Professor Zhang Peitong's Curative Effect Observation And Medication Rule Analysis On Patients With Pancreatic Cancer After Surgery

Objective:To observe the clinical efficacy and prognosis related factors of patients with pancreatic cancer after radical operation combined with Integrated Chinese and Western Medicine treatment,and to explore the rule of application and summarize the clinical experience in the treatment of pancreatic cancer by professor Zhang-Peitong.Method:This study was an uncontrolled case-observation study using a one-arm bidirectional(retrospective and prospective)cohort observation.During the period from January 1,2013 to January 1,2019,a total of 62 patients with pancreatic cancer after radical surgery were treated at the Oncology Clinic of Guang'anmen Hospital of China Academy of Chinese Medical Sciences.The basic conditions of the patients and tumor were collected and related influences on the prognosis were analyzed.Follow-up was conducted to collect the data of patients' disease-free survival,overall survival,annual survival rate and quality of life to assess the clinical efficacy.(2)Based on the "Beijing Famous Chinese Medicine Experience Data Warehouse and Analysis and Mining Platform" of Guang'anmen Hospital of China Academy of Chinese Medical Sciences,we used Liquorice,Crystal Report and other analytical query tools for data query and mining to analysis the rule of treatment of pancreatic cancer after radical surgery and postoperative adjuvant chemotherapy by Professor Zhang Peitong and compare the differences between prescriptions for different XU(deficiency)syndrome and SHI(excess)syndrome and survival prognosis patients.Results:As of the last follow-up,the median disease-free survival(mDFS)of the 52 radical postoperative pancreatic cancer patients was 17.0 months,and the median overall survival(mOS)was 46.0 months.The 1-year,2-year,3-year and 5-year survival rates were 86%,76%,50%,and 44%,respectively.Univariate analysis showed that the first diagnosis,the first diagnosis of syndrome differentiation,vascular or neural invasion,chemotherapy,radiotherapy,and Chinese medicine treatment were significantly associated with disease-free survival(P<0.05);vascular or neural invasion and treatment of traditional Chinese medicine were significantly associated with overall survival(P<0.05).However,there was no significant difference between 16 research variables including gender,age,KPS score,body mass index,smoking history,drinking history,family history,first visit interval,tumor location,degree of differentiation,pathological type,tumor margin,lymph node metastasis,pathological staging,surgical procedure,multi-course chemotherapy,target treatment and disease-free survival and overall(P>0.05).COX regression analysis showed that the first diagnosis without progression(relative risk,RR=0.29,95%CI 0.10-0.81)was a positive factor for disease-free survival.Treatment time of traditional Chinese medicine was a protective factor for overall survival,but there was no statistically significant(B=-0.34,P=0.64).Comparative analysis between groups showed that comparing with Chinese medicine treatment for more than 25 months,RR were 186.42(95%CI 11.11-3129.29),86.62(95%CI 5.73-1309.67)and 6.44(95%CI 1.10-37.79)in treatment of less than 6 months,7 to 12 months and 13 to 24 months,respectively.Data mining analysis showed that as of the last follow-up on March 5,2019,62 patients who underwent radical resection of pancreatic cancer,and 863 prescriptions were included in the data mining study.In the recovery period after radical resection of pancreatic cancer,replenish Qi and nourish blood,benefit spleen and harmonious stomach are used as principles when prescriping.The prescriptions are Bazhen Decoction and Shiquan Dabu Decoction.These basic methods will be modified according to the patient's symptoms.The treatment during postoperative chemotherapy is to nourish liver and kidney,reversing vomiting and activating blood stasis.The basic prescription is similar to the postoperative recovery period.The syndrome differentiation of tumor patients is mostly mixed XU(deficiency syndrome)and SHI(excess syndrome).If the excess syndrome is the main one,the treatment should mainly remove the evil spirits,and the auxiliary subsidy is righteous;If the deficiency syndrome is the main one,the treatment should mainly supplement the deficiency and assist the evil spirits.Most of the excess syndromes are dampness,blood stasis and Qi stagnation The deficiency syndromes mostly include spleen and stomach Qi(yang)deficiency and Qi and blood deficiency.Excess syndrome commonly used Xuefu Zhuyu Decoction to sputum blood and Liujun Ermu Decoction to remove phlegm and dampness;Deficiency syndrome commonly used Danggui Buxue Decoction,Bazhen Decoction and Shiquan Dabu Decoction to supplement Qi and nourish blood;Sijunzi Decoction and Liujun Ermu Decoction to benefit spleen and harmonious stomach.Patients with long-term disease-free survival have longer medication time.When the disease is stable in the later stage,Cremastra appendiculatad.and Hedyotis diffusa Willd.etc.are often used for heat-clearing and detoxification;Bulbus Fritillariae Thunbergii.and Anemarrhena asphodeloides.etc.are often used for removing dampness and softens nodules.Sparganium stoloni erum.and Curcuma zedoaria.etc.are often used for promoting blood circulation to strengthen anti-cancer effect For patients with shorter survival time,due to the unstable condition,the combination of traditional Chinese and Western medicine is often used.Therefore,Angelica sinensis.and Ligusticum chuanxiong hort.etc.are used to promote blood circulation and relieve pain;Astragalusmembranaceus,Codonopsis pilosula and Atractylodes macrocephala Koidz are used to invigorate the spleen and Qi.Conclusion:In this study,traditional Chinese medicine combined with adjuvant therapy before radical surgery can prolong the disease-free survival of pancreatic cancer patients and long-term application of combined traditional Chinese and Western medicine may extend their overall survival.Professor Zhang Peitong pays much attention to the treatment of pancreatic cancer in different stages,under the principle of strengthening the righteousness and eliminating evil,and with the dialectical premise of identifying the XU(deficiency syndrome)and SHI(excess syndrome).The main deficiency syndrome is often treated with Shiquan Dabu Decoction to harmonize Qi and blood,Liujunzi Decoction to invigorate spleen and stomach.As for the main excess syndrome is often treated with Xuefu Zhuyu Decoction to promote blood circulation,and Ermu Liujun Decoction to dissipate phlegm and remove dampness.