直肠癌新辅助放化疗前后肿瘤相关性中性粒细胞浸润的临床意义

发布时间：2018-04-17 21:29

  本文选题：直肠肿瘤 + 新辅助放化疗　； 参考：《安徽医科大学》2017年硕士论文

【摘要】：目的本研究旨在通过检测直肠癌患者新辅助放化疗前后肿瘤局部的肿瘤相关性中性粒细胞(Tumor-associated neutrophils,TANs)的浸润情况,进而探讨新辅助放化疗对TANs浸润数量的影响,以及TANs在新辅助放化疗前后的浸润数量对直肠癌患者新辅助放化疗敏感性和无瘤生存率的预测价值。方法选取2010年1月至2013年5月,47例在中国人民解放军陆军总医院行病理活检诊断为直肠腺癌,且为进展期中低位直肠癌(术前评估c T3-4Nx M0,肿瘤下缘距肛缘10 cm)患者的新辅助放化疗前的术前活检石蜡病理标本和经过新辅助放化疗后行手术治疗获得的术后石蜡病理标本。选取CD15作为标记性抗体,采用光镜结合免疫组织化学SP法检测TANs在新辅助放化疗前后肿瘤组织中的浸润情况。由两位对临床结果不知情的病理学专家对新辅助放化疗后的治疗效果进行评价。对该47例患者进行随访,并利用SPSS 19.0统计软件统计分析TANs在肿瘤组织中的浸润情况与直肠癌患者对新辅助放化疗的敏感性及其预后的关系。结果在400倍光镜下术前活检标本中TANs的浸润数量平均为(43.87±4.65)个;术后病理标本中TANs的浸润数量平均为(10.39±1.62)个。术前活检标本中TANs的浸润数量显著高于术后病理标本:(43.87±4.65,N=47 VS 10.39±1.62,N=47;P≤0.05)。经过对术后标本的组织病理学判定:yp T0-2期的患者28例,yp T3-4期的患者19例;Grade0-1的患者29例,Grade2-3的患者18例。术前活检标本中TANs浸润数量与新辅助放化疗的反应敏感性无明显相关性:按yp T分期(?)~2=0.430,P=0.662;按Grade分级(?)~2=0.060,P=0.806。经过对患者独立预后因素的分析,结果显示新辅助放化疗后术后病理标本中TANs较低的浸润数量与良好的预后有关(3年无瘤生存率:83.9%VS 25.0%,P=0.015);同时,新辅助放化疗后的yp T分期也是直肠癌患者预后的独立预测因子。结论新辅助放化疗可以显著降低直肠癌中TANs的浸润数量。新辅助治疗后肿瘤中TANs较低的浸润数量与良好的预后有关,可以作为预后的独立预测因子。
[Abstract]:Objective to investigate the effect of neoadjuvant radiotherapy and chemotherapy on the infiltration of TANs by detecting the tumor associated neutrophil infiltration before and after neoadjuvant radiotherapy and chemotherapy in patients with rectal cancer.And the predictive value of TANs infiltration before and after neoadjuvant chemotherapy for neoadjuvant chemosensitivity and tumor-free survival in rectal cancer patients.Methods from January 2010 to May 2013, 47 cases of rectal adenocarcinoma were diagnosed by pathological biopsy in the General Hospital of the Chinese people's Liberation Army (PLA).The paraffin paraffin biopsy specimens were obtained before neoadjuvant radiotherapy and chemotherapy in patients with advanced low rectal cancer (c T3-4Nx M0 before operation, 10 cm from the lower margin of tumor to anal margin) and after neoadjuvant radiotherapy and chemotherapy.The infiltration of CD15 in neoadjuvant tumor tissues before and after neoadjuvant radiotherapy and chemotherapy was detected by light microscopy and immunohistochemical SP method.Two pathologists who were not familiar with the clinical results evaluated the efficacy of neoadjuvant radiotherapy and chemotherapy.The 47 patients were followed up, and the relationship between the infiltration of TANs in tumor tissue and the sensitivity to neoadjuvant chemotherapy and prognosis of rectal cancer was analyzed by SPSS 19.0 statistical software.Results the average number of TANs infiltration was 43.87 卤4.65 in preoperative biopsy specimens and 10.39 卤1.62 in postoperative pathological specimens.The number of TANs infiltration in preoperative biopsy specimens was significantly higher than that in postoperative pathological specimens (43.87 卤4.65) and 47 vs (10.39 卤1.62) (P 鈮，

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