| PurposeLung cancer always occupies the first place in cancer incidence and mortality,among which non-small cell lung cancer is the main pathological type.Since June 2018,immunotherapy has become an important treatment after surgery,radiotherapy and chemotherapy.Traditional Chinese Medicine(TCM)treatment of lung cancer is the characteristics of our country,which prolongs survival time and the high quality of life.This study describes the advanced non-small cell lung cancer patients accepted PD-1 inhibitors for the first time treatment with TCM syndrome characteristics,and the relationship between TCM syndrome type in patients and clinical stage,pathological type,as well as the curative effect evaluation.It will provide a certain basis for further joint immune checkpoint inhibitor treatment and TCM treatment of patients in advanced non-small cell lung cancer.MethodProspective study method is used to collect non-small cell lung cancer patients on June 1,2018 to December 31,2019 in Beijing university of Chinese medicine dongzhimen hospital,Beijing huan xing cancer hospital,Chinese academy of medical sciences cancer hospital,China-Japan friendship hospital and Chinese academy of sciences wangjing hospital of traditional Chinese medicine.The patients who is the first time to use PD-1 inhibitor treatment for not less than 2 months,offering the basic information,history,type of syndrome,symptom,fatigue rating,KPS score and being observed the changes.We will analyze the relationship between the curative effect,pathological type,clinical stage and TCM syndromes,in addition to the relationship between the pathological type,clinical stage and curative effect.ResultsIn this study,a total of 57 patients with advanced non-small cell lung cancer meeting the criteria,among which 4 had exfoliation.The reason for exfoliation was refusal to follow up,and 53 patients were included in the statistics.1.General situation①The age was from 41 to 86 years.The mean age was 63.81±9.31 years,and the median age was 62 years.There were 42 males and 11 females,with a male-female ratio of 3.81 to 1.②Among the pathological types,there were 26 cases of adenocarcinoma,accounting for 49.05%.There were 25 cases of squamous cell carcinoma,accounting for 47.17%.There was 1 case of large cell carcinoma,accounting for 1.89%,and 1 case of adenocarcinoma combined with large cell carcinoma,accounting for 1.89%.③ln the clinical stage,there were 8 cases forⅢA period,accounting for 15.09%,5 cases for ⅢB phase,accounting for 9.44%,4 cases forⅢC phase,accounting for 7.55%and 36 cases for IV phase,accounting for 67.92%.④In the history of smoking,21 patients had never smoked,accounting for 39.62%.There were 3 patients with smoking for 20 years,accounting for 5.66%.7 patients had been smoking for 30 years,accounting for 13.21%.18 patients had been smoking for 40 years,accounting for 33.96%.Smoking for 50 years in 4 cases,accounting for 7.55%.⑤16 patients(30.19%)were treated with PD-1 inhibitors alone,PD-1 inhibitors combined with chemotherapy accounted for 26 cases(49.06%),5 cases(9.43%)were combined with targeting and 6 patients(11.32%)were treated with PD-1 inhibitors combined with chemotherapy and targeting.2.The overall situationTongue and pulse:Before treatment,light red,light white,red and crack were the main tongue images,thin white,white greasy and yellow greasy were the main tongue coating,and thready,slipper,string-like were the main pulse images.After treatment,light red tongue and white thick coating decreased,red tongue,crack,thin yellow coating and no coating increased,slipper pluse decreased,thread and rapid pluse increased.Syndrome elements and syndrome types:After treatment,the syndrome of blood deficiency,Yin deficiency,phlegm heat and complex syndrome elements(three kinds and more composite)increased,and the syndrome of qi deficiency,phlegm damp,blood stasis and two kinds of syndrome elements decreased.In terms of syndrome types,after treatment,the mutual knot of qi deficiency and blood stasis,intermingled phlegm and blood stasis(including phlegm dampness and blood stasis,phlegm heat and blood stasis),qi deficiency and phlegm obstruction(including phlegm dampness and phlegm heat of qi deficiency),Yang deficiency and blood stasis decreased,and qi deficiency and blood deficiency,Yin and Yang deficiency increasedCorrelation:For syndrome elements,there was no correlation between syndrome elements with the curative effect,pathological type and clinical stage.In terms of the curative effect,clinical stage was correlated with it,while pathological type had no correlation.Symptoms and scores:In terms of symptom scores,most of the patients showed improvement after the treatment,but the number of patients showed increased in blood in the sputum and diet reduction.Compared with the number before treatment,and the changes in symptom scores after treatment were meaningless.In terms of fatigue scale,the number of patients with mild or no fatigue increased after treatment,while the number of patients with moderate fatigue decreased.Statistical analysis showed that the improvement of fatigue score before and after treatment was insignificant.In terms of KPS,scores of 80 and 90 points increased after treatment,while those of 60 points increased.Statistical analysis showed that the improvement of KPS scores before and after treatment was insignificant3.PD-1 inhibitors aloneTongue and pulse:Before treatment,the tongue appearance of the patient mainly was light white,light red and red,while the tongue coating mainly was thin white and yellow greasy.After treatment,there was no significant change in the tongue,while the thin white and yellow greasy coating decreased,and the white greasy and thin yellow coating increased.Pulse imaging showed no significant change before and after treatmentSyndrome elements and syndrome types:After treatment,Yin deficiency,Yang deficiency and two syndromes decreased,and complex syndromes increased.In terms of syndrome types,qi deficiency and blood stasis,qi deficiency and phlegm obstruction(mainly qi deficiency and phlegm dampness)increased after treatment,while Yang deficiency and blood stasis,qi deficiency and Yin deficiency decreased.Correlation:For syndrome elements,there was no correlation between syndrome elements with the curative effect,pathological type and clinical stage.In terms of the curative effect,it had nothing to do with pathological type and clinical stage.Symptoms and scores:In terms of symptom scores,most of the patients showed improvement in symptoms after treatment,diet reduction and oropharyngeal dryness were slightly more than before treatment,and the changes in symptom scores before and after treatment were insignificant.In the aspect of fatigue scale,fatigue degree was found to be worse than before treatment in 1 case,and statistical analysis showed that the change of fatigue score before and after treatment was insignificant.In terms of KPS,the overall KPS score was relatively stable,and statistical analysis showed that the improvement of KPS score before and after treatment was insignificant4.PD-1 inhibitor combined with chemotherapyTongue and pulse:After treatment,the patient’s light red and light white tongue decreased,while the red tongue and cracked tongue increased.Thin white,yellow greasy increase and white thick coating decreased.In terms of pulse image,the number of rapid increased,and the number of slipper and string-like decreased.Syndrome elements and syndrome types:Compared with before and after treatment,qi deficiency,phlegm dampness,blood stasis reduced,Yin deficiency,phlegm heat increased after treatment.In terms of syndrome types,patients with qi deficiency and blood stasis,intermingled phlegm and blood stasis,qi deficiency and phlegm obstruction reduced,qi deficiency and Yin deficiency increasedCorrelation:For syndrome elements,there was no correlation between syndrome elements with the curative effect,pathological type and clinical stage.In terms of the curative effect,it has nothing to do with pathological type and clinical stageSymptoms and scores:In terms of symptom scores,the symptoms of shortness of breath,oropharyngeal dryness and constipation were significantly alleviated after treatment,but the changes in symptom scores before and after treatment were meaningless in statistics.In terms of fatigue scale,the fatigue of patients improved significantly with nobody deterioration after treatment.Statistical analysis showed that the improvement of fatigue score before and after treatment was insignificant.In terms of KPS,the overall KPS score was relatively stable,and statistical analysis showed that the improvement of KPS score before and after treatment was insignificant.Conclusions1.Overall syndrome characteristicsBased on this study with PD-1 inhibitors before and after treatment of TCM syndrome types,qi deficiency,phlegm dampness,and blood stasis were the main syndrome factors before and after treatment.After treatment,blood deficiency,Yin deficiency,phlegm heat and complex syndrome factor increased,qi deficiency,blood stasis and phlegm dampness,two kinds of syndrome factor decreased,which changes obviously was that an increasing in blood deficiency syndrome,and decreasing in blood stasis.In terms of syndrome types,the main syndromes of qi deficiency and blood stasis,intermingled phlegm and blood stasis and qi deficiency and phlegm obstruction decreased after treatment.While qi and blood deficiency as well as Yin and Yang deficiency increased.Combined with the tongue and pulse condition,it is speculated that the treatment containing PD-1 inhibitors can lead to Yin injury and blood consumption2.Hierarchical characteristicsIn the PD-1 inhibitors group alone,the syndrome elements were mainly qi deficiency,phlegm dampness and blood stasis before and after treatment,and Yin deficiency and Yang deficiency were reduced after treatment.In terms of syndrome type,qi deficiency and blood stasis,qi deficiency and phlegm obstruction syndrome(mainly qi deficiency and phlegm dampness syndrome)increased,while Yang deficiency and blood stasis syndrome and qi deficiency and Yin deficiency syndrome decreased.Combined with the tongue and pulse condition,it is speculated that the cold syndrome may be increased after using PD-1 inhibitors alone.In PD-1 inhibitor combined with chemotherapy group,the syndromes of qi deficiency,phlegm dampness and blood stasis decreased after treatment,while Yin deficiency and phlegm heat increased.In terms of syndrome types,patients with qi deficiency and blood stasis,intermingled phlegm and blood stasis,qi deficiency and phlegm obstruction decreased after treatment,and qi deficiency and Yin deficiency increased.Therefore,the main change trend of the patients was the deficiency of qi and Yin,and there was a tendency to injure the internal heat of Yin.3.Other aspectsThe overall efficacy of treatment with PD-1 inhibitors was correlated with clinical stage.Therefore,the earlier the clinical staging of the patients,the better the curative effects combined with clinical practice.There was no correlation between syndrome elements with the curative effect,pathological type and clinical stage.In terms of symptoms,KPS score,and fatigue scale,the overall condition after treatment was stable or improved.In the PD-1 inhibitor group alone,there were 5 patients whose symptoms were evaluated as effective or stable and efficacy was evaluated as SD,accounting for 31.25%of the total number of patients in this group.In the PD-1 inhibitor combined chemotherapy group,there were 18 patients with effective or stable symptom evaluation and efficacy evaluation of PR or SD,accounting for 69.23%of the total number of patients in this group,so the benefit rate of PD-1 inhibitor combined chemotherapy was higher than that of PD-1 inhibitor alone in patients with advanced non-small cell lung cancer. |
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