syndrome of internal obstruction of stasis and toxin or the syndrome of dampness and heat accumulation.