术前区域化疗联合放疗对低位直肠癌细胞凋亡及术后复发的影响

THE EFFECT OF PRAC COMBINED WITH RADIATION ON THE APOPTOSIS OF TUMOR CELL AND THE POSTOPERATE RECURRENCE IN LOW RECTAL CARCINIMA

目的:探讨术前区域动脉灌注化疗(Preoperativeregionalintra-arteralchemotherapy,PRAC)联合放疗在低位直肠癌新辅助治疗中可能发挥的作用。方法:对61例低位直肠癌病例随机分为3组,A组19例进行术前化、放疗,B组15例术前单纯放疗,C组27例术前未行任何化、放疗。采用原位末端标记技术(TUNEL法)检测每例治疗前及手术后的凋亡细胞。所有病例均得到18个月以上的随访。结果:全部施行根治性切除术。A组治疗前后凋亡指数(ApoptosisIndexes,AI)分别为(0·867±0·101)%和(5·389±0·517)%,B组分别为(0·875±0·098)%和(2·757±0·251)%,差异有统计学意义(P<0·01);C组分别为(0·927±0·135)%和(0·877±0·139)%,差异无统计学意义(P>0·05)。三组治疗前AI之间无明显差异,三组术后AI之间差异有统计学意义(P<0·01)。A组复发率5·26%(1/19),B组13·33%(2/15),C组33·33%(9/27),A组与B组的复发率均低于C组,差异有统计学意义(P<0·05)。A组保肛率31·58%(6/19),B组26·67%(4/15),C组3·70%(1/27),A组与B组的保肛率均高于C组,差异有统计学意义(P<0·05)。结论:低位直肠癌PRAC联合放疗可以促进癌细胞凋亡、降低复发率、提高保肛率,其用于新辅助化疗是安全、合理而有效的。

Objective： To explore the preoperative regional intra-arteral chemotherapy（PRAC） in neoadjuvant therapy for low rectal carcinoma. Methods： 61 cases of low rectal carcinoma were randomined into three groups, Group A （19 cases, PRAC combined with radiation）,Group B （15 cases, preoperative radiotherapy） ,Group C （27 cases, without PRAC or preoperative radiotherapy）. Using the methods of TUNEL, we determined the apoptosis of tumor cells before the treatment and after ther operation, and consequently proceeded to statistical analysis. All cases were followed-up for at least 18 months. Result：All the patients underwent successful curative resections. The apoptosis indexes（AI） before the treatment in Group A was （0. 867＋0. 101）% ,obviously lower than that of the post-operation （5. 389＋0. 517）%（ P 〈0.01）. The AI in Group B before the treatment （0. 875 ＋ 0. 098%）, obviously lower than the post-operation （2. 757＋ 0. 251）% （ P 〈0.01）. There was no difference in Group C（0. 927＋0. 135）% and （0. 877＋0. 139）% （ P 〉 0.01）. The AI in Group B of post-operation was significantly more as compared with Group B and C（ P〈 0.001 ）. The local recurrence rates in Groups A was 5.26 % （ 1 / 19）, while in Group B it was 13.33 % （2/15）, obviously lower than in Group C（33.33%, 9/27） （ P 〈0.05）. The reserving anus rates in Group A was 31.58% （6/19）, 26.67% in Group B （4/15）, significantly more as compared with that in Group C（3. 70%, 1/27） （ P d0.05）. Conclusion.PRAC combined with radiation for low rectal carcinoma can accelerate the apoptosis of tumor cells, reduce the local recurrence rates, and increase the rate of reserving the anus,therefore the therapy is safe, rational and effective for improving the therapeutic results in low rectal carcinoma.