Study On TCM Syndromes And Correlation Of EGFR-TKIs Targeted Therapy In Patients With Advanced NSCLC

Objective:A retrospective study was conducted to evaluate the distribution characteristics of TCM syndromes in patients with advanced non-small cell lung cancer(NSCLC)after targeted therapy with epidermal growth factor receptor tyrosine kinase inhibitors(EGFR-TKIs).The correlation between the substance and the therapeutic effect of the targeted therapy provides a basis for syndrome differentiation and treatment for patients with NSCLC after targeted therapy.Method:A retrospective study was conducted to collect clinical data of patients with advanced NSCLC who were hospitalized in the Department of Hematology,Dongzhimen Hospital,Beijing University of Chinese Medicine for nearly8 years,and to develop a unified" Senior NSCLC Targeted Therapy Data Record Form",which was strictly selected to meet the criteria.Cases,detailed records of patients’general information and clinical disease data,EGFR gene detection,taking EGFR-TKIs targeted treatment,targeted therapy and targeted treatment for 1 month of serum tumor markers(NSE,CEA,CYFRA21-1,CA-125)level,four diagnostic information and physical examination of Chinese medicine at admission,statistical analysis of the distribution characteristics of TCM syndromes in patients with advanced NSCLC after taking EGFR-TKIs targeted therapy,and evaluation of serum tumor markers and targets The relevance of treatment efficacy,and thus draw conclusions.Results:After strict screening,86 cases were included in the study.(1)Distribution of TCM syndromes after taking EGFR-TKIs in patients with advanced NSCLC:The frequency of occurrence of qi deficiency syndrome was 76.74%,followed by blood stasis syndrome(52.33%)and yin deficiency syndrome(46.51%),phlegm dampness syndrome(33.72%),phlegm heat syndrome(4.65%),qi stagnation syndrome(3.49%)and heat poisoning syndrome(1.16%);composite syndrome with the highest frequency of qi and yin deficiency syndrome,32.56%,followed by:qi deficiency and blood stasis syndrome(30.23%),qi deficiency and dampness syndrome(26.74%),yin deficiency and blood stasis syndrome(23.26%),phlegm and blood stasis syndrome(11.63%),qi and yin deficiency and bloodstasis syndrome(10.47%),Qi deficiency and heat syndrome(4.65%),Yin deficiency and phlegm dampness syndrome(4.65%),Qi and Yin deficiency and phlegm dampness syndrome(4.65%),Qi deficiency and phlegm dampness and blood stasis syndrome(4.65%),qi stagnation and blood stasis syndrome(2.33%),qi deficiency and qi stagnation syndrome(1.16%),yin deficiency heat syndrome(1.16%),yin deficiency and phlegm dampness and blood stasis syndrome(1.16%),qi and yin deficiency Hemorrhage and blood stasis syndrome(1.16%).(2)Distribution of TCM syndromes after treatment with different EGFR-TKIs:The frequency of distribution of syndromes after taking ectinib was followed by Qi deficiency and blood stasis syndrome(32.43%),Qi deficiency and dampness syndrome(29.73%),Yin deficiency and blood stasis syndrome(27.03%)and Qi and Yin deficiency syndrome(24.32%);after taking gefitinib,the top 4 Chinese medicine syndromes are:Qi and Yin deficiency syndrome(46.43%),Qi deficiency Wet syndrome(28.57%),qi deficiency and blood stasis syndrome(25.00%)and Yin deficiency and blood stasis syndrome(25.00%);the distribution of TCM syndromes after taking Oxytinib was:Qi and Yin deficiency syndrome(26.67%),Yin deficiency Blood stasis syndrome(20.00%),Qi deficiency and dampness syndrome(13.33%),Qi deficiency and blood stasis syndrome(13.33%),phlegm and blood stasis syndrome(13.33%),Qi deficiency and heat syndrome(6.67%)and qi stagnation and blood stasis Certificate(6.67%).(3)The relationship between TCM syndromes and EGFR-TKIs treatment time:The distribution of TCM syndromes in the treatment period<9 months is:Qi deficiency syndrome,blood stasis syndrome,Yin deficiency syndrome,phlegm-dampness syndrome,phlegm-heat syndrome,gas The stagnation syndrome and heat-toxin syndrome;the frequency of distribution of TCM syndromes in the ≥9-month group were:qi deficiency syndrome,blood stasis syndrome,phlegm-dampness syndrome,yin deficiency syndrome,and phlegm-heat syndrome.The non-parametric test of two independent samples showed P<0.05,indicating that the difference in syndrome distribution between the two groups was statistically significant.(4)Relationship between TCM syndromes and EGFR-TKIs-targeted drug resistance:The distribution of TCM syndromes in the drug-resistant group after treatment was:Qi deficiency syndrome,blood stasis syndrome,Yin deficiency syndrome,phlegm-dampness syndrome,phlegm-heat syndrome,Qi stagnation syndrome;the frequency of TCM syndrome distribution in the unresistant group was:Qi deficiency syndrome,Yin deficiency syndrome,blood stasis syndrome,phlegm-dampness syndrome,qi stagnation syndrome,phlegm-heat syndrome,and heat-toxin syndrome.The differences in drug resistance between the two groups were compared with those of qi deficiency syndrome,blood stasis syndrome,yin deficiency syndrome and phlegm-dampness syndrome by chi-square test P>0.05.The difference was not statistically significant.(5)Comparison of tumor markers before and after EGFR-TKIs targeted therapy:The levels of CEA,CYFRA21-1,NSE and CA-125 in the effective group were lower than those before treatment,and the levels of CYFRA21-1,NSE and CA-125 were The differences before and after treatment were statistically significant(P<0.05).There were no significant differences in CEA,CYFRA21-1,NSE and CA-125 levels before and after treatment(P>0.05).The difference between the two groups before and after treatment showed that the difference between CYFRA21-1 and CA-125 was statistically significant(P<0.05),but the difference between CEA and NSE was not statistically significant(P>0.05).Conclusions:(1)The distribution of single syndromes after EGFR-TKIs targeted therapy in patients with advanced NSCLC was most distributed by qi deficiency syndrome,followed by blood stasis syndrome,yin deficiency syndrome,phlegm-dampness syndrome,phlegm-heat syndrome,qi stagnation syndrome,The heat syndrome proves that the pathogenesis of EGFR-TKIs in patients with advanced NSCLC is based on qi deficiency.Therefore,Chinese medicine treatment should focus on qi and righting during the clinical use of EGFR-TKIs.In the compound syndrome,the frequency of Qi and Yin deficiency syndrome was the most frequent,followed by the frequency of qi deficiency and blood stasis syndrome,qi deficiency and dampness syndrome and y:in deficiency and blood stasis syndrome,suggesting that patients with advanced NSCLC were treated with EGFR-TKIs.Sexuality is based on virtuality,mixed with false and real,and deficiency syndrome is mainly qi deficiency and yin deficiency.The empirical evidence is blood stasis and phlegm-dampness.Therefore,TCM treatment should focus on the relationship between tonic and phlegm and anti-cancer,and can be based on the actual situation.Appropriately choose the method of benefiting Qi,nourishing yin,dissipating phlegm and sputum.(2)There is no significant difference in TCM syndromes between patients with advanced NSCLC who take gefitinib,ectinib and occitonib.All of them have qi and yin deficiency syndrome,qi deficiency and blood stasis syndrome,qi deficiency and dampness syndrome and yin deficiency.The blood stasis syndrome is the main,suggesting that the effects of the above three different EGFR-TKIs on TCM syndromes are basically the same,both of which are manifested as qi and yin damage and sputum formation.(3)TCM syndromes in patients with advanced NSCLC are related to the time of administration of EGFR-TKIs.With the prolongation of medication,qi deficiency syndrome always exists,while yin deficiency syndrome is gradually reduced,blood stasis syndrome and phlegm dampness syndrome are gradually aggravated,so in clinical treatment,For patients taking longer EGFR-TKIs,the strength of phlegm can be appropriately increased while supplementing the qi.(4)There was no significant difference in the TCM syndromes between the resistant group and the unresistant group in patients with advanced NSCLC after taking EGFR-TKIs.All of them were mainly qi-deficiency syndrome,blood stasis syndrome,yin deficiency syndrome and phlegm-dampness syndrome,suggesting that EGFR-TKIs Drug resistance may have no effect on TCM syndromes,but further expansion of sample size is needed for research.(5)Serum tumor marker levels can be used to evaluate the clinical efficacy of EGFR-TKIs targeted therapy in patients with advanced NSCLC,especially CYFRA21-1 and CA-125.