中医药治疗胃癌淋巴转移的研究进展

胃癌的发病率和死亡率在所有肿瘤中均较高,我国因为胃癌死亡的人数每年高达49. 8万人。由于早期胃癌的发病特征不明显,多数到医院治疗的患者均已是中晚期胃癌,给家庭和社会都带来了沉重的负担。中晚期胃癌的术后生存期显著低于早期胃癌,其中最重要的原因在于胃癌的淋巴转移。淋巴转移是胃癌的主要转移途径,进展期胃癌的淋巴转移率高达70%左右,早期胃癌也可有淋巴转移。胃癌的淋巴结转移率和癌灶的浸润深度呈正相关。目前的治疗手段除手术切除、淋巴化疗及分子靶向治疗外,中医药因其中毒性低、治疗效果好、价格低的优势也发挥了重要的作用。中医认为胃癌的发生多因饮食不洁、情志失调、素体亏虚而致痰凝、气阻、血瘀与胃发为本病,病机总属本虚标实,临床中医治疗多以化痰解毒、健脾益气、温中散寒为主。近年来,多项研究证明中医药治疗胃癌淋巴转移在临床中疗效显著、作用广泛,其可能通过抑制基质金属蛋白酶对基底膜和细胞外基质(ECM)的水解,激发肿瘤失巢凋亡,抑制淋巴管新生,调控与肿瘤相关基因的表达等途径来治疗胃癌淋巴转移。文章从近年来中医药在治疗胃癌淋巴转移中的理论研究、实验研究以及临床研究的进展进行综述,揭示中药作用的机制及其作用靶点,以期为中医药治疗胃癌淋巴转移的深入研究以及临床上的应用提供科学依据。

Effect of Traditional Chinese Medicine in Treatment of Lymphatic Metastasis of Gastric Cancer

The incidence and mortality of gastric cancer are higher among all kinds of tumors, and the number of deaths due to gastric cancer in China is as high as 498 000.Because the pathogenesis of early gastric cancer is not obvious, most patients who have been treated in hospitals are already in middle and advanced stages of gastric cancer, which brings a heavy burden to families and the society. The postoperative survival of patients of advanced gastric cancer is significantly lower than those of early gastric cancer. The most important reason is lymphatic metastasis of gastric cancer. Lymphatic metastasis is the main metastasis pathway of gastric cancer. The lymphatic metastasis rate of progressive gastric cancer is as high as 70%, and early gastric cancer can also have lymphatic metastasis. The lymph node metastasis rate of gastric cancer was positively correlated with the infiltration depth of the tumor. In addition to surgical resection, lymphatic chemotherapy and molecular targeted therapies, traditional Chinese medicine(TCM) has also played an important role due to the advantages of a low toxicity, good therapeutic effect and low price. According to the theory of TCM, the occurrence of gastric cancer is caused by unclean diet, emotional disorders, and deficiencies, which result in phlegm, Qi resistance, blood stasis, and attack the stomach. The pathogenesis is the asthenia in origin and asthenia in superficiality, and clinical TCM therapies mostly focus on phlegm and blood stasis, spleen and Qi, warm and cold. In recent years, a number of studies have proved that TCM has a significant and effective effect in the treatment of lymphatic metastasis of gastric cancer. It may inhibit the anoikis and the tumor by inhibiting the hydrolysis of matrix metalloproteinase on the basement membrane and extracellular matrix (ECM), stimulating tumor anoikis, suppressing lymphatic neovascularization, regulating tumor-associated gene expression and other pathways, so as to treat lymphatic metastasis of gastric cancer. This article reviews the advance of theoretical research, experimental research and clinical research of TCM in the treatment of lymphatic metastasis of gastric cancer in recent years, and reveals the mechanism of TCM and its targets, in order to provide scientific basis for further studies and clinical application of the effect of TCM on the lymphatic metastasis of gastric cancer.