术前新辅助放化疗对食管癌原发灶病理形态学及Ki-67表达的影响

Expression of Ki-67 and pathomorphological response after preoperative chemoradiotherapy in patients with esophageal cancer

目的研究术前新辅助放化疗对食管肿瘤病理形态学改变及对食管癌细胞增殖的影响,并探讨二者之间的关系。方法选择40例食管鳞癌初治患者,治疗前经食管镜活检病理确诊,行新辅助放化疗加根治性手术治疗,术后常规进行手术标本病理学检查,免疫组化染色分别检测治疗前活检标本和手术标本Ki-67表达的标记指数。结果放化疗后重度反应者12例(30.0%),中度反应20例(50.0%),轻度反应8例(20.0%)。显著有效率30.0%,总有效率80.0%。放化疗前、后食管鳞癌组织中Ki-67表达的标记指数差异有统计学意义(P<0.01);重、中度放化疗反应组放化疗前、后Ki-67标记指数的差异有统计学意义(P<0.01);轻度反应组放化疗前Ki-67标记指数与放化疗后存在差异,但差异无统计学意义(P>0.05)。结论多数食管癌患者接受新辅助放化疗后仍有肿瘤病灶存在,约20%的患者肿瘤组织退缩不明显。放化疗前后食管鳞癌组织中Ki-67表达的标记指数明显下降,提示放化疗后肿瘤的增殖能力较放化疗前下降。

Objective To investigate the effect of preoperative radiochemotherapy on proliferation and alteration of primary lesion pathology in esophageal carcinoma.Methods 40 patients with esophageal carcinoma enrolled into this study received biopsy by an esophagoscope prior to treatment and then preoperative adjuvant radiochemotherapy and surgical treatment.Expression of the Ki-67 protein in both biopsy and postoperative specimens was detected by immunohistochemical staining technique.Results After surgery,8（20%） patients were detected with tumor regression in a mild degree,20（50%） in a moderate degree,and 12（30%） in a severe degree.The overall response rate was 80%.Expression of Ki-67,as a predictive marker of response to preoperative chemoradiotherapy for esophageal cancers,was significantly correlated with tumor regression.Expression of Ki-67 was significantly decreased in tumors with severe response to preoperative treatment,when compared to those with moderate and mild responses（P〈0.01）.Expression of Ki-67 in the slightly shrank group was lower after radiochemotherapy than that before radiochemotherapy,while the difference was not significant（P〉0.05）.Conclusion There are still relict tumor cells after radiochemotherapy in most patients with esophageal carcinoma,about 20% of which are detected without significant tumor regression.Expression level of Ki-67 in esophageal carcinoma tissues significantly descends after radiochemotherapy,which may imply proliferation and invasion of the tumor decrease.