血清肿瘤异常蛋白与胃癌化疗效果的相关性研究

发布时间：2018-05-18 20:52

本文选题：肿瘤异常蛋白(TAP) + 肿瘤标志物　；参考：《南京医科大学》2015年硕士论文

【摘要】：背景与目的在中国,胃癌是最常见的恶性肿瘤之一,并且其发病率和死亡率近几年来仍然有升高的趋势。对于胃癌患者来说,化疗是一种有效的非手术治疗方法。部分患者发现及时,接受手术和辅助化疗。而有些患者确诊时已为中晚期,失去手术机会,只能行姑息化疗。以培美曲塞为基础的二、三线化疗在治疗晚期胃癌方面的临床疗效已逐渐获得肯定。对病情进展难以避免的患者,尽快找到能快速有效地对患者病情及疗效进行预测的方法,是一项紧迫而有意义的工作。目前临床应用的肿瘤标志物检测包括甲胎蛋白(AFP)、癌胚抗原(CEA)、糖原125(CAl25)、糖原199(CA199)、糖原153(CA153)、前列腺特异性抗原(PSA)、神经元特异性烯醇化酶(NSE)及细胞角蛋白19片段(c YFRA21-1)等。单一肿瘤标志物检测存在灵敏度低、特异性低等不足。肿瘤异常蛋白(TAP)同时将几十种糖链异常的肿瘤标志物组合检测,期望大大提高肿瘤检测的灵敏度和特异性。本研究比较胃癌患者TAP与化疗效果的相关性,为肿瘤患者的个体化诊疗提供依据。材料与方法将2014年9月至2015年2月期间在江苏省肿瘤医院住院化疗的胃癌患者分为两组:A组以铂类或5-Fu为基础的术后辅助化疗,B组以培美曲塞为基础的姑息化疗。入选条件:年龄25-75岁,KPS评分≥70,预期生存时间3个月;血常规:白细胞数4.0×109/L,中性粒细胞数2.0×109/L,血小板计数100×109/L,血红蛋白90g/L;血生化:胆红素和转氨酶1.5倍正常上限和肌酐水平低于1.5倍正常上限;无严重心脏、肺、肝脏、肾脏功能障碍;已签署化疗知情同意书。于化疗前后行CT扫描和血液检查(TAP,CEA,CA125和CA199)。监测A、B两组外周血中TAP、CEA、CA125和CA199变化情况,并对B组患者姑息化疗后的疗效评价。根据数据处理结果,推断TAP变化与患者一般情况(包括年龄、性别、病理分化程度及转移器官数目)间的关系,TAP变化与姑息化疗疗效之间的关系,TAP变化与两组患者肿瘤标志物CEA、CA125、CA199的关系。结果(1)共82例患者符合入组标准,其中A组45例,B组37例。将患者化疗前后的TAP、CEA、CA125、CA199变化与患者一般情况进行单因素相关分析,对应的各项统计得出P值均大于0.05,即发现目标差异无统计学意义(P0.05)。胃癌患者年龄、性别、病理分化程度及转移器官数目各分类间互为独立因素,不影响TAP及CEA、CA125、CA199在化疗后的变化。(2)TAP,CEA,CA125和CA199变化与B组患者疗效的关系进行相关分析,发现TAP,CEA,CA125和CA199各自独立地与姑息化疗疗效相关(P0.05)。TAP的变化与B组疗效间相关系数r=0.80,提示患者的TAP变化与培美曲塞为基础的姑息化疗疗效存在显著相关。病情有效控制时TAP指标下降;病情进展时,TAP指标升高。肿瘤指标CEA、CA125、CA199分别与B组中姑息化疗疗效之间的相关性比较,r值均小于0.80。由此发现TAP与姑息化疗疗效的相关性更高。(3)A、B两组患者化疗前后CEA、CA125、CA199变化与TAP变化进行reg回归分析。A组TAP与CA125比较,相关系数0.49(P0.05),存在正相关;TAP与CEA、CA199比较,p0.05,说明TAP的变化与CEA、CA199各变化无关,是互相独立的检测项目。B组TAP变化与CEA、CA125、CA199各变化比较,P值均大于0.05,说明TAP的变化与CEA、CA125、CA199各变化无关。由此可知TAP变化与肿瘤指标CEA、CA199各变化无相关,TAP与CA125仅在辅助化疗患者中呈正相关,姑息化疗者中无关。TAP检测不可被肿瘤指标检测所取代。结论通过监测胃癌患者化疗前后TAP的变化,可判断当前方案对病情是否可有效控制。TAP可对胃癌患者化疗的疗效判断提供参考,为肿瘤患者实行个体化治疗提供依据。
[Abstract]:Background and objective gastric cancer is one of the most common malignant tumors in China, and its incidence and mortality are still rising in recent years. For patients with gastric cancer, chemotherapy is an effective nonoperative treatment. Some patients are found to be in time, receiving surgery and adjuvant chemotherapy. Some patients have been diagnosed at the middle and late stages. The clinical efficacy of two and three line chemotherapy based on pemetrexed is gradually affirmed in the treatment of advanced gastric cancer. It is an urgent and meaningful work to find a quick and effective way to predict the patient's condition and efficacy as soon as possible. The detection of tumor markers in the pre clinical application includes alpha fetoprotein (AFP), carcinoembryonic antigen (CEA), glycogen 125 (CAl25), glycogen 199 (CA199), glycogen 153 (CA153), prostate specific antigen (PSA), neuron specific enolase (NSE) and cytokeratin 19 (C YFRA21-1). The detection of single tumor markers has low sensitivity and low specificity. This study compares the correlation between TAP and chemotherapy in gastric cancer patients and provides a basis for the individualized diagnosis and treatment of cancer patients. Materials and methods will be from September 2014 to February 2015. The patients with gastric cancer hospitalized in Jiangsu tumor hospital were divided into two groups: group A with platinum or 5-Fu based adjuvant chemotherapy and pemetrexed based palliative chemotherapy in group B. The conditions were 25-75 years old, the KPS score was more than 70, the expected survival time was 3 months, the blood routine was 4 x 109/L, the number of neutrophils was 2 * 109/L, and the blood was small The plate counts 100 x 109/L, hemoglobin 90g/L, blood biochemistry: the normal upper limit of bilirubin and transaminase 1.5 times the normal upper limit and the creatinine level lower than 1.5 times the normal upper limit; no serious heart, lung, liver, renal dysfunction; had signed chemotherapy informed consent. Before and after chemotherapy, CT scan and blood examination (TAP, CEA, CA125 and CA199). Monitoring A, B two group of peripheral blood TAP in TAP. The changes of CEA, CA125 and CA199, and the evaluation of the curative effect after palliative chemotherapy in the B group. According to the data processing results, the relationship between the changes of TAP and the general situation of the patients (including age, sex, the degree of pathological differentiation and the number of metastatic organs), the relationship between the changes of TAP and the curative effect of palliative chemotherapy, the changes of TAP and the two group of tumor markers C The relationship between EA, CA125 and CA199. Results (1) a total of 82 patients were in accordance with the standard of entry group, including 45 cases in group A and 37 cases in group B. The changes of TAP, CEA, CA125, CA199 in patients before and after chemotherapy were correlated with the general situation of patients, and the corresponding statistics showed that the value of P was greater than 0.05, that is, there was no statistical significance (P0.05). Age, sex, pathological differentiation and number of metastatic organs were independent factors, which did not affect the changes of TAP and CEA, CA125, CA199 after chemotherapy. (2) the relationship between the changes of TAP, CEA, CA125 and CA199 and the curative effect of the B group was related, and found that TAP, CEA, CA125, and CA199 were independently associated with the changes of palliative chemotherapy. The correlation coefficient between the B group and the B group was r=0.80, suggesting that there was a significant correlation between the changes of the patients and the palliative chemotherapy based on pemetrexed. The TAP index decreased when the condition was effectively controlled; the TAP index increased when the condition progressed. The correlation between the tumor index, CEA, CA125, CA199 and the palliative therapeutic effect in the B group was less than that of 0.80.. The correlation between TAP and palliative chemotherapy was higher. (3) A, group B two, CEA, CA125, CA199 changes and TAP changes before and after chemotherapy in group B, and reg regression analysis of.A group TAP and CA125, correlation coefficient 0.49 (P0.05), there is a positive correlation. The changes of TAP in group.B were compared with CEA, CA125 and CA199, and the P values were more than 0.05, indicating that the changes of TAP were not related to the changes of CEA, CA125, CA199. Conclusion by monitoring the changes of TAP in patients with gastric cancer before and after chemotherapy, it can be used to determine whether the current scheme can effectively control the condition of the disease and provide a reference for the evaluation of the efficacy of chemotherapy for gastric cancer patients, and provide the basis for the individualized treatment of cancer patients.
【学位授予单位】：南京医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R735.2

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