中国鼻咽癌患者放射敏感性的蛋白标志物：meta分析

发布时间：2018-01-10 18:15

本文关键词：中国鼻咽癌患者放射敏感性的蛋白标志物：meta分析　出处：《吉林大学》2013年硕士论文　论文类型：学位论文

【摘要】：背景：我国鼻咽癌发病率占世界80%左右，尤其广东、广西等华南地区，，鼻咽癌死亡率占全部恶性肿瘤死亡率的2.81%，居第八位。放疗是目前治疗鼻咽癌的首要手段，局部复发和远处转移是治疗失败的主要原因。放射治疗效果考虑与肿瘤内在放射敏感性相关，放射敏感性理论上与细胞周期调控、DNA损伤修复、细胞凋亡及增殖、乏氧与血管生成等蛋白相关，但是目前尚缺乏快速、灵敏、准确预测肿瘤放射敏感性的蛋白标志物。关于鼻咽癌放疗敏感性与蛋白标志物的临床研究结果不一致，目前尚无鼻咽癌放射敏感性与蛋白标志物的meta分析。方法：检索1977年-2013年3月Pubmed、CNKI电子数据库查找文献，并通过对已纳文献的参考文献手工追溯查找遗漏的相关文献。文献纳入标准：⑴研究对象:①初治患者；②种族为中国人；③病理诊断为鼻咽鳞癌；⑵干预措施：根治性放射治疗，且近期疗效评估前未进行化疗或其它治疗；⑶有明确疗效指标；⑷排除综述性、重复发表及数据不全的研究。结果：共纳入96篇文献，近期疗效指标多为肿瘤完全缓解率，远期疗效指标多为5年总生存率，涉及12种蛋白，其中仅对研究数目较多的近期、远期疗效指标均有的5种蛋白（p53、Cyclin D1、PCNA、Ki-67、Survivin）进行meta分析。p53高表达的鼻咽癌患者根治性放疗后肿瘤完全缓解率低（OR=0.672（95%CI：0.455~0.992），P=0.046），5年总生存率低（OR=2.488（94%CI：1.749~3.539），P=0.000）；Cyclin D1表达水平与鼻咽癌放疗后肿瘤完全缓解率无相关性（OR=0.575（95%CI：0.085~3.882），P=0.570），但其高表达的鼻咽癌患者放疗后5年总生存率低（OR=3.950（94%CI：1.638~9.524），P=0.002）；PCNA高表达的鼻咽癌患者根治性放疗后肿瘤完全缓解率低（OR=0.347（95%CI：0.212~0.566），P=0.000），5年总生存率低（OR=2.564（95%CI：1.176~5.591），P=0.018）；Ki-67高表达的鼻咽癌患者根治性放疗后肿瘤完全缓解率高（OR=5.597（95%CI：3.276~9.561），P=0.000），5年总生存率低（OR=2.747（95%CI：1.592~4.740），P=0.000）；Survivin高表达的鼻咽癌患者根治性放疗后肿瘤完全缓解率低（OR=0.208（95%CI：0.112~0.386），P=0.000），5年总生存率低（OR=2.709（95%CI：1.974~3.716），P=0.000）。结论：p53、PCNA、Survivin高表达的鼻咽癌患者放疗后肿瘤完全缓解率低，5年总生存率低。Ki-67高表达者放疗后肿瘤完全缓解率高，但5年总生存率低。鼻咽癌患者放射治疗前联合检测蛋白标志物可以实现个体化放射治疗，但需要高质量、大样本的病例对照研究证实，特别是前瞻性随机对照研究。
[Abstract]:Background: the incidence of nasopharyngeal carcinoma (NPC) in China accounts for about 80% in the world, especially in Guangdong, Guangxi and South China. The mortality rate of NPC accounts for 2.81% of the total mortality of malignant tumors. Radiotherapy is the most important method in the treatment of nasopharyngeal carcinoma. Local recurrence and distant metastasis are the main causes of failure. The effect of radiotherapy is related to the internal radiosensitivity of the tumor. Radiosensitivity is theoretically related to cell cycle regulation of DNA damage repair, cell apoptosis and proliferation, hypoxia and angiogenesis, etc. The results of clinical studies on radiosensitivity and protein markers of nasopharyngeal carcinoma (NPC) were not consistent. There is no meta analysis of radiosensitivity and protein markers in nasopharyngeal carcinoma. Methods: search the electronic database of Pubmedus from 1977 to March 2013. And through the manual tracing the missing related literature to the reference document of the accepted literature, the literature was included in the standard of "1: 1" study object: 1 newly treated patient; (2) ethnic group is Chinese; 3pathological diagnosis of nasopharyngeal squamous cell carcinoma; 2Interventional measures: radical radiotherapy, and no chemotherapy or other treatment before the evaluation of short-term curative effect; 3There are definite curative effect indexes; (4) exclude the research of summarization, duplicate publication and incomplete data. Results: a total of 96 articles were included. Most of the short-term efficacy indicators were complete remission rate of tumor, and the long-term curative effect index was 5-year overall survival rate, involving 12 kinds of proteins, among which, only for the short term with a large number of studies. There were 5 kinds of protein p53 Cyclin D1 and PCNAfi-67 in all the long-term curative effect indexes. Meta analysis with survivin. P53 overexpression in patients with nasopharyngeal carcinoma (NPC) after radical radiotherapy, the complete remission rate was low and OR0.672 (. 95CI: 0.4550.992. The 5-year overall survival rate was 2.488 / 94 CI: 1.749 ~ 3.539%, P = 0.000 ~ 0.000; There was no correlation between the expression of Cyclin D1 and the complete remission rate of nasopharyngeal carcinoma after radiotherapy. However, the 5-year overall survival rate of NPC patients with high expression after radiotherapy was low. The complete remission rate of nasopharyngeal carcinoma patients with high expression of PCNA after radical radiotherapy was low. The 5-year overall survival rate was lower than that of 2.564 / 95 CI: 1.176 / 5.591/ P0.018; The complete remission rate of nasopharyngeal carcinoma (NPC) patients with high expression of Ki-67 was 5.597% and 0.000 respectively after radical radiotherapy. The overall 5-year overall survival rate was 2.747 ~ 95% CI: 1.592 ~ 4.740% ~ 0.000 ~ 0.000; The complete remission rate of nasopharyngeal carcinoma (NPC) patients with high expression of Survivin was 0.208% and 0.208% respectively after radical radiotherapy. The overall 5-year overall survival rate was 2.709 / 95% CI: 1.974 / 3.716 / P = 0.000. Conclusion the complete remission rate of nasopharyngeal carcinoma patients with high expression of survivin is low after radiotherapy. The overall 5-year survival rate was low in patients with high expression of Ki-67, but the complete remission rate was higher after radiotherapy, but the 5-year overall survival rate was low. Combined detection of protein markers before radiotherapy in patients with nasopharyngeal carcinoma could realize individualized radiotherapy. But high-quality, large-sample case-control studies are needed, especially prospective randomized controlled trials.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R739.63

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