Inflammatory response after hepatocellular carcinoma intervention and the modulating effect of traditional Chinese medicine

  1.Interventional (TACE) is an important treatment method for liver cancer Primary liver cancer is one of the common malignant tumors in clinical practice, which progresses rapidly and has insidious symptoms, and most of the patients are already in the middle and late stages when liver cancer is detected. The main treatment modality at this stage is transcatheter arterial chemoembolization (TACE), which is usually referred to as interventional treatment.  By embolizing the tumor’s trophoblastic vessels, TACE can cause cancer cells to die due to lack of nutrition and oxygen deprivation.  However, TACE has some drawbacks that affect its long-term effect, such as post-embolization syndrome, which is prone to pain, vomiting, abdominal distension and fever, and the effect of chemotherapeutic drugs may cause immune function decline, bone marrow suppression and liver function damage. These adverse reactions share a common background mechanism: inflammation caused by TACE, and the impact of this problem on the long-term prognosis of liver cancer is gradually gaining attention.  2. Inflammatory reaction caused by intervention affects the efficacy The blockage of tissue blood supply during TACE treatment will cause hepatocyte degeneration and necrosis, high edema of interlobular tissues and inflammatory reaction, and a large amount of acute inflammatory cell infiltration can be seen at the junction of embolization area and normal liver tissue.  This inflammatory process will cause adverse effects such as liver function impairment, fever and pain on the one hand, and more importantly, it will cause cell proliferation, resist apoptosis and adjust abnormal gene expression through the network of inflammatory factors, which in turn will promote tumor development.  Meanwhile, various cytokines produced during inflammation can regulate the activation and migration of vascular endothelial cells and their proliferation, summoning new angiogenesis. Clinical studies have found that there is an important relationship between the severity of inflammation level and prognosis after TACE.  3.How to detect inflammation level There is a close relationship between inflammation and hepatocellular carcinoma, and the inflammation status of the body not only promotes the occurrence of hepatocellular carcinoma, but also has an important impact on the development of hepatocellular carcinoma after formation and the prognosis of the disease. It is found that the higher the inflammation indexes such as C-reactive protein, interleukin 6 and granulocyte/lymphocyte ratio (NLR) in the serum of liver cancer patients, the shorter the survival time.  4.How Chinese medicine can regulate inflammatory response after TACE Chinese medicine has been widely used in liver cancer treatment, and many past studies have proved the role of certain Chinese medicines in killing cancer cells, but the clinical treatment of middle and late stage liver cancer more often adopts the method of “helping the righteous”. However, the clinical treatment of intermediate and advanced liver cancer is more often based on the “corrective” method, which does not directly target cancer toxicity, but can also prolong the life of patients, which strongly suggests that the effect of Chinese medicine is multi-path and multi-target. The inflammation regulation function of Chinese medicine in the treatment of other diseases such as infectious diseases may be one of the ways for Chinese medicine to exert its anti-tumor effects.  Ginseng has been frequently used in anti-tumor formulas for thousands of years and has the function of “nourishing yin, tonifying life and strengthening the root”. The involvement of ginsenosides in mediating inflammatory responses has received increasing attention. In a previous study, GS was applied to prevent and treat post-TACE embolism syndrome, and it was found that GS could protect the liver and kidney function of patients. In-depth studies on the mechanism of action of GS revealed that the target of GS is the glucocorticoid receptor, and GS exerts its anti-inflammatory effect by increasing the level of glucocorticoid receptor, thus increasing the promotion of glucocorticoid potency in vivo.