Retrospective Study Of TACE Combined With TCM Syndrome Differentiation In The Treatment Of Hepatitis B-related Intermediate And Advanced Primary Liver Cancer In Southern Sichuan

Objective:To study the clinical characteristics,TCM syndrome types,long-term efficacy and factors affecting the prognosis of patients with HBV-related primary hepatocellular carcinoma(HBV-PLC)undergoing TACE combined with TCM syndrome differentiation treatment in southern Sichuan,providing the basis in the combining treatment for HBV-PLC.Methods:Using retrospective research method,the primary liver cancer related to middle and advanced stage with HBV infection between January 1,2013 and December 31,2017 in the Department of Hepatobiliary Diseases of the Traditional Chinese Medicine Hospital of Southwest Medical University was treated with TACE for the first time.Department of Hepatobiliary Diseases,Department of Hepatobiliary Diseases,Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University,conducted a dialectical treatment of hospitalized patients who had taken Chinese medicine prescriptions for more than 3 months.COX risk proportion regression model was established to analyze its risk factors.Data analysis and plotting were performed using SPSS25.0 and Graphpad Prism 8.0.The follow-up of survival time is December31,2018.Results:1.Clinical features:1.1 Gender:A total of 77 cases were included in this study,including 68 males and 9 females,with a male to female ratio of 7.56:1(p<0.05).1.2 Age:The minimum age is 38 years old,the maximum age is 80 years old,and the median age is(57.79±10.97)years old.Among them,5 cases were under 40 years old,accounting for 6.49%;17 cases were 41-50 years old,accounting for 22.08%;25 cases were 51-60 years old,accounting for 32.47%;21 cases were 61-70 years old,accounting for 27.27%;71~80 years old were 9cases for 11.69%,with the highest incidence rate from 51 to 60 years(p<0.05).1.3 HBV infection and cirrhosis:15 cases were HBeAg positive,accounting for19.48%,62 cases were HBeAg negative,accounting for 80.52%.There were 26cases with HBV DNA>10~5 copies/ml,accounting for 33.77%.56 cases with cirrhosis,accounting for 72.73%;21 cases without cirrhosis,accounting for27.27%.(all p<0.05).1.4 Tumor situation and alpha-fetoprotein:9 cases were located in the left lobe,accounting for 11.69%;45 cases were located in the right lobe of liver,accounting for 58.44%;23 cases were intrahepatic multiple,accounting for29.87%.The pathological type was 32 cases of massive type,accounting for41.56%;44 cases of nodular type,accounting for 57.14%;1 case of diffuse type,accounting for 1.30%.There were 46 cases with more than 3 tumors,accounting for 59.74%;31 cases with less than 3 tumors,accounting for40.26%.68 patients with a single tumor diameter greater than 5cm,accounting for 88.13%;9 patients less than 5cm,accounting for 11.69%;28 patients with portal vein tumor thrombus,accounting for 36.36%;49 patients without portal vein tumor thrombus,accounting for 63.64%(all p<0.05).64 cases of AFP test positive,accounting for 83.12%;13 cases of AFP negative,accounting for16.88%(p<0.05);38 cases of AFP greater than 400ng/ml,accounting for49.35%;39 cases of AFP less than 400ng/ml,Accounting for 50.64%(p>0.05).1.5 Liver function:Child-Pugh grade 48 cases of grade A,accounting for62.34%,29 cases of grade B,accounting for 37.66%.Serum alanine aminotransferase ALT(66.61±19.18)U/L,serum aspartate aminotransferase AST(65.64±16.61)U/L,serum albumin ALB(34.40±5.29)g/L,total blood Bilirubin TBil(29.67±12.15)umol/L,prothrombin time PT(13.90±1.61)s.2.TCM syndrome type:41 cases of liver stagnation and spleen deficiency syndrome,accounting for 53.25%;77 cases of qi deficiency and blood stasis syndrome,accounting for 33.77%;5 cases of liver and kidney yin deficiency syndrome,accounting for 6.49%;There were 5 cases of kidney-yang deficiency syndrome,accounting for 6.49%;about 1/4 of patients had damp heat on the basis of the above syndrome(19/77).3.Survival:The overall median survival of the cases is 13 months(95%CI:7.343-18.657);the cumulative survival rates at1 year,2 years,3 years,and 5 years are 53.25%(41/77)and 31.17,respectively.%(24/77),10.40%(8/77),1.30%(1/77).The median survival time of liver depression and spleen deficiency syndrome is 13 months(95%CI:6.727~19.273);the cumulative survival rates at 1 year,2 years,3 years,and 5years are 58.54%(24/41)and 39.02%(16/16),respectively.41),19.51%(8/41),2.43%(1/41).The median survival time of Qi deficiency and blood stasis syndrome was 13 months(95%CI:1.224~24.776);the cumulative survival rates at 1 year,2 years,3 years,and 5 years were 50.00%(13/26)and 26.92%(7/26),0%(0/26),0%(0/26).The median survival time of liver and kidney yin deficiency syndrome is November(95%CI:8.853~13.147);the cumulative survival rates at 1 year,2 years,3 years,and 5 years are 20.00%(1/5),0%(0/5),0%(0/5),0%(0/5).The median survival time of spleen and kidney yang deficiency syndrome is 15 months(95%CI:0.000~36.471);the cumulative survival rates of 1 year,2 years,3 years and 5 years are 60.00%(3/5)and20.00%(1/5),0%(0/5),0%(0/5).There were 24 cases of HBV-PLC with a survival period of more than 24 months,including 16 cases of liver depression and spleen deficiency syndrome,7 cases of qi deficiency and blood stasis syndrome,and 1 case of spleen and kidney yang deficiency syndrome.4.Risk factors:males,portal vein tumor thrombus,tumors are multiple in the liver,HBeAg positive,HBV DNA>10~5copies/ml,elevated serum total bilirubin is a risk that affects the survival of primary and advanced liver cancer factor.Conclusion:1.The incidence of HBV-PLC in the middle and late stages of southern Sichuan is mostly male,with the highest incidence at the age of 50 to 60 years.Most patients develop on the basis of cirrhosis,and the lesions are mostly located in the right lobe of the liver.The pathological types are mostly nodular.The number of tumors is more than 3.The diameter of a single tumor is more than 5cm.Some patients have portal vein tumor thrombus and alpha-fetoprotein positive.2.HBV-PLC in the middle and late stages of southern Sichuan can be divided into four syndrome types:liver stagnation and spleen deficiency,qi deficiency and blood stasis,liver and kidney yin deficiency,and spleen and kidney yang deficiency.Liver depression and spleen deficiency syndrome are the most common,about 1/4 of patients with damp heat in the above basic syndrome.3.In terms of survival period,the median survival period of this study is 13months,which is a certain advantage over the median survival period reported in the literature by simple TACE treatment and previous TCM treatment combined with TACE treatment.And the middle-advanced HBV-PLC with a survival period of more than 24 months is mostly due to liver stagnation and spleen deficiency syndrome.TACE combined with the treatment of middle-advanced HBV-PLC from the liver and spleen may benefit from improving its survival.4.Men,tumors are multiple,portal vein tumor thrombus,HBeAg positive,HBV DNA>10~5copies/ml,and elevated serum total bilirubin are risk factors that affect survival,suggesting poor prognosis.