| OBJECTIVE: Anorexia, weight loss and malnutrition are commonly in non-small lung cancer patients, and are related to poor prognosis. Weight loss of advanced NSCLC patients is correlated with inflammatory response intensity, and CRP, sTNF-R and sIL-6R levels elevated.IL-6 may be the factor of weight loss of cancer patients. In TCM theory, spleen dominate the transportation and digestion, dominate muscles and limbs, elevate the clear refined substance. Anorexia, inertia and emaciation etc. spleen-stomach deficiency symptoms. This was coincidence with poor prognosis factors such as weight loss, performance status, anorexia and malnutrition. So from the point of view of TCM theory, spleen is the important prognosis factor of advanced NSCLC. This study investigate the relations of spleen-deficiency and NSCLC prognosis through analyzing the database of simple, randomized, controlled clinical trial; and through establishing the animal model of spleen-deficiency Lewis lung cancer mice, investigate the treatment of invigorating the spleen how to influence on the LLC mice.1. The Relations Between Spleen-deficiency And NSCLC PrognosisFrom Dec, 2001 to Jan, 2004, 276 inpatients, with NSCLC in stage Ⅲ-Ⅳ, were recruited in six hospitals including The 1st affiliated hospital of Guangzhou University of TCM, the Henan Province Hospital of TCM, Department of Oncology of 1st Military Medical University Nanfang -Hospital and Department of Oncology of Railway Center Hospital,etc..99 cases in group TCM, 103 cases in group integrated western medicine with TCM, and 74 cases in group western medicine. And I spleen-deficiency is 209 cases(75.7 %), Ⅱ spleen-deficiency is 119 cases(43.1%).METHODS: Project for group TCM: with combination of syndrome differentiation and disease differentiation, Hechan tablets and Shenyi capsules were used according to disease differentiation, and different decoctions were determined from four patterns: phlegmatic stagnation due to passive congestion of lungs(FYTY), phlegmatic hygrosis due to spleen asthenia(PXTS), yin-deficiency and phlegmopyrexia(YXTR) and deficiency of both qi and yin(QYLX) according to syndrome diffentiation, and the period of treatment was three courses, 1 month per course. Project for group integrated western medicine with TCM: the treatment of TCM is the same as group TCM, chemotherapy is the same as group western medicine. Project for group western medicine: Platinum-based chemotherapy were used, either NP or VP regimen was adopted, and were repeated every 21 days, 3 times. The primary end point wais survival, the other end points included time to disease progression(TTP), tumor response rate, symptoms improvement, weight change etc..RESULTS: Tumor response rate(CR+PR) were 4% of group TCM, 26.2% of group integrated western medicine with TCM, 16.2% of group western medicine; there were statistical significance between group TCM and the other groups.. The disease control rate were 66.7%of group TCM, 81.6%of group integrated western medicine with TCM, 85.1 % of group western medicine; there were statistical significance between group TCM and the other groups.Symptoms scales changes after treatment of three groups compared, there were statistical significance between group integrated western medicine with TCM and group western medicine (F—4.573, P=0.011); Symptoms scales after treatment compared, there were statistical significance between group integrated western medicine with TCM and group western medicine(x2 = 14.002, P=0.001). This suggested that treatment integrated western medicine with TCM could improve symptoms well.Body weight changes after treatment compared, patients of weight loss ^ 5 % increased with disease history grow, there was no statistic significance between three groups on 28th day and 63th day, and on 91th day, cases of weight loss^5% were group TCM 27 cases, group integrated western medicine 22 cases and group western medicine 45 cases, respectively; there were statistic significance between three groups (x2== 18.479, P=0.000) .This suggested that TCM treatment could keep body weight well.The median survival time of three group were group TCM 292 days, group integrated western medicine with TCM 355 days, group western medicine 271 days, respectively, there were no statistical significance between three groups. TTP of three group were group TCM 187 days, group integrated western medicine with TCM 239 days, group westernmedicine 213 days respectively, there were no statistical significance between three groups. The median survival time of four syndrome differentiation were FYTY 210 days, PXTS 214 days, YXTR 205 days and QYLX 181 days; there were no statistical significance between four syndrome differentiation. The median survival time of ^ I degree spleen-deficiency patients was 270 days, shorter than that of non-spleen-deficiency patients(515 days); there were statistical significance both of them(P<0.05). The median survival time of I degree spleen-deficiency(299 days)longer than that of ^11 degree spleen-deficiency(265 days); the survival time shorten gradually with degree of spleen-deficiency aggravated; this suggested that more severe of degree of spleen-deficiency, more shorter of survival time. The COX regression analysis showed that independent prognosis factors included performance status(PS), lactate dehydrogenase(LDH), hemoglobin(HGB), I degree spleen-deficiency(PIXUl), sex, TCM syndrome differentiation.CONCLUSIONS: Treatment with TCM could prolong survival time of advanced NSCLC, and cooperate with chemotherapy, the survival time could be more improved.Treatment integrated western medicine with TCM had advantages in tumor response rate, tumor related symptoms improved, keep body weight etc; but response rate of group TCM was lower than that of group western medicine.Spleen-deficiency had higher incidence rate in stage III-IV NSCLC patients.The survival time shorten gradually with degree of spleen-deficiency aggravated; this suggested that degree of spleen-deficiency was relative with survival time, and spleen-deficiency was one of independent prognosis factor. Strengthening earth to generate metal was one cf important treatment methods of advanced NSCLC.About the treatment method of managing spleen-Yin, supporting spleen was keeping lung function, and keeping lung function was supporting spleen also; nourishing spleen-Yin should be introduced to treatment of advanced lung cancer.2. The Experimental Research of Invigorating Spleen in Treatment of Spleen-deficiency Lewis Lung Cancer(LLC) Mice.METHODS: 72 C57BL/6 mice were randomly divided into four groups, there were 18 mice each group, and four groups as follows: LLC saline (group AX spleen deficiency LLC TCM(group B), spleen deficiency LLC chemotherapy(group C) and spleen deficiency LLC saline(group D).Step 1: establish spleen-deficiency animal model: mice of group B, C and D were intragastric administration by 0.3ml/20g rhubarb decoction, every day forseven days. Step2:After awaking LLC cells to be frozen by liguid nitrogen, four C57BL/6 mice' right axilla subcutaneous part were inoculated by LLC cells 2.5 x 105, for establishing transfer of culture LLC mice. The mice were killed after transfer to three generation, and tumor was taken in sterile to make tumor cell suspension which concentration was 5xlO6/ml.Every mouse' right axilla subcutaneous part was inoculated by 0.2ml tumor cell suspension. On the second day Post inoculation, intragastric administration began. Group B were intragastric administration by 0.2ml drug fluid(corresponden\ to crude drug 43.83g/kg, convert to 5 times dosage of adult with 70kg by body surface area)every day for 10 days; Group C were administrated intraperitoneal cisplatin by 0.1ml/20g every day, at the same time were intragastric administration by 0.4ml saline every day for 10 days; Group B were intragastric administration by 0.4ml saline every day for 10 days.RESULTS: After continues administrated drugs for ten days, survival mice number of group A, B, C and D were 18, 10, 13 and 13 respectively o Weight of tumor of group A, B, C and D were 2.58±0.83g, 3.27±0.39g, 2.11±0.48g and 2.30±0.72g respectively; There were statistical significance between group B and other groups(P<0.05); There was no statistical significance between other groups. Suppress tumor rate of group B> C and D were -26.85%,18.24% and 10.48% respectively. Body weight except tumor of group A, B, C and D were 18.37±1.84g, 16.63±3.21g, 17.66±2.14g and 18.69±2.31g respectively. Group D was the most weightest, and group B was the most lightest, but there were no statistical significance between groups.Weight of spleen of group A, B, C and D were 0.1964±0.052g, 0.2738±0.070g, 0.1722±0.055g and 0.2522±0.070g respectively; Weight of thymus gland of group A, B, C and D were 0.055±0.016g, 0.036±0.015g, 0.031±0.008g and 0.045±0.012g respectively; There was no statistical significance between group A and group D; There were statistical significance between group B, group C and group A. Serum TNF-a level of group A, B, C and D were 3.82±0.60ng/ml 3.70±0.87ng/ml, 4.77±0.96ng/ml and 4.31±0.96ng/ml respectively, there were statistical significance between group A, group Band group C; there was no statistical significance between group C and group D. Serum IL-6 levels group A, B, C and D were 66.18±28.28 pg/ml, 54.3U33.33 pg/ml, 87.65±24.03 pg/ml and 24.03±8.94 pg/ml respectively; there were statistical significance between group B, group B and group C, and between group A and group D. Serum TGF-oc levels: there was no statistical significance between groups.CONCLUSIONS: Spleen-deficiency can accelerate the growth of tumor; The treatment of invigorating the spleen could suppress tumor growth of LLC mice, which was weaker than chemotherapy, but there was no statistical significance between groups o This...
|
PDF Full Text Request