Survival Benefit of Traditional Chinese Herbal Medicine (A Herbal Formula for Invigorating Spleen) in Gastric Cancer Patients with Peritoneal Metastasis Lu Zhao,1,2 Ai-Guang Zhao,1 Gang Zhao,3 Yan Xu,1 Xiao-Hong Zhu,1 Ni-Da Cao,1 Jian Zheng,1 Jin-Kun Yang,1 and Jian-Hua Xu2
1Department of Oncology, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China 2Department of Oncology, Putuo District Central Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200062, China 3Department of Surgery, Renji Hospital Affiliated to Shanghai Jiao Tong University, Shanghai 200127, China Abstract Objective. We evaluated the efficiency of traditional Chinese herbal medicine (a compound herbal formula for invigorating spleen) as a complementary and alternative therapy for gastric cancer patients with peritoneal metastasis. Methods. Between 2001 and 2012, 93 gastric cancer patients with peritoneal metastasis were enrolled in this study. The effect of traditional Chinese herbal medicine on their long-term outcome was investigated. Kaplan-Meier method was used to assess the difference in survival time, and Cox proportional hazards regression analysis was performed to identify independent prognostic factors. Result. First-line palliative chemotherapy plus traditional Chinese herbal medicine was performed in 47 patients and the other 46 patients received chemotherapy alone. The overall survival was different between patients with and without traditional Chinese herbal medicine (12.0 versus 10.5 months; P=0.046 ). According to the Cox proportional hazard model, first-line chemotherapy cycle (hazards ratio [HR] = 0.527; 95% CI = 0.323~0.860) and TCHM (hazards ratio [HR] = 0.644; 95% CI = 0.481~0.992) were selected as independent prognostic factors for survival. Conclusion. The results suggest that traditional Chinese herbal medicine could improve the prognosis of the gastric cancer patients with peritoneal metastasis. Source : Evidence Based Complementary and Alternative Medicine Link to Full Article Prognostic effects of 25-hydroxyvitamin D levels in gastric cancer
Abstract Background Results from large epidemiologic studies on the association between vitamin D and gastric cancer are controversial. Vitamin D significantly promotes apoptosis in the undifferentiated gastric cancer cell, but the prognostic effects of its levels are unknown.
Methods 197 gastric carcinoma patients who received treatment in the cancer centre of Sun Yat-sen University from January 2002 to January 2006 were involved in the study. The stored blood drawn before any treatment was assayed for 25-hydroxyvitamin D levels. The clinicopathologic data were collected to examine the prognostic effects of vitamin D.
Results The mean vitamin D levels of the 197 gastric patients was 49.85 ± 23.68nmol/L, among whom 114(57.9%) were deficient in Vitamin D(<50nmol/L), 67(34%) were insufficient (50-75nmol/L) and 16(8.1%) were sufficient (>75nmol/L). Clinical stage (P = 0.004) and lymph node metastasis classification (P = 0.009) were inversely associated with vitamin D levels.
The patients with high vitamin D levels group (≥50nmol/L) had a higher overall survival compared with the low vitamin D levels group (<50nmol/L)(P = 0.018). Multivariate analysis indicated that vitamin D levels were an independent prognostic factor of gastric cancer (P = 0.019).
Conclusions Vitamin D deficiency may be associated with poor prognosis in gastric cancer.
Source : Journal of Translational Medicine 2012, 10:16 doi:10.1186/1479-5876-10-16 Link to Full Article
Antiproliferative activity of different extracts from Daphne altaica Pall. on selected cancer cells Murat Kizaibek1,3, Marzia Daniar2, Lin Li2 and Halmurat Upur3*
1Traditional Kazakh Medicine Research Institute of Ili Kazakh Autonomous Prefecture, 835000 Yining, Xinjiang, P. R. China. 2Department of Biochemistry and Molecular Biology, College of Basic Medicine, Xinjiang Medical University, 830011 Urumqi, Xinjiang, P. R. China. 3Faculty of Traditional Uighur Medicine, Xinjiang Medical University, 830011 Urumqi, Xinjiang, P. R. China.
Abstract Daphne altaica Pall. (Thymelaeaceae) is a medicinal plant that has long been used to treat cancer and respiratory ailments in Traditional Kazakh Medicine. In order to systematically evaluate its potential anticancer activity, six extracts of different polarity, namely: aqueous, n-butanol, ethyl acetate, chloroform, petroleum ether and ethanol extracts were obtained from this plant and they were tested for their antiproliferative effects on four human cancer cell lines: esophageal squamous cell carcinoma, gastric carcinoma, hepatoma and cervical carcinoma cells. Results from the proliferation assay showed that all extracts, except for aqueous extract, exhibited a dose-dependent growth inhibitory effect on all cancer cell lines. Of these extracts, two fractions obtained from partitioning of ethanol extract, namely: chloroform extract and ethyl acetate extract, could be considered a potential source of anticancer compounds. Further studies are necessary for identification and chemical characterization of the active principles.
Conclusion The results of this study represent the first evidence that barks of D. altaica possess effective antiproliferative activities on human cancer cells. Future phytochemical investigations on this medicinal plant should be encouraged.
Source : Journal of Medicinal Plants Research Vol. 5(15), pp. 3448-3452, 4 August, 2011 Link to Full Article
Chemoprevention of Gastric Dysplasia: Randomized Trial of Antioxidant Supplements and Anti-Helicobacter pylori Therapy Pelayo Correa, Elizabeth T. H. Fontham, Juan C. Bravo, Luis E. Bravo, Bernardo Ruiz, Guillermo Zarama, J. Luis Realpe, Gray T. Malcom, Daner Li, William D. Johnson, Robertino Mera
Background: Previous research has identified a high risk of gastric carcinoma as well as a high prevalence of cancer precursor lesions in rural populations living in the province of Nariño, Colombia, in the Andes Mountains. Methods: A randomized, controlled chemoprevention trial was conducted in subjects with confirmed histologic diagnoses of multifocal nonmetaplastic atrophy and/or intestinal metaplasia, two precancerous lesions. Individuals were assigned to receive anti-Helicobacter pylori triple therapy and/or dietary supplementation with ascorbic acid, β-carotene, or their corresponding placebos. Gastric biopsy specimens taken at baseline were compared with those taken at 72 months. Relative risks of progression, no change, and regression from multifocal nonmetaplastic atrophy and intestinal metaplasia were analyzed with multivariate polytomous logistic regression models to estimate treatment effects. All statistical tests were two-sided.
Results: All three basic interventions resulted in statistically significant increases in the rates of regression: Relative risks were 4.8 (95% confidence interval [CI] = 1.6–14.2) for anti-H. pylori treatment, 5.1 (95% CI = 1.7–15.0) for β-carotene treatment, and 5.0 (95% CI = 1.7–14.4) for ascorbic acid treatment in subjects with atrophy. Corresponding relative risks of regression in subjects with intestinal metaplasia were 3.1 (95% CI = 1.0–9.3), 3.4 (95% CI = 1.1–9.8), and 3.3 (95% CI = 1.1–9.5). Combinations of treatments did not statistically significantly increase the regression rates. Curing the H. pylori infection (which occurred in 74% of the treated subjects) produced a marked and statistically significant increase in the rate of regression of the precursor lesions (relative risks = 8.7 [95% CI = 2.7–28.2] for subjects with atrophy and 5.4 [95% CI = 1.7–17.6] for subjects with intestinal metaplasia).
Conclusions: In the very high-risk population studied, effective anti-H. pylori treatment and dietary supplementation with antioxidant micronutrients may interfere with the precancerous process, mostly by increasing the rate of regression of cancer precursor lesions, and may be an effective strategy to prevent gastric carcinoma.
Source : JNCI J Natl Cancer Inst (2000) 92 (23): 1881-1888. doi: 10.1093/jnci/92.23.1881LINK TO FULL ARTICLE
Survival benefit of an herbal formula for invigorating spleen for elderly patients with gastric cancer 1. Ai-guang ZHAO (Department of Oncology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China 2. Wen CAO (Department of Oncology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China ) 3. Yan XU (Department of Oncology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China ) 4. Gang ZHAO (Department of General Surgery, Renji Hospital, Medical College, Shanghai Jiao Tong University, Shanghai 200127, China ) 5. Bing-ya LIU (Institute of Digestive Surgery, Ruijin Hospital, Medical College, Shanghai Jiao Tong University, Shanghai 200025, China ) 6. Yong CAI (Department of Preventive Medicine, School of Public Health, Shanghai Jiao Tong University, Shanghai 200025, China ) 7. Jin-zu YANG (Department of Oncology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China ) 8. Ying GU (Department of Oncology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China ) 9. Wei YUAN (Department of Oncology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China ) 10. Ying-jie ZHU (Department of Oncology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China ) 11. Ying-ying HAN (Department of Oncology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China ) 12. Jin-kun YANG (Department of Oncology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China )
Background: Gastric cancer is one of the most common malignant tumors. Traditional Chinese medicine (TCM) has been widely used in treatment of gastric cancer, but still lacking large sample controlled trial to evaluate its efficacy.
Objective: To analyze the prognostic factors of 220 elderly patients with gastric cancer, and to further study the efficacy of an herbal formula for invigorating spleen and its modifications based on syndrome differentiation of TCM in treatment of gastric cancer in elderly patients and the influence on prognosis.
Design, setting, participants and interventions: A total of 220 elderly patients aged 65 years or over with gastric cancer from Longhua Hospital of Shanghai University of Traditional Chinese Medicine, and Renji Hospital and Ruijin Hospital of Shanghai Jiao Tong University Medical College were prospectively enrolled. All patients were assigned to either traditional Chinese herbal medicine (TCHM) group (89 cases) or non-TCHM group (131 cases). Patients in the TCHM group were treated with an herbal formula for invigorating spleen plus chemotherapy, while patients in the non-TCHM group were only treated with chemotherapy. Main outcome measures: Univariate and Cox regression analyses were performed to determine all the potential prognostic factors. Kaplan-Meier curves were used to assess the differences in survival time between TCHM group and non-TCHM group after stratification for TNM stage, surgery or chemotherapy.
Results: The 220 eligible patients were histologically confirmed adenocarcinoma of the stomach from 2001 to 2007. Eighty-nine cases in the TCHM group received three or more months of TCHM treatment, and 131 cases in the non-TCHM group did not receive TCHM treatment. Cox regression analysis suggested that the TNM stage, radical resection, three or more treatment cycles of chemotherapy, and TCHM treatment were independent prognostic factors (P<0.01). The patients receiving TCHM treatment demonstrated better prognosis than the other prognostic factors in multivariate analysis; the odds ratio [Exp(β)] of overall group was 0.322, and 95% confidence interval (CI) was from 0.212 to 0.489. Median overall survival of TCHM group was 41.129 months, and one-, three-, and five-year survival rates were 85.2%, 55.6% and 45.7% respectively. Median overall survival of non-TCHM group was 17.195 months, and one-, three-, and five-year survival rates were 63.9%, 26.9% and 21.9% respectively. In stratification analysis of stage for 96 patients who did not accepted radical resection or suffered from recurrence and metastasis (36 cases in the TCHM group, and 60 cases in the non-TCHM group), Cox regression analysis suggested that three or more treatment cycles of chemotherapy and TCHM treatment were independent prognostic factors for improving survival respectively (P<0.01). The hazard ratio [Exp(β)] of TCHM in stratification for late stage was 0.421, and 95% confidence interval was from 0.255 to 0.693. Median overall survivals were 17.819 months for TCHM group and 8.548 months for non-TCHM group. In stratification analysis of surgery and chemotherapy for 102 patients with Ib-Ⅳ (M0) who accepted radical resection (R0 resection) and three or more treatment cycles of chemotherapy (33 cases in the TCHM group, and 69 cases in the non-TCHM group), the disease-free survival and overall survival did not reach the median at the time of analysis. In the TCHM group, one-, three-, and five-year disease-free survival rates were 97.0%, 59.9% and 50.4%, and one-, three-, and five-year survival rates were 100.0%, 74.1% and 61.4%, respectively. In the non-TCHM group, one-, three-, and five-year disease-free survival rates were 82.6%, 51.1% and 51.1%, and one-, three-, and five-year survival rates were 86.9%, 55.6% and 55.6%, respectively.
Conclusion:The herbal formula for invigorating spleen has an important value for improving the prognosis of elderly patients with gastric cancer. This herbal formula shows survival benefit for advanced gastric cancer in elderly patients. The influence of TCHM on disease-free survival and overall survival of postoperative gastric cancer in elderly patients need to be further evaluated
LINK TO SOURCE (Chinese + English) Prescription rules of Chinese herbal medicines in treatment of gastric cancer
1. Wen CAO (First Department of Oncology, Longhua Hospita1, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China ) 2. Ai-guang ZHAO (First Department of Oncology, Longhua Hospita1, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
Abstract: Analysis of the nature, tastes, channel distributions and effects of the frequently used herbal medicines in the prescriptions involved in the clinical literatures about treatment of gastric cancer published from 1988 to 2007 was made in the paper. The literatures were categorized into three types: 1) treatment of middle- and late-stage gastric cancer; 2) prevention and treatment of the recurrence and metastasis after operation; 3) Chinese herbal medicines combined with chemotherapy for enhancing efficacy and reducing toxicity. The most frequently used herbal medicines in the three literature types were qi-invigorating herbs, such as Atractylodes, Astragalus, Codonopsis, Glycyrrhiza and Ginseng, etc. The herbal medicines for promoting urination to subside swelling such as tuckahoe and Semen Coicis, etc were used more frequently than the herbal medicines for regulating qi such as dried orange peel and putchuck, etc, as well as for clearing away heat to remove toxin such as spreading hedyotis herb, Herba Scutellariae Barbatae, yangtao actinidia root, and Rhizoma Paridis, etc. From another angle, the most frequently used herbal medicines for the treatment of gatric cancer were those cold, warm and neutral in nature, sweet, bitter and pungent in taste, and distributed to spleen and liver channels. LINK TO FULL ARTICLE
Effects of Xiaotan Sanjie Decoction on expressions of interleukin8 and its receptors in gastric tumor xenografts and gastric tissue adjacent to the tumor in mice
1. Dawei JU (Department of Traditional Chinese Medicine, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China ) 2. Pinkang WEI (Department of Traditional Chinese Medicine, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China 3. Huiming LIN (Department of Traditional Chinese Medicine, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China ) 4. Dazhi SUN (Department of Traditional Chinese Medicine, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China ) 5. Shan YU (The 309th Hospital of People’s Liberation Army, Beijing 100091, China ) 6. juan XIU (Department of Traditional Chinese Medicine, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China )
Objective: To explore the mechanisms of Xiaotan Sanjie Decoction (XTSJD), a compound traditional Chinese herbal medicine, in inhibiting the tumor growth and preventing recurrence by testing the protein expressions of interleukin-8 (IL-8) and its receptors chemokine receptor 1 (CXCR1) and chemokine receptor 2 (CXCR2) in gastric tumor xenografts and gastric tissue adjacent to the tumor in mice. Methods: Fifty Kunming mice were randomly divided into normal group, normal saline (NS) group, Heat-clearing and Detoxicating Decoction (HCDD) group, tegafur (FT-207) group and XTSJD group. Except for mice in the normal group, S180 tumor block was transplanted into the gastric walls of the mice, and the mice were administered with corresponding medicine for 3 weeks. Weight of tumor xenografts was measured and tumor inhibition rate was calculated. IL-8 protein expression was tested by enzyme-linked immunosorbent assay. Expressions of CXCR1 and CXCR2 were tested by immunohistochemical method. Results: The protein expressions of IL-8 and its receptors in tumor xenografts and gastric tissue adjacent to the tumor were markedly higher than those in the gastric tissue in normal mice (P<0.01); compared with HCDD and FT-207, XTSJD could significantly decrease the IL-8 protein expression in tumor xenografts and gastric tissue adjacent to the tumor (P<0.05); compared with FT-207, XTSJD could significantly decrease the CXCR1 protein expression in tumor xenografts (P<0.01), and XTSJD could also significantly decrease the CXCR1 protein expression in gastric tissue adjacent to the tumor as compared with HCDD and FT-207 (P<0.01); compared with HCDD and FT-207, XTSJD could significantly decrease the CXCR2 protein expression in tumor xenografts (P<0.01), and there was no significant difference among the three drug-treated groups in CXCR2 protein expression in gastric tissue adjacent to the tumor (P>0.05). Conclusion: XTSJD can decrease the protein expressions of IL-8 and its receptors in tumor xenografts and gastric tissue adjacent to the tumor. It may be one of the mechanisms of XTSJD in inhibiting the tumor growth and preventing recurrence. LINK TO FULL ARTICLE (in English + Chinese)
Survival time of advanced gastric cancer patients treated with integrated traditional Chinese and Western medicine therapy
1. Ni-da CAO (The First Department of Oncology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China ) 2. Ai-guang ZHAO (The First Department of Oncology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China ) 3. Jin-kun YANG (The First Department of Oncology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China )
Background: Advanced gastric cancer has a low survival rate while traditional Chinese medicine (TCM) therapy has effects in inhibiting tumor growth, lengthening survival time and improving the quality of life. Objective: To analyze the effects of integrated traditional Chinese and Western medicine therapy on the survival time and quality of life of advanced gastric cancer patients.
Design, setting, participants and interventions: A total of 95 advanced gastric cancer patients were enrolled and divided into comprehensive group (48 cases) and control group (47 cases). The patients in the comprehensive group from the First Department of Oncology, Longhua Hospital, were treated with TCM therapy and chemotherapy based on the gastric cancer treatment guidelines made by the First Department of Oncology of Longhua Hospital, and the patients in the control group from Renji Hospital and Ruijin Hospital in Shanghai were treated with chemotherapy only. Main outcome measures: The survival time in the two groups were observed and compared. The Karnofsky score, body weight, the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30) score, response rate and chemotherapy-related adverse events in the comprehensive group were observed. Results: The estimated median survival time in the comprehensive group was 16.12 months, longer than 9.64 months in the control group (P<0.05). The scores of function and symptom of EORTC QLQ-C30 in the comprehensive group decreased, while the overall health status increased, and the results indicated that the quality of life of the patients in the comprehensive group was improved. In the comprehensive group, the body weight after treatment was higher than that before treatment (P=0.037), while there was no difference in Karnofsky scores between that before and after treatment (P=0.061). All the patients in the comprehensive group were assessable. The complete response rate was 0, 3 cases had a partial response, 34 cases had stable disease, and 11 cases had disease progression. The overall response rate was 6.25% (3/48), and the disease control rate was 77.08% (37/48). No patient withdrew because of severe adverse events and there was no chemotherapy-related death. Conclusion: Integrated traditional Chinese and Western medicine can prolong the survival time and improve the quality of life of advanced gastric cancer patients, and enhance the comprehensive effects