A Research Of The Traditional-Chinese-Medicine Constitution Of Primary Liver Cancer

Objectives:To study on the relationship between Chinese medicine constitution and the primary liver cancer through investigating the distribution of Chinese medicine constitution among cases with the primary liver cancer(PLC for short), so as to seek some laws from the characteristics of Chinese medicine constitution and corelation between Chinese medicine constitution and the primary liver cancer.Then the study is supposed to provide some evidence for individual treatment and prognosis judgement of PLC patients basing on.Methods:A prospective study was performed in this research.In accordance with inclusion and exclusion criteria,the data collected was about Chinese medicine constitution in Chinese medicine,demographic information,body index,TCM Syndromes,hepatitis infection,pathological types,TNM staging, AFP level,ascites,liver function,CLIP score,Okuda staging,cirrhosis or not,portal vein tumor thrombosis of the 151 patients.Clinical follow-up of the patients was conducted to calculate the survival time.Finally all the data was analysised to investigate the distribution characteristics of constitution in Chinese medicine of PLC patients,and explore the relationship between the constitution in Chinese medicine and the related factors of PLC.Results:From May.2007 to Apr.2009,151 patients were involved in this study,there were 127 male and 24 female patients,the male/female ratio is 5.3.Their ages ranged from 27 to 81,the average age was 55.3±12.5 years old,the onset age mainly concentrated on patients at the age from 40 to 70,specially at the age of from 50 to 60.The constitution in Chinese medicine of the patients with PLC were mostly Gentleness type,Qi-deficiency type,Yang-deficiency type and Wet-heat type. Their constitution in Chinese medicine were as follows:Gentleness type, Qi-deficiency type,Yang-deficiency type,Wet-heat type,Qi-depression type, Blood-stasis type,Special diathesis type,Yin-deficiency type and Phlegm-wetness type.The frequencies of which were 37(24.5%),36(23.8 %),25(16.6%),21(13.9%),14(9.3%),10(6.6%),4(2.6%),2 (1.3%) and 2(1.3%),respectively.The biased constitution were mostly Qi-deficiency type,Yang-deficiency type and Wet-heat type,which together more than half(54.3%).Gender differences existed in the constitution in Chinese medicine of the patients with PLC.In male patients,the biased constitution were mostly Qi-deficiency type,totally with 27.56 percent,followed by Yang-deficiency type,Wet-heat type,Qi-depression type,Blood-stasis type,Yin-deficiency type and Phlegm-wetness type,The frequencies of which were 21(16.54%), 18(14.17%),11(8.66%),9(7.09%),2(1.57%),1(0.79%),respectively. While in female patients,the biased constitution were mostly Yang-deficiency type,followed by Wet-heat type,Qi-depression type,Phlegm-wetness type, Qi-deficiency type,Blood-stasis type and Phlegm-wetness type,The frequencies of which were 4(16.67%),3(12.5%),3(12.5%),3(12.5 %),1(4.17%),1(4.17%),respectively.There was statistic difference between gender differences and the constitution in Chinese medicine(P 0.05).There was no significant correlation between the constitution in Chinese medicine and TCM Syndromes.The biased constitution in the patient with the syndrome of liver-qi stagnation and spleen-qi deficiency were mostly Qi-deficiency type(21.2%),Phlegm-wetness type(15.4%) and Qi-depression type(13.5%).And in the patient with the syndrome of qi-stagnancy and blood-stasis,the biased constitution were mostly Yang-deficiency type(33.3 %),Qi-deficiency type(13.3%) and Phlegm-wetness type(13.3%).While the biased constitution in the patient with the syndrome of endoretention of damp heat were mostly Qi-depression type(33.3%),Wet-heat type(20.0%) and Yang-deficiency type(13.3%).The biased constitution were mostly Qi-deficiency type(26.1%),Yang-deficiency type(18.8%) and Wet-heat type (11.6%) in the patient with the syndrome of retention of dampness and blood stasis.Overall,The biased constitution in the patients with different syndromes were mostly Qi-deficiency type and Yang-deficiency type.However, after the data was analysised by statistic software,there was no significant statistic differences as compared to each other(P＞0.05).There was a certain correlation between the constitution in Chinese medicine and Okuda staging,TNM staging.The frequencies of Okuda stageⅠ, Okuda stageⅡ,Okuda stageⅢwere 33.8%,48.3%,17.9%,respectively.The biased constitutions of the patients with Okuda stageⅠwere mostly Wet-heat type,Qi-depression type,Qi-deficiency type and Yang-deficiency type,followed by Blood-stasis type and Yin-deficiency type.While the patients at Okuda stageⅡwere mostly Qi-deficiency type,Yang-deficiency type and Wet-heat type, followed by Blood-stasis type and Qi-depression type.And the patients at Okuda stageⅢwere mostly Qi-deficiency type and Yang-deficiency type,followed by Phlegm-wetness type and Wet-heat type.The biased constitutions of the patients at TNM stageⅠwere mostly Qi-deficiency type,Blood-stasis type,Wet-heat type and Yang-deficiency type. The constitution of the patients at TNM stageⅡwas mostly Gentleness type, the biased constitution was mostly Yang-deficiency type,followed by Qi-deficiency type and Yin-deficiency type.The biased constitutions of those who at TNM stageⅢA were mostly Qi-deficiency type and Wet-heat type,followed by Yang-deficiency type,Qi-depression type and Blood-stasis type.The constitution of the patients at TNM stageⅢB was mostly Gentleness type,too, the biased constitution was mostly Qi-deficiency type and Yang-deficiency type, then were Blood-stasis type.The biased constitution of those who at TNM stageⅢC was mostly Qi-deficiency type,followed by Yang-deficiency type, Qi-depression type,Phlegm-wetness type,Wet-heat type and Special diathesis type.The biased constitution of those who at TNM stage were mostly Yang-deficiency type,followed by Qi-deficiency type,Qi-depression type, Special diathesis type and Phlegm-wetness type.There was also a certain correlation between the constitution in Chinese medicine and survival time.The longest survival time was the patients with Gentleness type,while the shortest was those who with Qi-deficiency type. The median survival times of the four main constitutions in Chinese medicine were as follow:The median survival time of the patients with Gentleness type was 13.3 months,those who with Qi-deficiency type was 3.7 months,the median survival time of the patients with Yang-deficiency type and Wet-heat type were 6.1 months and 10.2 months,respectively.There was no statistic difference between the four main constitutions in Chinese medicine and survival time (P＞0.05).A univariate analysis of the survival time between patients with Gentleness type and Qi-deficiency type was conducted.The outcome indicated that there was statistic difference on the survival time between patients with Gentleness type and Qi-deficiency type(P＜0.05).Univariate and multivariate analysis indicated that Qi-deficiency type, TNM stating,AFP level and CLIP score were independent prognostic factors for survival time,and Qi-deficiency type was important independent factor which might be worth of a further investigation for predicting prognosis.Conclusion:1.The constitution in Chinese medicine of the patients with PLC were mostly Gentleness type,Qi-deficiency type,Yang-deficiency type and Wet-heat type.2.Gender differences exist in the constitution in Chinese medicine of the patients with PLC.For male patients,the biased constitution were mostly Qi-deficiency type,Yang-deficiency type and Wet-heat type,while in the female patients was mostly Yang-deficiency type.There was no significant correlation between the constitution in Chinese medicine and TCM Syndromes.3.There was a certain correlation between the constitution in Chinese medicine and Okuda staging,TNM staging.The biased constitutions of the patients at TNM stageⅠand stageⅡwere mostly Qi-deficiency type and Yang-deficiency type,those who with stageⅢA were mostly Qi-deficiency type and Wet-heat type,and the patients with advanced PLC(stageⅢB,ⅢC orⅣ) were mostly Yang-deficiency type and Qi-deficiency type.4.There was a certain correlation between the constitution in Chinese medicine and survival time,Qi-deficiency type was a type with the worst prognosis,which median survival time was 3.7 months.5.Univariate and multivariate analysis indicated that Qi-deficiency type,TNM stating,AFP level and CLIP score were independent prognostic factors for survival time.