Background: Syndrome (ZHENG in Chinese) in
traditional Chinese medicine (TCM) refers to the intrinsic characteristics of a
pathological process at a certain stage; these characteristics are influenced by
internal and external environments and reveal the nature of a disease. Proper
syndrome differentiation is the basic principle that guides clinical treatment.
Objective: To have a good understanding of tumor progression
and the different mechanisms related to ZHENG that have
occurred before and after tumor development and to explore the valid evaluation
criteria of different pancreatic cancer syndromes to improve the guiding role of
TCM syndrome differentiation in pancreatic cancer treatment.
Methods: In this study, we established mouse subcutaneous
pancreatic cancer models, namely, Con (control), Pi-Xu (Spleen-Deficiency),
Shi-Re (Dampness-Heat), and Xue-Yu (Blood-Stasis). Then, for the first time, we
compared the different effects of “ZHENG-first” (referring to a
different disease status that occurred before tumor occurrence) and
“Tumor-first” (referring to the change in the tumor microenvironment and the
resulting changes in the state of the body) conditions on tumor progression and
evaluated the associated molecular mechanisms. Results: We found
that tumor growth in the “ZHENG-first” and “Tumor-first”
conditions was different. In the “Tumor-first” model, the tumor growth in the
Pi-Xu group was faster than that in the other groups. However, in the
“ZHENG-first” model, the tumor growth trend was most
obvious in the Shi-Re group. There was a difference in tumor-associated
macrophage infiltration between the 2 models. The expression levels of the
inflammatory cytokines IL-6, IL-10, and P-STAT3 were also
differentially altered. Conclusion: The emergence of
ZHENG conditions before or after tumor occurrence had
different impacts on pancreatic cancer development, and these impacts may be
related to differences in tumor-associated macrophage infiltration and the
involved inflammatory cytokines IL-6, IL-10, and P-STAT3. The
study results uncovered the molecular basis of syndrome differentiation in
pancreatic cancer progression, which might provide more specific guidance for
TCM treatment of pancreatic cancer.