| Background:Thyroid cancer is one of the most common malignant tumors of the head and neck,and its incidence has been increasing globally in recent years.For patients with differentiated thyroid cancer,the western medicine "surgery+thyroid stimulating hormone(TSH)suppression therapy+131I" treatment mode improves the patient’s survival rate and prolongs the life cycle,but there are also some patients with thyroid cancer after surgery Non-specific symptoms,such as:TSH suppression treatment may cause adverse cardiovascular reactions and osteoporosis,and may also affect fertility for women of childbearing age;some patients may have pronunciation change due to damage to the recurrent laryngeal nerve.Radioactive 131Ⅰ treatment may damage the parotid glands of some patients,and in severe cases have difficulty swallowing;for most patients,there is a problem of anxiety and tension,and "over-concern" their own condition after surgery.These Symptoms directly or indirectly affect the quality of life of patients.Based on the thinking mode of syndrome differentiation and holistic concept,TCM also combines disease differentiation with syndrome differentiation,which is more in line with the requirements of individualized treatment.For the diagnosis and treatment of patients with differentiated thyroid cancer after surgery,we advocate multi-disciplinary collaboration.In addition to Western medicine departments such as surgery,ultrasound,radiology,pathology and nuclear medicine,traditional Chinese medicine can also be involved in the standardized treatment and dynamic follow-up after surgery.In the previous work,we innovatively proposed to distinguish the thyroid cancer syndrome based on the preoperative and postoperative criteria through the Delphi method[6],and summarized the preoperative and postoperative symptom.Subsequently,cluster analysis of the syndrome of 304 patients with thyroid cancer after surgery showed that the syndrome of Qi and Yin deficiency accounted for the largest proportion(53.9%),followed by the syndrome of liver stagnation and Qi stagnation(36.8%),the syndrome of spleen and kidney Yang deficiency(2.6%),and the syndrome of stasis and heat injury to Yin(2.3%)[5].The prescription after thyroid cancer is the tutor’s experience in the treatment of thyroid cancer after surgery,with nourishing qi and nourishing Yin,regulating qi and resolving phlegm as the treatment formula,in clinical application for many years shows a good effect.Traditional evaluation of the efficacy of traditional Chinese medicine is mainly based on the improvement of clinical symptoms,which is subjective to a certain extent,but may not be comprehensive.We are based on the preliminary study of TCM syndromes of patients with thyroid cancer after surgery,the treatment response in the "Expert Consensus on Clinical Application of Thyroid Cancer Serum Markers(2017 Edition)" is used as the main outcome evaluation index,combining applies to all cancer patients quality of life scale and assessed as a secondary outcome of syndromes,is a more formal and multi-dimensional evaluation method.Objective:①Analyze the clinical characteristics of patients with thyroid cancer after surgery;②Evaluate the clinical efficacy and safety of Traditional Chinese medicine prescriptions after thyroid cancer surgery for postoperative patients with differentiated thyroid cancer.Methods:A retrospective cohort study was conducted on postoperative patients with differentiated thyroid cancer who were admitted to China-Japan Friendship Hospital from June 2019 to December 2020.A total of 358 patients were collected according to the inclusion and exclusion criteria,and they were divided into two groups according to whether patients took Traditional Chinese medicine prescriptions after thyroid cancer surgery:observation group(n=119)and control group(n=239).The control group was simply taking levothyroxine sodium tablet(Youjiale),the observation group was taking Youjiale+Traditional Chinese medicine prescriptions after thyroid cancer surgery,the formula specific composition is:Dangshen,Radix Ophiopogonis,Schisandra fruit,Salvia miltiorrhiza,Prunella subtilis,method Pinellia pinellia,turmeric gold,white paeoniae root,angelica,Yuanshen,Astragalus root,licorice.Patients in both groups were followed up for 10 months,and the general information,TG,TG-AB,thyroid ultrasound,treatment response,clinical symptoms and quality of life scale of the patients were recorded in the Case Report Form(CRF).SPSS26.0 was used for statistical analysis.In this study,multivariate Logistic regression model was used for propensity score matching analysis.Thirty-three factors affecting efficacy,including gender,age,pathological characteristics,lesion type,gene mutation,surgical method,131Ⅰ treatment,side effect risk stratification of TSH inhibition therapy,lesion size,and number of lymph node metastases,were included in the model as covariates,and 76 pairs were successfully matched according to 1:1.The treatment response,TCM syndromes and quality of life scale of the two groups before and after treatment were used as evaluation criteria to evaluate the clinical efficacy of Traditional Chinese medicine prescriptions after thyroid cancer surgery treatment on patients with differentiated thyroid cancer after surgery.Result:(1)Baseline:There were statistically significant differences in gender,history of hyperlipidemia,family history of thyroid disease,pathological characteristics,type of lesion,gene mutation,surgical method,131Ⅰ treatment,postoperative course of disease,and medication course between the two groups(P<0.05).Propensity score matches 30 items:Age,history of marriage,reproductie history,height,weight,BMI,gender,history,history of hypertension,diabetes mellitus,coronary heart disease history,family history of thyroid cancer and recurrence risk stratification of TSH suppression therapy,history of hyperlipidemia,history,family history of thyroid disease,mammary gland hyperplasia focal size,whether outside the capsule invasion,the number of lymph node metastasis,distant metastasis,TNM,TNM staging Risk stratification,pathological characteristics,type of lesions,gene mutation,number of operations,surgical methods,131Ⅰ treatment.Postoperative course of disease showed no statistically significant differences in baseline items between the two groups after matching(P>0.05),which was equilibrated(2)Main efficacy indicators:There was no statistical difference in the treatment response between the two groups of patients(P>0.05),and the number of good responders in the two groups increased.(3)Secondary curative effect indicators:There were significant differences in TCM syndrome scores at baseline(before follow-up)and at the end of follow-up(after follow-up)between the two groups(P<0.05).The baseline TCM syndrome score of the observation group(13±6.61)was about 3 times that of the control group(3.87±2.69).The end TCM syndrome score of the observation group(5.69±6.17)was smaller than that of the control group(3.21±2.72)The change of TCM syndrome scores between the two groups(before and after treatment)was statistically significant(P<0.05).The change of TCM syndrome scores in the observation group(9.79±5.4)was much higher than that in the control group(-1.82±6.16).Therapeutic effect index(76.46±15.58)in the observation group was higher than that in the control group(25.13±3 5.71)The clinical cure,remarkable effect and effective of the observation group were 11.8%,56.6%and 31.6%respectively,which were all higher than those of the control group(7.9%.10.5%and 13.1%respectively).The total effective rate of the observation group(100%)was much higher than that of the control group(31.6%).In the improvement of clinical symptoms,the observation group was significantly better than the control group.In the assessment of quality of life scale,the observation group was better than the control group in terms of emotional function,fatigue and total health status(P<0.05).There was no significant difference in physiological function,role function,cognitive function,social function,nausea and vomiting,pain,dyspnea,sleep disorder,loss of appetite,constipation,diarrhea and perception of economic difficulty between the two groups(P>0.05).Conclusions and significance:Traditional Chinese medicine prescriptions after thyroid cancer surgery can improve the clinical symptoms of patients with low-risk differentiated thyroid cancer after surgery,and can improve the effectiveness of good responses in treatment responses without definite adverse reactions.Therefore,it is suitable for individualized treatment and dynamic follow-up evaluation and management of patients after surgery. |
PDF Full Text Request