| Objective:China is a high-risk area for esophageal cancer.Although the number of anti-tumor treatment methods is increasing,surgery remains the primary choice for patients.However,in early to mid stage patients,postoperative recurrence and metastasis remain a key factor in reducing patient survival and prognosis.Traditional Chinese medicine has rich experience and advantages in promoting postoperative patient recovery,reducing adverse reactions of anti-tumor treatment,improving patient quality of life,and prolonging survival.Previous studies have shown that Qizhuyuling Decoction can significantly improve the pathogenesis of esophageal cancer patients,improve their postoperative discomfort symptoms,quality of life,and survival after surgery,but the characteristics of the beneficiaries are still unclear.Therefore,this study screened the advantageous population of Qizhuyuling Decoction in preventing postoperative recurrence and metastasis of esophageal cancer,with the aim of exploring,summarizing,and summarizing the characteristics of the beneficiaries of Qizhuyuling Decoction,in order to improve the accuracy of its clinical application and provide certain guidance for rational clinical medication.Method:The retrospective study design was used to select patients with recurrence and metastasis of esophageal cancer after surgery from the Department of Oncology,Guang’anmen Hospital,China Academy of Chinese Medical Sciences who were treated with Qizhuyuling Decoction.The median disease-free survival(mDFS)of all patients was used as the boundary to determine the dominant group and non-dominant group of Qizhuyuling Decoction for the prevention and treatment of recurrence and metastasis of esophageal cancer after surgery.Collect demography data,esophageal cancer related data,anti-tumor treatment data,clinical symptoms before taking Qizhuyuling Decoction,TCM syndrome elements,TCM syndrome related data,preoperative peripheral blood indicators and imaging data of all patients.Survival analysis was conducted using Kaplan Meier univariate analysis and multivariate Cox regression model to summarize the influencing factors of postoperative recurrence and metastasis of esophageal cancer under the intervention of Qizhuyuling Decoction.Using chi square test to analyze the differences between the dominant group and the non dominant group,and summarize the core pathogenesis of postoperative recurrence and metastasis of esophageal cancer,as well as the population characteristics of the dominant group in the prevention of postoperative recurrence and metastasis of esophageal cancer with Qizhuyuling Decoction.Results:(1)This study retrospectively included 77 postoperative patients with esophageal cancer who experienced recurrence and metastasis after treatment with Qizhuyuling Decoction.①General information:67 male patients and 10 female patients,with a gender ratio of 6.7:1;The age distribution is between 43 and 83 years old,with an average age of 61.21 ± 8.18 years;59 patients had a history of smoking,57 had a history of drinking,4 had a history of allergies,38 had a history of unhealthy eating habits,and 30 had a family history of tumors,accounting for 76.62%,74.03%,5.19%,49.35%,and 38.96%respectively;A total of 60 patients with preoperative BMI values were collected,including 7 patients with preoperative low body weight,33 patients with normal body weight,and 20 patients with overweight;The preoperative KPS scores of 77 patients ranged from 80 to 100 points,with 25,44,and 8 patients each scoring 80,90,and 100 points.②Esophageal cancer data:Among 77 patients,71 were squamous cell carcinoma,3 were adenocarcinoma,and 3 were other types(one was intramucosal carcinoma,one was sarcomatoid carcinoma,and one was adenosquamous carcinoma);The lesions were mainly located in the lower thoracic segment,middle lower segment,and middle segment,with 27 cases,21 cases,and 15 cases respectively;The pathological grading is mainly medium differentiation and low differentiation,with 35 cases and 22 cases respectively;The TNM staging includes stages ⅠA-ⅢC,with stages ⅢB,ⅡB,and ⅢA being the main stages,with 23 cases,19 cases,and 14 cases each;There were 14,18,37,and 8 patients in T1,T2,T3,and T4 stages,respectively;The majority of patients had tumors infiltrating into the outer membrane layer,with 37 cases accounting for 48.05%;There were 4 patients with neurological invasion,10 patients with vascular invasion,and no incisional margin invasion in all patients;18 patients had precancerous lesions,5 patients had precancerous diseases,and 1 patient had comorbidities;55 patients were found to have lymph node metastasis during surgery,and 69 patients underwent lymph node dissection surgery;14 patients received radiation therapy before taking Qizhuyuling Decoction,47 patients received chemotherapy,and all patients did not receive any other traditional Chinese medicine treatment.③ Tr-aditional Chinese medicine data before taking Qizhuyuling Decoction:Cluster analysis found that the most common symptoms after surgery were foreign body sensation,bloating in the stomach,stomach pain,chest tightness,fear of cold limbs,clear and long urine,followed by swallowing and choking,acid reflux,heartburn,and dry mouth,bitter mouth,and insomnia;According to the frequency,the TCM syndrome elements are phlegm dampness syndrome(43/77),qi stagnation syndrome(43/77),qi deficiency syndrome(25/77),yang deficiency syndrome(17/77),blood stasis syndrome(15/77),yin deficiency syndrome(14/77),and heat toxin syndrome(1/77);The main syndrome type of traditional Chinese medicine is phlegm qi obstruction,with 43 cases(55.85%),followed by 17 cases(22.08%)of qi deficiency yang micro syndrome,12 cases(15.58%)of jin deficiency heat accumulation syndrome,and 5 cases(6.49%)of blood stasis internal accumulation syndrome.The core pathogenesis of postoperative esophageal cancer patients is phlegm qi obstruction.④Peripheral blood data:A total of 68 patients were collected with preoperative ALB,PNI,LMR,and NLR values.According to the range and critical values of each indicator,there were 44 patients with high ALB,18 patients with moderate ALB,and 6 patients with low ALB,respectively.There were 23 patients in the high PNI group(33.82%),45 patients in the low PNI group(66.18%),66 patients in the high LMR group(97.06%),2 patients in the low LMR group(2.94%),17 patients in the high NLR group,and 51 patients in the low NLR group(75%);55 patients collected preoperative PLR and dNLR values.According to the critical values,46 patients in the high PLR group(83.64%),9 patients in the low PLR group(16.36%),18 patients in the high dNLR group(32.73%),and 37 patients in the low dNLR group(67.27%)were identified;Pre operative LIPI scores were performed on 50 patients,with 40 showing good results,6 showing moderate levels,and 4 showing poor LIPI scores.Survival analysis:① The DFS range is from 5 to 102.83 months,with a median DFS of 21.20 months and an average DFS of 27.65±21.95 months.After conducting Kaplan Meier univariate survival analysis on the above data,it was found that age,TNM stage,T stage,phlegm dampness syndrome,qi stagnation syndrome,dry stool,NLR,and PLR had statistical differences in the impact of DFS.Further COX multivariate analysis found that TNM stage,T2 stage,accompanied by dry stool symptoms,and NLR value may be independent influencing factors for DFS,among which dry stool symptoms and high preoperative NLR may be risk factors and T2 phase may be a beneficial factor after surgery,and the risk of recurrence and metastasis in patients is significantly reduced.② Pathological grade,family history of tumor,smoking history,history of bad habits,preoperative dNLR,LIPI score,BMI,ALB value and other factors P>0.05 are not statistically significant,but according to the Kaplan Meier survival curve trend,patients with no smoking,no drinking history,no family history of tumor,no bad eating habits,no lymph node metastasis,high differentiation,medium to high differentiation,preoperative low dNLR,low PLR have a better survival trend,LIPI score,The preoperative ALB level are positively correlated with patient survival,and the survival trend of preoperative weight loss and overweight patients is worse than that of normal weight patients.In patients with upper,middle,lower,upper,and lower thoracic segments,the survival trend of patients with lesions located in the middle and lower thoracic segments is relatively poor.Among patients who received adjuvant therapy before taking Qizhuyuling Decoction,the prognosis of patients who received neoadjuvant and postoperative chemotherapy was better than those who only received neoadjuvant or postoperative chemotherapy.The survival of preoperative radiotherapy patients was better than that of postoperative radiotherapy patients.(2)Stratified analysis:Age≥60 years old,T2 stage,ⅢB stage,tumor infiltration into the muscle layer,Preoperative low PLR,traditional Chinese medicine syndrome elements of phlegm dampness syndrome,qi stagnation syndrome,traditional Chinese medicine syndrome types of phlegm qi obstruction syndrome,hiccup belching,and preoperative PLR showed statistical differences between the dominant and non dominant groups,P<0.05.Conclusion:(1)This study shows that the core pathogenesis of postoperative patients with esophageal cancer is mainly the obstruction of phlegm and qi,and the Qizhuyuling Decoction,which mainly regulates qi to dissipate phlegm and detoxify and disperse nodules,can prolong the postoperative DFS of patients;(2)This study shows that under the intervention of Qizhuyuling Decoction,age,TNM staging,T staging,phlegm dampness syndrome,qi stagnation syndrome,accompanied by dry stool symptoms,NLR,PLR values may be influencing factors for postoperative recurrence and metastasis of esophageal cancer;TNM staging,T2 stage,dry stool symptoms,and NLR value may be independent influencing factors,among which accompanying dry stool symptoms and high preoperative NLR value may be risk factors for postoperative recurrence and metastasis of esophageal cancer under the intervention of Qizhuyuling Decoction,and T2 phase may be a beneficial factor after surgery,and the risk of recurrence and metastasis in patients is significantly reduced;(3)This study found that the advantageous population of Qizhuyuling Decoction in preventing and treating postoperative recurrence and metastasis of esophageal cancer may be those aged ≥60 years old,with T staging of T2 stage,TNM staging earlier than ⅢB stage,tumor infiltration into the muscle layer,Preoperative PLR,traditional Chinese medicine syndrome elements of phlegm dampness syndrome,qi stagnation syndrome,phlegm qi obstruction syndrome,and accompanied by hiccup and belching symptoms. |
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