EGFR在预测老年食管癌患者同步放化疗敏感性中的作用及其临床意义研究

发布时间：2019-05-07 05:49

【摘要】：目的:探究表皮生长因子受体(epidermal growth factor receptor,EGFR)对于老年食管癌患者进行同步放化疗的敏感性进行预测,具有十分重要的临床意义与价值。方法:选取我院2014年7月-2015年7月期间收治的老年食管鳞癌患者共60例,其中男56例、女4例,年龄65-77岁。病变部位为胸段,病变长度2.5-8cm不等,TNM分期II-III期。其中:胸上段20例,占34%(20/60),胸中段23例,占38%(23/60),胸下段17例,占28%(17/60)。II期患者30例,占50%(30/60),III期患者30例,占50%(30/60)。获取患者肿瘤组织的病理标本,经免疫组织化学染色确定EGFR表达性质。食管癌放疗方案:6MV-X体外照射,靶区剂量45-60Gy,单次分割剂量2Gy/次,5次/W。均于放疗开始后行同步化疗。给予患者紫杉醇联合顺铂化疗方案(紫杉醇135mg/m2 d1,顺铂20mg/m2 d1-5)。同步化疗每3周为一个疗程,共行2个疗程。疗程过后,通过食管钡及造影对患者进行全面的复查,并且将结果分为:完全缓解、部份缓解与无缓解三类。最后比较两组患者EGFR表达与同步放化疗缓解率的关系。结果:根据免疫组织化学评分法,将60例标本分为EGFR表达阳性41例和阴性19例,进行了EGFR表达且结果呈现阳性的标本当中,大多数的细胞质以及细胞膜都被染色,且均呈现出棕褐色。而EGFR表达且结果呈现阴性的一系列标本中,绝大多数的细胞没有发生着色现象。在EGFR的阳性组患者当中,28例患者的症状得到了完全意义上的缓解,19例患者部份症状得以缓解,4例患者症状没有丝毫的缓解;在EGFR的阴性组患者当中,3例患者的症状得到了完全意义上的缓解,10例患者部份症状得以缓解,6例患者症状没有丝毫的缓解;将两组结果进行综合的对比分析,EGFR阳性组症状缓解率(68.29%)明显高于阴性组(15.79%),且差异存在统计学意义(P0.05)。结论:老年食管癌患者EGFR阳性组同步放化疗后症状缓解率明显高于阴性组。老年食管癌EGFR表达水平的高低可能在预测其同步放化疗敏感性中起到重要作用。
[Abstract]:Aim: to explore the sensitivity of epidermal growth factor receptor (epidermal growth factor receptor,EGFR) to concurrent radiotherapy and chemotherapy in elderly patients with esophageal carcinoma, which is of great clinical significance and value. Methods: from July 2014 to July 2015, 60 elderly patients with esophageal squamous cell carcinoma were selected, including 56 males and 4 females, aged 65 to 77 years. The lesion was located in the thoracic segment, the length of the lesion was 2.5-8cm, and the TNM stage was II-III stage. Among them, 20 cases were upper thoracic segment (34%), 23 cases were middle thoracic segment (38%), 17 cases were lower thoracic segment (28%), 30 cases were in stage II (50%), 30 cases were in stage III (30 cases), 30 cases were in stage III (30 cases), 23 cases were in middle segment (38%, 23%), 17 cases were in lower segment of chest (28%). 50% (30 / 60). The pathological specimens of tumor tissue were obtained and the expression of EGFR was determined by immunohistochemical staining. Radiotherapy regimen for esophageal cancer: 6MV-X irradiation in vitro, target dose of 45? 60 Gy, single dose of 2Gy/, 5 times / W. All patients were treated with concurrent chemotherapy after the beginning of radiotherapy. Patients were given paclitaxel plus cisplatin chemotherapy regimen (paclitaxel 135mg/m2 D1, cisplatin 20mg/m2 D1, 5). Synchronous chemotherapy was a course of treatment every 3 weeks, and 2 courses were performed. After the course of treatment, the patients were reviewed by esophageal barium and angiography, and the results were divided into three groups: complete remission, partial remission and non-remission. Finally, the relationship between the expression of EGFR and the remission rate of concurrent radiotherapy and chemotherapy was compared between the two groups. Results: according to the immunohistochemical method, 60 specimens were divided into 41 positive and 19 negative for EGFR expression. Most of the samples with positive EGFR expression were stained with cytoplasm and cell membrane. And all of them are brownish brown. In a series of samples with negative expression of EGFR, no staining was found in most of the cells. In the EGFR positive group, the symptoms of 28 patients were completely relieved, 19 patients were partially relieved, and 4 patients had no remission. In the negative group of EGFR, the symptoms of 3 patients were completely relieved, 10 patients were partially relieved, and 6 patients were not relieved. The results showed that the symptom remission rate of EGFR positive group (68.29%) was significantly higher than that of negative group (15.79%), and the difference was statistically significant (P0.05). Conclusion: the symptom remission rate of EGFR positive group was significantly higher than that of negative group. The expression level of EGFR in elderly esophageal carcinoma may play an important role in predicting the sensitivity of concurrent radiotherapy and chemotherapy.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.1

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