新辅助化疗对结直肠癌的作用

The effect of neoadjuvant chemotherapy on colorectal carcinoma

目的探讨短程5-FU/CF方案新辅助化疗对结直肠癌细胞凋亡、增殖和p53表达以及术后并发症和预后的影响。方法分别采用脱氧核糖核苷酸末端转移酶介导的缺口末端标记法(TUNEL)和免疫组化SP法检测68例患者结直肠癌组织的细胞凋亡指数(AI)和ki-67增殖指数(PI)及凋亡相关基因p53的表达,并比较新辅助化疗组和对照组患者术后并发症的发生情况和预后情况。结果新辅助化疗组肿瘤细胞的AI均数为3.56%,明高于对照组的2.29%(P<0.01),PI均数为22.60%明显低于对照组的33.60%(P<0.01),p53阳性表达率为28.9%(11/38)明显低于对照组的56.7%(17/30)(P<0.05)。两组中大肠癌细胞的AI与PI均呈负相关(r=-0.790,r=-0.663)(P<0.01)。两组术后并发症的发生差异无显著性(P<0.05)。两组的复发转移率和复发转移平均时间差异有显著性(P<0.05)。结论短程5-FU/CF方案新辅助化疗可以显著诱导结直肠癌细胞凋亡,并抑制其增殖;降低结直肠癌组织p53的阳性表达率,而不增加术后并发症的发生,能延缓和减少结直肠癌术后的复发转移。

Objective To investigate the effect of short-term neoadjuvant chemotherapy （ NC ） with 5-FU/CF on tumor cell apoptosis, tumor cell proliferation, expression of p53, postoperative complications and prognosis of colorectal carcinoma. Methods Apoptosis index （AI） of tumor cells was assayed by TUNEL, proliteration index （PI） and expression of p53 were examined by immunohistochemical S-P method in 68 colorectal carcinoma samples, while postoperative complications and prognosis were compared in NC groups and non- NC control group. Results AI in NC group （ x^- = 3.56 % ） was significantly higher than that in control group（x^- =2.29% ）（ P 〈0. 01 ）. PI in NC group（22.60% ） was significantly lower than that in control group（33.60% ） （ P 〈 0. 01 ） . The p53 positive expression rate in NC group （ 28. 9% , 11/38 ） was significantly lower than that in control group （ 56. 7% , 17/30 ） （ P 〈 0. 05 ）. There was no significant difference in the occurrence rate of postoperative complications between NC group and control group. There was significant negative association between AI and PI in both groups （ r = - 0. 790 ; r = - 0. 663 ） （P〈0.01）. There was significant difference in the rate and average time of recurrence and metastasis between NC group and control group （ P 〈 0.05 ）. Condusions Short-term neoadjuvant chemotherapy with 5-FU/CF could significantly induce cell apoptosis, inhibit tumor cell proliferation and decrease the positive rate of p53 expression in carcinoma of large intestine. Short-term 5-FU/CF neoadjuvant chemotherapy could delay and decrease the postoperative recurrence and metastasis in colorectal carcinoma without increasing the occurrence of postoperative complications.