Pancreatic cancer has a high degree of malignancy, rapid development and poor prognosis.Therefore, pancreatic cancer was a difficult problem in the treatment of malignant tumors. In the present study, Clinical staging was an independent prognostic factor of OS in pancreatic cancer; surgery was an independent prognostic factor of OS in overall group, chemotherapy group and non-chemotherapy group of pancreatic cancer. Therefore, early diagnosis and surgical treatment are crucial for pancreatic cancer patients. Surgery remains the only ways of radical cure for pancreatic cancer. Because pancreatic cancer can be a difficult imaging diagnosis early in its course8, most patients are diagnosed at an advanced stage and lose the opportunity for surgery. At present, the overall resection rate of pancreatic cancer is only 10%-15%,with a median survival of 15–17 months and a 5-year survival rate of 5%-7%9–10, similar to that of 40 years ago11.
For patients with locally advanced or metastatic pancreatic cancer, chemotherapy is the main treatment, gemcitabine has been established as providing clinical benefit and a modest survival advantage over treatment with bolus 5-FU12. Therefore, gemcitabine-based chemotherapy is the basis of chemotherapy for pancreatic cancer. It is now often combined with other chemotherapeutic agents (such as cisplatin, oxaliplatin, capecitabine, 5-FU, and irinotecan) for patients with good performance status13–16. MPACT trial show that long-term survival is possible with gemcitabine plus albumin-bound paclitaxel versus gemcitabine only17. PRODIGE trial evaluating FOLFIRINOX ( a combination therapy consisting of 5-FU/leucovorin plus oxaliplatin and irinotecan ) versus gemcitabine in patients with metastatic pancreatic cancer,the results showed that patients in the group receiving FOLFIRINOX had longer OS18. Eligibility criteria for this trial, however, were stringent,the patient was required to have a good performance status, limiting real-world generalizability19. In China, the number of patients receiving FOLFIRINOX chemotherapy is relatively small. In our study, most patients adopt gemcitabine-based chemotherapy. We find that Chemotherapy can prolong the OS of patients and is an independent prognostic factor of pancreatic cancer. At present, chemotherapy is still the cornerstone of pancreatic cancer treatment.
A meta-analysis identified The majority of the data comparing chemoradiation to chemotherapy do not generally show an advantage to the addition of survival20. Radiotherapy is often used to relieve local pain symptoms. Poly (ADP-ribose) polymerase (PARP) inhibitors provide a promising avenue of targeted therapy for pancreatic cancers associated with BRCA1/2 mutations.However, there are few patients with BRCA1/2 mutation, and targeted therapy is expensive. Therefore, the number of patients who can benefit from radiotherapy and targeted therapy is still small.
Traditional Chinese medicine developed from a totally different background from Western medicine. According to the theory of TCM,the spleen is believed to be responsible for governing transformation and transportation as well as the root of after-birth and the source of Qi ( the fundamental theory of TCM holds that Qi is often translated as vital energy) and blood. In terms of function, the function of spleen in TCM is similar to that of pancreas in anatomy. Based on the symptoms and characteristics of patients and guided by the theories of TCM, we believe that the main cause of pancreatic cancer is the insufficiency of the spleen, so we designed a formula which contain a combination of different kinds of plants or minerals to improve clinical efficacy. In this compound formula, invigorating spleen herbs are the principal elements, whereas heat-clearing and detoxicating herbs as well as blood stasis removing herbs are adjuvant components to assist the effects of invigorating spleen. The major ingredients in this formula were Radix pseudostellariae 12 g, Rhizoma atractylodis macrocephalae 12 g, Green tangerine peel 5 g, Dried tangerine peel 5 g, Poria cocos 30 g, Pinellia ternata 9 g, Concha ostreae 15 g, Sargentodoxa cuneata 15 g, solanum nigrum 15 g. And the attributes of the constituents of this compound formula are as follows: Radix pseudostellariae and Rhizoma atractylodis macrocephalae are used to replenish Qi and invigorate the spleen function; Poria cocos is used for invigorating the spleen function, promoting diuresis and reducing swelling, calming the heart and calming the nerves; the action of Green tangerine peel and Dried tangerine peel is used to promote the circulation of Qi and blood; Pinellia ternata and Concha ostreae are used to resolving hard lump and to dissolve phlegm; the action of Sargentodoxa cuneata and solanum nigrum are heat-clearing and detoxifying. In our previous studies, it was found that TCHM spleen-invigorating compound adopted in this study has effects on improving the survival rate and quality of life of pancreatic cancer patients21. Furthermore, it can significantly inhibit the growth of human pancreatic cancer BxPC−3 cell line subcutaneous xenografts in nude mice.
In the present study, the TCHM spleen-invigorating compound had a positive effect on pancreatic cancer patients. Clinical staging, surgery, Chemotherapy and the TCHM treatment were independent prognostic factors for pancreatic cancer patients. The TCHM spleen-invigorating compound could prolong OS of pancreatic cancer in chemotherapy group, suggesting that the combination may be a feasible clinical treatment. The TCHM spleen-invigorating compound could also prolong OS of pancreatic cancer in non-chemotherapy group. This suggests that the simple TCHM spleen-invigorating compound has a certain curative effect, however, the number of cases in non-chemotherapy group was too small, so it is necessary to expand the sample size for further study.
Prospective clinical and randomized controlled studies are considered the best evidence. Though there is limitation associated with retrospective study in providing robust evidence, but it is closer to the actual situation of the patient's clinical treatment. In this retrospective study, patients were equally at baseline. Our results suggest that TCHM may be an effective treatment option for pancreatic cancer.