TCM-based syndrome stratification and biological profiling of cancer-related fatigue: A cross-sectional study and scale validation.

e24137 Background: Cancer-related fatigue (CRF) is a prevalent symptom with limited interventions. Traditional Chinese Medicine (TCM) offers syndrome-based, holistic approaches that may provide insights for precision supportive care. Methods: A cross-sectional study of 383 CRF patients was conducted at Xiyuan Hospital. Using Two-Step cluster analysis and Delphi expert consensus, a TCM-based syndrome stratification model and diagnostic scale were developed and externally validated. Multilevel analyses examined demographic, emotional, and biological differences across subtypes. Results: Four TCM subtypes of CRF were identified: Subtype 01 (Liver Depression & Spleen Deficiency): Associated with mood disturbance, predominantly well-educated patients (head/neck or breast cancer), showing heavy emotional burden, elevated ALT/NEUT%, and decreased CD4+%/glucose. Subtype 02 (Yin Deficiency): Primarily female radiotherapy patients exhibiting the mildest fatigue, characterized by chronic inflammation and immune-coagulative imbalance. Subtype 03 (Yang Deficiency): Mainly older colorectal cancer patients, showing endocrine and immune dysregulation (elevated ProGRP, reduced γδT cells). Subtype 04 (Qi and Blood Deficiency): Common among low-income, lung cancer patients, presenting the most severe fatigue and abnormalities in coagulation, thyroid function, and hepatic metabolism. The diagnostic scale demonstrated good discrimination (AUC = 0.70–0.86), with high sensitivity and specificity, and was successfully validated externally. Significant differences across subtypes were confirmed in terms of demographic, fatigue, emotional, and biological characteristics. Conclusions: This study links symptom networks with TCM syndrome subtypes, highlighting emotional, endocrine, and immune factors in CRF heterogeneity. It provides a robust framework for precise TCM differentiation and biological profiling, supporting personalized strategies for global cancer care.