| Objective:1 To Summarize the experience of prof. Zhang Yaqiang of the treatment of bladder cancer;2 To observe the efficacy oftraditional chinese medicine(TCM)in thetreatment for treating non-muscle-invasive bladder cancer for prevention for 1-year recurrence and 2-year recurrence rate;3 Tostudy the inhibitory effect ofFuzhengxiaozhengtang decoction on MB49 cells Tumor-bearing Balb/c mice and reveal theeffect of thedecoction on cellular immunityfunction.Methods:This topic is composed of three sections.The first is to sort out the experience of the treatment of bladder cancer of prof. Zhang Yaqiang.Then the patients ofbladder cancer in Mr. Zhang’s outpatient were followed from 2014-10-08 to 2016-03-31.we analysised the 1-year and 2 year recurrence rate of the patients with non muscle invasive bladder cancer.finally we observed the anti-tumor effect and theinfluenceof cellular immunity on experimental animals using Fuzhengxiaozhengtang decoction. Specific research methods:1 clinical research1.1 case collectionCollecting the data of patients with non muscle invasive bladder cancer treated by TCM in the outpatient department of prof. Zhang Yaqiang between 2014-10-08 and 2016-03-31 and recorded each outpatient clinic data.1.2 survey contents1.2.1 The general data and disease information:name,gender,age,operation time,operation method,postoperative pathological results,the history of bladder instillation,recurrence information.1.2.2 TCM treatment data:Initial medication time of TCM, course, check results after the treatment of traditional Chinese medicine and the pathologyif recurrence.2 experimental study:2.1 MB49 cells Tumor-bearing Balb/c mice which is established xenograft bladder cancer model were injected with MB49 cells in right scapular region, observed the growth trend of transplanted tumor, verified the feasibility of the model;2.2 Producing the fodder mixed with Chinese herbal medicine then feeded the tumor-burdened mice, observing the amount of mice intakeing mixed feed one day, Validating the feasibility of Chinese medicine mixed fodder;2.3 The thirty BALB/c mice were inoculated with MB49 cells suspension, then, according to the weight, mice were randomly divided into control group, low dose group and high dose group with Fuzhengxiaozhengtang decoction, with 10 mice in each group including five Male and five female.The mice in control group were fed with normal food, the mice in low dose group were fed with low dose mixed fodder, and the high dose group were fed with high dose mixed fodder.Observing the changes of body weight, tumor size and weight of mixed fodder daily. After 15 days, the mice in each group were sacrificed by the broken neck, and the primary tumor was stripped under sterile condition, weighed the tumor,then calculated the tumor inhibition rate.Tumor inhibition rate= (the average tumor weight of the control groupminus the average tumor weight of experimental group)/the average tumor weight of the control group ×100%.2.4 Observing the effect of CD4+ and CD8+ in the spleen of mice after 15 days feeding with Fuzhengxiaozhengtang decoction through flow cytometry,;2.5 Measured the secretion of INF-y in splenic lymphocytes of mice with bladder cancer by elispot.Results:1 clinicl researchAt the end of follow-up, there were 5 patients recurred totally in lyear,and 2 in l-2years. After treated with TCM,one year recurrence rate was 8.2%.All of the recurred bladder cancer patients were in intermediate or high risk groups,account for 14.6%(41 cases).However,in this research, only 37 cases were observed 2 years,in this group,one case recurred in one year and the other case recurred in 2 years.Thus,the recurrence rate was 5%.6 recurred bladder cancer cases were in intermediate or high risk after surgery,in which 2 cases were in intermediate risk,4 cases in high risk. Before treated with TCM,there were 2 cases recurrence.In these patients, the shortest time of recurred cases was 2.8 months,another longest time was 13.2 months,the average recurrence time was 7.2 months.After Chinese medicine treatment, the shortest time of recurred cases was 7.9 months,the longest time was 30.9 months,the average time was 16.2 months.At the end of follow-up,4 cases recurred (More than 2 years after surgery),in which 3 cases recurred separately in 29.9 months,32.8 months and 80.1 months.These 3 cases all did transurethral resection of the bladder.in which one pathological result was from low level to high level of urothelial carcinoma,another was transitional cell carcinoma Ⅱ-level Ⅲ with no significant advanced.The left one former pathological result was transitional cell carcinoma Ⅱ-level Ⅲ,when recurred 86.3 months later, progressed to muscleinvasive bladder cancer,then received radical cystectomy and ureterocutaneostomy. One case recurred twice before Chinese medicine interval,the shortest time of recurred was 6.4 months,longest 41.9 months,average time was 17.4 months.After Chinese medicine interval, average survival time without tumor was 44 months,shortest 13 months,longest 82 months.2 Experimental research results in vivo2.1 The anti-tumor effect of of Fuzhengxiaozhengtang decoctionThe weight of high dose group was 0.81±0.17g,the weight of low dose group was 0.91±0.15g,control group was 1.04±0.30g.The maximum weight of high dose group was 1.10g,minimum was 0.47g; The maximum weight of low dose group was 1.23g,minimum was 0.72g; The maximum weight of control group was 0.75g,maximum was 1.65g.There was a significant difference (P<0.05) in tumor weight betweenhigh dose group and control group.but there was no significant differencebetweenlow dose group and control group(P>0.05),the same was found betweenhigh dose groupandlow dose group.Tumor inhibition rate:the tumor inhibitory rate of high dose group was 22.3%,low dose group was11.9%.2.2 Fuzhengxiaozhengtang decoction effect on splenic CD4+T cells,CD8+T cells in miceComparision between each group,there were no statistic significancein CD4+T cells(P>0.05). CD4+T cells in high dose group was 21.11±3.54, low dose group was 21.06±4.86, control group was 22.74±3.45.After TCM interval, CD8+T cells in high dose group was 7.14±1.46, low dose group was 5.56±0.89,control group was 4.84±0.44. Therewere significant difference (P<0.05) in CD8+T cellsbetweenhigh dose group and low dose group and between high dose group and control group,but therewas no significant difference the between low andcontrol(P>0.05).The CD4+/CD8+ rate in high dose group was 3.05±0.83,low dose group was 4.06±1.58, control group was 4.79±1.19.After TCM interval, Comparision between high dose group with control group,the rusult had statistic significance(P<0.05).There were no significant difference betweenhigh dose group and low dose group,also between low and control had no statistic significance (P>0.05)2.3the effect of Fuzhengxiaozhentang decoction on the the secretion of INF-γ in mouse splenic lymphocytesThe positive results was the spots number ratio which betweenexperimental well and negative wellgreater than two. Comparision the number of spots between each group,the rusult had no statistic significance(P>0.05),but present a sight that high dose group outnumber low dose group,and low dose group outnumber control group. Compared experimental group and negative control group spot number, the ratio between high dose group and low dose group, high dose group and control group had statistically significant(P< 0.05), but the low and the control had no statistical significance (P> 0.05)Conclusion:1. TCM could effectively preventof recurrence in postoperative carcinoma of Urinary Bladder, improve the whole effect of bladder instillation, prolongthe disease free survival of patients.2. Fuzhengxiaozhengtang decoction showed significant inhibition of tumor growth andthe effect is also becoming more and more obvious with the increase of the dose. Fuzheng Xiaozheng decoction can enhance the specific killing effect of immune cells by increasing CD8+T cells to achieve anti-tumor effect.3. Fuzheng Xiaozheng decoction can promote the secretion of mouse spleen lymphocytes INF-γ,enhance the immune killing effect. |
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