胰岛素样生长因子在胃癌新辅助化疗疗效评估中的价值

The value of insulin-like growth factor in the evaluation of the effect of neoadjuvant chemotherapy in gastric cancer

背景与目的:近年来研究发现,胰岛素样生长因子(insulin-like growth factor,IGF)与肿瘤的发病和进展相关。该研究主要探讨IGF在胃癌新辅助治疗疗效评估中的价值。方法:该研究回顾性分析了96例确诊的Ⅲ期胃癌患者临床资料,使用FOLFOX4方案作术前静脉新辅助化疗后行胃癌根治术,并评估治疗的效果。按病理分化程度分为低分化、中分化、高分化3组。采用酶标化学发光免疫分析的方法分别检测各组患者在新辅助化疗前后的外周血IGF-Ⅰ和胰岛素样生长因子结合蛋白-3(insulin-like growth factor-bindingprotein-3,IGFBP3)表达水平,另选择50例体检健康人作为对照组,分析外周血IGF-Ⅰ和IGFBP3对胃癌新辅助治疗疗效评估的意义。结果:胃癌患者治疗前IGF-Ⅰ较对照组明显增高,对照组为(156±19)ng/mL,高、中、低分化组分别为(188±19)、(212±24)和(240±27)ng/mL,肿瘤的恶性程度越高,IGF-Ⅰ值越高(P<0.05)。而IGFBP3较对照组明显降低,对照组为(4.9±0.6)μg/mL,高、中、低分化组分别为(3.9±0.8)、(3.1±0.6)和(2.6±0.8)μg/mL,肿瘤的恶性程度越高,IGFBP3值越低(P<0.05)。胃癌患者经新辅助化疗有效后IGF-Ⅰ值较治疗前明显降低,高、中、低分化组分别为(165±15)、(176±20)和(186±19)ng/mL。而IGFBP3值较治疗前明显升高,高、中、低分化组分别为(4.4±0.9)、(4.2±0.8)和(4.0±0.9)μg/mL,但均不能恢复至对照组水平(P<0.05)。结论:IGF-Ⅰ和IGFBP3有助于评估胃癌的恶性程度及新辅助治疗效果,可能是一种新的协助诊断胃癌并判断预后的生物学指标。

Background and purpose： Recent research shows that insulin-like growth factor （IGF） is related to the pathogenesis and progression of tumor. This research aimed to explore the value of IGF in the evaluation of the effect of neoadjuvant chemotherapy in gastric patients. Methods： Ninety-six cases of definitely diagnosed gastric cancer patients were collected and were treated with FOLFOX4 neoadjuvant chemotherapy, and were subdivided into poorly moderately and well differentiated group according to the degree of pathological differentiation. Their clinical data and the enzyme-labeled chemiluminescent immmaometric assay were collected to detect the IGF- I and IGFBP3 before and after treatment. Their changes and the association among IGF- I, IGFBP3, the differentiation degree and therapeutic efficacy were analyzed. Fifty cases of healthy people were enrolled as control. Results： The level of IGF- I was much higher in the well, moderately and poorly differentiated groups [（188±19）, （212±24） and （240±27） ng/ mL] than in the control group [（156±19） ng/mL] before neoadjuvant chemotherapy, and increased with the degree of malignancy. On the contrary, the level of IGFBP3 was much lower in 3 differentiated groups [（3.9±0.8）, （3.1±0.6） and （2.6±0.8） μg/mL] than in the control group [（4.9±0.6） ~tg/mL] and decreased with the degree of malignancy. The level of IGF- I decreased obviously when treated effectively, were （165±15）, （176±20） and （186±19） ng/rnL in the well,moderately and poorly differentiated groups respectively, while the IGFBP3 were （4.4±0.9）, （4.2±0.8） and （4.0±0.9） μg/ mL in category respectively. Eaeh of them could not be normalized. Conclusion： IGF- I and IGFBP3 are useful to evaluate the degree of malignancy and therapeutic efficacy of gastric cancer. Perhaps they will be a novel biomarkers for gastric cancer.