Study On The Correlation Between Traditional Chinese Medicine Syndrome Types And Inflammatory Response Parameters In Primary Liver Cancer And Its Predictive Effect On Immunotherapy Efficacy

Objective: Based on Cite Space’s literature visualization research,understand the current status and research hotspots of traditional Chinese medicine in the comprehensive treatment of primary liver cancer(PLC).Select the research of liver cancer syndrome and inflammatory microenvironment as the entry point to explore the TCM syndrome differentiation types of liver cancer(qi stagnation and blood stasis syndrome,damp heat accumulation syndrome,liver stagnation and spleen deficiency syndrome,liver kidney yin deficiency syndrome)and the distribution of symptoms,as well as the correlation with peripheral blood neutrophil lymphocyte ratio(NLR),platelet lymphocyte ratio(PLR);Analyze the predictive effect of traditional Chinese medicine syndrome types and inflammatory response parameters on the efficacy of immunotherapy in the middle and late stages(II-IV stage)of PLC.Methods: The first part of literature research is to use the scientific metrology tool Citespace6.1.R6 to draw the knowledge map of TCM’s participation in comprehensive treatment of liver cancer by searching the literature published in China national knowledge infrastructure(CNKI)in the past 10 years about TCM’s participation in comprehensive treatment of liver cancer.The second part of the clinical study collected blood samples,traditional Chinese medicine syndrome elements,and symptoms from60 PLC patients admitted to the Oncology Department of the First Affiliated Hospital of Anhui Medical University from June 1,2020 to December 31,2022.The NLR and PLR of the patients were tested,and the distribution pattern of traditional Chinese medicine syndrome elements and symptoms was analyzed,The correlation between traditional Chinese medicine syndrome types and NLR,PLR.At the same time,32 intermediate and late stage(II-IV)PLC patients who received immune checkpoint inhibitor treatment were selected from 60 patients for subgroup analysis.NLR and PLR were stratified by the cutoff values of NLR and PLR,and the clinical efficacy and Karnofsky performance status(KPS)before and after treatment were evaluated.The preliminary exploration of the predictive role of traditional Chinese medicine syndrome types and NLR and PLR on the efficacy of immunotherapy was conducted.Result:(1)After searching and screening,102 literature studies were obtained,and it was found that the research hotspots were liver cancer,traditional Chinese medicine,inflammatory cells,immunity,etc A total of 60 patients were included in the clinical study.After analyzing the distribution patterns of traditional Chinese medicine syndrome elements and symptoms,as well as the correlation between traditional Chinese medicine syndrome types and NLR and PLR,it was found that patients with pathological stages I and II were mainly characterized by qi stagnation and blood stasis syndrome,and dampness heat accumulation syndrome;III.Phase IV patients are mainly characterized by liver depression and spleen deficiency,as well as liver and kidney yin deficiency syndrome elements.The main symptoms and manifestations of Phase IV patients are similar to the syndrome elements.The NLR and PLR values are related to the distribution of traditional Chinese medicine syndromes in PLC patients,with the liver depression spleen deficiency group and liver kidney yin deficiency group having a higher risk of high NLR and PLR compared to the qi stagnation and blood stasis group.By stratifying NLR and PLR and evaluating the clinical efficacy and KPS before and after treatment in 32 intermediate and late stage(II-IV)PLC patients who received immunotherapy,it was found that traditional Chinese medicine syndrome types and NLR and PLR have predictive effects on the efficacy of immunotherapy.Clinical efficacy is better for low NLR,PLR,empirical,and single syndrome types,with significant improvement in KPS.Conclusion: From the analysis of various visualization graphs,it can be seen that the predictive effect of traditional Chinese medicine syndrome types and inflammatory response parameters on the immunotherapy effect of liver cancer is currently a research hotspot.The distribution of traditional Chinese medicine syndrome symptoms in PLC patients shows consistency with the distribution of syndrome elements,but as the disease progresses,the symptoms show a transformation pattern from solid to weak,simple to complex,and one organ disease and other organ diseases.The NLR and PLR values are related to the distribution of traditional Chinese medicine syndrome types in PLC patients.Among them,liver depression and spleen deficiency are mixed syndrome types of deficiency and excess,but like liver and kidney yin deficiency,they are mainly positive deficiency,indicating poor nutritional and immune status of the body,making it more likely to have an increase in NLR and PLR,and more susceptible to infection.Traditional Chinese medicine syndrome types and NLR,PLR are related to the prognosis of immunotherapy.Single syndrome types have better prognosis than composite syndrome types,while empirical syndrome types have better prognosis than deficiency syndrome.Therefore,the conversion of traditional Chinese medicine deficiency syndrome to positivism may improve patients’ response rate to immunotherapy and reduce the incidence of infection.Therefore,monitoring the changes in traditional Chinese medicine syndrome types and the ratio of NLR to PLR in PLC can help determine the prognosis of immunotherapy and provide reference for the objectification of traditional Chinese medicine syndrome types and clinical diagnosis and treatment of this disease.