Analysis of Clinical Syndromes in 47 Patients with Pancreatic Cancer at Late Stage Academic research paper on "Health sciences"

Clinical Observations

Analysis of Clinical Syndromes in 47 Patients with Pancreatic Cancer at Late Stage

LIANG Fang SUN Jue LI Qi LI Chao-heng and FAN Zhong-ze

Objective: To analyze the law governing the distribution of traditional Chinese medicine (TCM) syndromes of pancreatic cancer.

Methods: The authors used retrospective study to statistically analyze TCM syndromes of patients, separated complex syndromes and calculated the frequency of appearance of single syndromes.

Results: The patients mainly suffered from 4 syndromes: blood stasis syndrome, qi stagnation syndrome, qi (yang) deficiency syndrome, and phlegm dampness syndrome. The distribution of syndromes is rarely related to sex, age and morbid site of patients.

Conclusion: Owing to complicated distribution of its syndromes, pancreatic cancer should be diagnosed and treated according to its characteristics of deficiency in origin and excess in superficiality.

Keywords: pancreatic cancer; distribution of its syndromes

Pancreatic cancer is a malignant tumor with the poorest prognosis and its incidence rising year by year.1 Because it is very difficult to discover pancreatic cancer and there is no simple and specific diagnostic method, most patients are diagnosed as suffering from late pancreatic cancer with low excision rate and insensitivity to chemotherapy. Although traditional Chinese medicine (TCM) therapy is widely used to treat late pancreatic cancer, there is no unified standard for differentiating its syndromes at present. Therefore, it is necessary to analyze and sum up the characteristics of its TCM syndromes in order to direct their clinical use.

METHODS

Among the inpatients with late pancreatic cancer in the TCM Tumor Department of Putuo Hospital Affiliated to Shanghai TCM University from 1996 to 2006 were 21 males and 26 females (0.8:1) aged 41-94, 71 on average, 28 cases of tumor at the head of pancreas, 10 cases of tumor at the tail of pancreas, and 9 cases of tumor at the body of pancreas. All the patients were treated with Chinese herbal drugs or Chinese patent drugs. Among them were 12 cases simultaneously treated with chemotherapy and 15 cases simultaneously treated with intervention therapy. 25 cases were treated with Chinese herbal drug alone while the other 22 cases were treated with more than one therapy. Their average survival period was 8.5 months.

Retrospective study was used to summarize the clinical symptoms of the 47 pancreatic cancer patients, analyze TCM syndrome types, separate complex syndromes into single ones (For example, the syndrome of qi stagnation and blood stasis is separated into qi stagnation syndrome and blood stasis syndrome), and analyze the frequency of appearance of single syndromes with % test as statistical method.

RESULTS

Distribution of Common Symptoms

Symptoms from first onset were in the following order: abdominal pain in 42 cases, emaciation in 13 cases, jaundice in 6 cases and vomiting in 6 cases. The frequencies of appearance of symptoms were in the following order: abdominal pain in 42 cases, poor appetite in 25 cases, lassitude in 19 cases, abdominal distension in 17 cases, jaundice in 11 cases, vomiting in 9 cases, constipation in 4 cases, diarrhea in 3 cases, fever in 2 cases, black stool in 1 case, and aversion to cold and cold limbs in 1 case. Analysis of fur and pulse showed red tongue in 21 cases, reddish or purplish tongue in 15 cases, thready uneven or taut thready pulse in 40 cases and taut slippery pulse in 7 cases, as shown in Table 1.

Distribution of TCM Syndromes

TCM syndromes, mainly complex syndromes, were in the order of their frequencies of appearance: syndrome of qi stagnation and blood stasis (23), syndrome of spleen deficiency and qi stagnation (6), syndrome of deficiency of both qi and yin (4), syndrome of vital qi deficiency and blood stasis (4), syndrome of damp-heat retention (3), syndrome of qi stagnation and dampness obstruction (2), syndrome of spleen deficiency and dampness obstruction (2), syndrome of yin deficiency (2), and syndrome of obstruction of both phlegm and blood stasis (1), as shown in Table 2.

TCM Tumor Department, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200062, China Correspondence to: Dr. FAN Zhong-ze, Tel.: 86-21-625727233404, E-mail: fanzhongze@citiz.net

This study was financially supported by TCM Science and Research Foundation of Shanghai Health Bureau (No. 2005L026A).

Table 1. Distribution and frequency of clinical symptoms

Clinical symptoms_Frequency

Abdominal pain 42

Poor appetite 25

Lassitude 19

Abdominal distension 17

Jaundice 11

Vomiting 6

Diarrhea, fever, black stool, vexation, insomnia, aversion to cold, 12 cold limbs

Red tongue 21

Reddish or purplish tongue 15

Thready uneven or taut thready pulse 40

Taut slippery pulse 7

Table 2. Distribution and frequency of TCM syndromes

TCM syndromes Frequency Proportion (%)

Syndrome of qi stagnation and blood 23 48.94*

stasis

Syndrome of spleen deficiency and qi 6 12.77*

stagnation

Syndrome of deficiency of both qi and yin 4 8.51

Syndrome of vital qi deficiency and blood 4 8.51

stasis

Syndrome of retention of damp-heat 3 6.38

Syndrome of qi stagnation and dampness 2 4.26

obstruction

Syndrome of spleen deficiency and 2 4.26

dampness obstruction

Syndrome of yin deficiency 2 4.26

Syndrome of obstruction of both phlegm 1 2.11

and blood stasis

Note: *P<0.05 as compared with the lowest frequency in test.

Distribution of TCM Single Syndromes

TCM complex syndromes of the 47 patients with pancreatic cancer were separated into single ones and frequencies of their appearance were calculated as follows: blood stasis syndrome (24.76%), qi stagnation syndrome (23.81%), qi (yang) deficiency syndrome (20.00%), phlegm dampness syndrome (15.24%), yin (blood) deficiency syndrome (9.52%) and noxious heat syndrome (6.67%) with the first 4 syndromes mostly seen. Deficiency syndromes were mainly manifested in qi (yang) deficiency, but yin (blood) deficiency syndrome was not so common. Excess syndromes mainly focused on blood stasis syndrome, qi stagnation

syndrome and dampness obstruction syndrome, while noxious heat syndrome was less seen. Excess syndromes accounted for about 70.48% of all the syndrome types and deficiency syndromes for about 29.52%, as shown in Table 3.

Analysis the Distribution of TCM Syndromes in Relation to Sex, Age and Morbid Site of Patients

The authors selected 4 syndromes with higher frequencies of their appearance and observed their distribution in relation to sex, age and morbid site. The result showed that sex, age and morbid site had no influence on the distribution of syndromes of pancreatic cancer, as shown in Table 4.

Table 3. Distribution and frequency of TCM single syndromes

TCM syndromes Frequency Proportion (%)

Blood stasis syndrome 26 24.76*

Qi stagnation syndrome 25 23.81*

Qi (yang) deficiency syndrome 21 20.00*

Dampness obstruction syndrome 16 15.24*

Yin (blood) deficiency syndrome 10 9.52

Noxious heat syndrome 7 6.67

Note: *P<0.05 as compared with the lowest frequency in test.

Table 4. Relations of syndrome distribution to sex, age and morbid site (Cases)

Syndrome Cases Sex Age Site

Male Female <60 (11) >60 (36) Pancreatic head and body Pancreatic tail and body

Blood stasis syndrome 26 14 12 7 19 16 10

Qi stagnation syndrome 25 10 15 5 20 11 14

Qi (yang) deficiency syndrome 21 11 10 7 14 11 10

Dampness obstruction syndrome 16 7 9 5 11 9 7

Note: P>0.05 in %2 test.

DISCUSSION

According to its syndrome manifestations, pancreatic cancer can be put in TCM category of "abdominal pain", "abdominal mass" and "jaundice". Vital qi deficiency as its basic pathogenesis in addition to irregular diet, invasion by six climatic factors and internal injury by seven emotional factors causes obstructed qi of the liver and gallbladder and dysfunction of the spleen and stomach. The combined effect of stagnation of liver qi unable to govern the normal flow of qi and deficiency of spleen qi unable to transport and transform nutrients causes qi stagnation, dampness obstruction, phlegm retention, blood stasis and other pathological changes.

There are diversified manifestations of clinical symptoms of pancreatic cancer and its complex syndrome characteristics. However, there has been no report on research into syndromes of pancreatic cancer so far. Physicians diagnose and treat the disease mainly according to their experiences. For example, syndromes of pancreatic cancer are divided into the type of exuberant noxious damp-heat and the type of spleen deficiency and blood stasis by Liu,2 the type of exuberant noxious damp-heat and the type of qi stagnation and blood stasis by Xiao,3 the type of qi stagnation and blood stasis, the type of damp-heat in the liver and spleen and the type of deficiency of both qi and blood by Wang,4 and the type of attack by pathogenic toxin, the type of qi stagnation and blood stasis, the type of spleen deficiency and dampness obstruction and the type of yin deficiency and internal heat by Lu.5 Our retrospective clinical data show that diversified names of pancreatic cancer syndromes and great disparity of its syndrome differentiation and its diagnosis and treatment can not reflect characteristics of its syndromes and main features of its pathogenesis. In order to highlight characteristics of its syndromes, we have separated complex syndromes and calculated the frequencies of appearance of single syndromes. The results show that blood stasis syndrome,

qi stagnation syndrome, qi (yin) deficiency syndrome and dampness obstruction syndrome are the foremost syndromes of pancreatic cancer, that blood stasis and phlegm dampness are its main pathological products, and that pancreatic cancer is mainly manifested in excess syndrome but "deficiency in origin", mainly qi (yin) deficiency, can not be neglected. Analysis shows that the distribution of pancreatic cancer syndromes is rarely related to sex, age and morbid site of patients. This conclusion remains to be further confirmed with larger samples.

To sum up, pancreatic cancer is a syndrome of deficiency in origin and excess in superficiality. Its single syndromes rarely seen in clinical practice only appear at different stages of its development. Attention should be paid to whole concept in its treatment. Only by always protecting vital qi of patients and considering qi stagnation and blood stasis, can good curative effect be achieved.

REFERENCES

1. Yuan S. Pancreatic Cancer. Shanghai: Shanghai Sci-tech Press; 2001: 1.

2. Liu HX, Liu XZ. Observations on Curative Effect of TCM on Pancreatic Cancer. Chin J Clin Oncol and Rehabil 1996; 3: 77-78.

3. Xiao JX, Gao GJ. Report on Treatment of 32 Pancreatic Cancer Patients with Combination of TCM with Western Medicine. Suzhou University J Med Sci 2002; 22: 233-234.

4. Wang T. Preliminary Discussion of TCM Treatment of Pancreatic Cancer. Guangming J Tradit Chin Med 2003; 18: 21-22.

5. Lu JX, Yang BK. Treatment of 30 Patients with Pancreatic Cancer at Moderate or Late Stage. Zhejiang J Tradit Chin Med 2000; 4: 150-151.

(Received April 10, 2011)