新辅助放化疗对cⅡ-cⅢ期中低位直肠癌的疗效分析及对VEGF表达的影响
发布时间：2019-03-17 15:21
【摘要】：背景 近年来,许多学者开始对如何降低局部晚期直肠癌患者的局部复发率和改善预后生存情况进行了多种模式的探索。随着新辅助放化疗(NCRT)在乳腺癌治疗中的疗效被肯定和直肠癌术后放化疗取得的可靠效果,其逐渐被应用于直肠癌,到现在已成为局部晚期直肠(LARC)癌多学科综合治疗的重要组成部分,得到了众多医疗中心的认同。NCCN指南及《中国结直肠癌诊疗规范》中也都明确指出:对于距肛门12cm以内的cⅡ-c Ⅲ期直肠癌推荐行NCRT。但NCRT对LARC的预后生存影响仍存在争议。本研究分两部分,目的如下:1.分析NCRT对cⅡ-c Ⅲ期中低位直肠癌的治疗疗效;2.了解NCRT对血管内皮生长因子(VEGF)的影响,分析其在预测NCRT敏感性上的作用。第一部分NCRT对cⅡ-cⅢ期中低位直肠癌的疗效目的:探讨NCRT对cⅡ-cⅢ期中低位直肠癌患者的临床疗效方法:回顾性分析了2008年1月—2011年12月期间在陕西省人民院住院治疗的cⅡ-cⅢ期的154例中低位直肠癌患者。根据是否接受NCRT将患者分组,其中NCRT组(A组)62例,直接手术组(B组)92例。统计两组患者的一般病理特征及手术相关资料。分析两组患者在肿瘤保肛率、手术相关并发症、术后肿瘤复发率及术后生存率上的差异。结果:A组患者在NCRT后有8.1%(5/62)达到完全缓解(CR),有48.4%(30/62)达到部分缓解(PR),有43.5%(27/62)达到稳定(SD),无疾病进展病例;A组保肛率为66.7%(24/36),高于B组的36.7%(18/49),差异有统计学意义(P0.05);两组在术中出血量、肠梗阻及吻合口瘘等发生率上的差异无统计学意义(均P0.05);但A组患者术后切口愈合不良及前切除综合征的的发生率较B组高,差异有统计学意义(均P0.05)。分析随访资料后发现:两组的5年总生存率(OS)无差别,但A组的5年无瘤生存率(DFS)较B组高(P=0.007)。结论:1.NCRT能使cⅡ-c Ⅲ期中低位直肠癌缩小、降期,能降低术后局部复发率,还能提高保肛率;2.NCRT不能改善cⅡ-c Ⅲ期中低位直肠癌患者术后5年的OS,但可以提高术后5年的DFS第二部分NCRT对直肠癌组织VEGF表达的影响目的:1.NCRT对直肠癌组织VEGF表达的影响;2.探讨VEGF在预测NCRT敏感性上的作用。方法:收集62例NCRT前及NCRT后的直肠癌患者的组织病理标本切片,分别标记为NCRT前组及NCRT后组,并以同期15例直接手术的直肠癌患者的癌旁5cm且经病理证实为正常的直肠组织为对照组,通过免疫组织化学法分别检测VEGF在NCRT前组、NCRT后组及对照组中的表达,比较NCRT前组与对照组、NCRT前组、NCRT后组间的表达差异。根据新辅助治疗反应分级系统判断肿瘤对NCRT的敏感性,探讨VEGF表达与NCRT敏感性的关系。结果:VEGF在对照组中阳性率为26.7%(4/15),在NCRT前组中阳性率为77.4%(48/62),在NCRT后组中阳性率为41.9%(26/62)。VEGF的阳性表达率在对照组与NCRT前组相比,差异有统计学意义(x2=14.189,P0.001);在NCRT前组与NCRT后组相比较,VEGF的阳性表达率差异也有统计学意义(x2=16.221,P0.001)。根据术后病理采用改良自Ryan等的新辅助治疗反应分级系统判定有44例患者对NCRT敏感,在对NCRT敏感的患者中,接受NCRT前VEGF阳性表达者约88.6%(39/44);在对NCRT不敏感的患者中,VEGF阳性者约50%(9/18),通过对NCRT前VEGF表达情况与NCRT敏感性的相关性研究显示,NCRT敏感性与VEGF的表达成等级相关(r=0.483,P=0.000)。结论:1.NCRT能够降显著低直肠癌组织中VEGF的表达;2.VEGF表达与NCRT敏感性成等级相关,对预测NCRT敏感性可能会有一定作用。
[Abstract]:In recent years, many scholars have started to explore how to reduce the local recurrence rate and improve the prognosis of patients with locally advanced rectal cancer. With the effect of neoadjuvant chemoradiotherapy (NCRT) in the treatment of breast cancer and the reliable effect of radiotherapy and chemotherapy after operation of rectal cancer, it is gradually applied to rectal cancer, and now has become an important part of the comprehensive treatment of local advanced rectal (LRC) cancer. I've got a lot of medical centers. The NCCN guidelines and the Chinese Code for Diagnosis and Treatment of Colorectal Cancer have also made it clear that NCRT is recommended for the c II-c stage III rectal cancer within 12 cm from the anus. However, the impact of NCRT on the prognosis of LRC is still controversial. The purpose of this study is as follows:1. The effect of NCRT on the treatment of c-鈪，
本文编号：2442427
[Abstract]:In recent years, many scholars have started to explore how to reduce the local recurrence rate and improve the prognosis of patients with locally advanced rectal cancer. With the effect of neoadjuvant chemoradiotherapy (NCRT) in the treatment of breast cancer and the reliable effect of radiotherapy and chemotherapy after operation of rectal cancer, it is gradually applied to rectal cancer, and now has become an important part of the comprehensive treatment of local advanced rectal (LRC) cancer. I've got a lot of medical centers. The NCCN guidelines and the Chinese Code for Diagnosis and Treatment of Colorectal Cancer have also made it clear that NCRT is recommended for the c II-c stage III rectal cancer within 12 cm from the anus. However, the impact of NCRT on the prognosis of LRC is still controversial. The purpose of this study is as follows:1. The effect of NCRT on the treatment of c-鈪，
本文编号：2442427
本文链接：https://www.wllwen.com/yixuelunwen/zlx/2442427.html
