支气管动脉灌注化疗治疗非小细胞肺癌的疗效及血清相关因子变化的研究

Efficacy of bronchial arterial chemotherapy on non-small cell lung cancer and correlations with changes of ERCC1, VEGF and SE-CAD

目的探讨支气管动脉灌注化疗(BAI)治疗非小细胞肺癌(NSCLC)的疗效及治疗前、后患者血清中切除修复交叉互补基因1(ERCC1)、血管内皮生长因子(VEGF)和可溶性钙粘蛋白(SE-CAD)水平变化与疗效的相关性。方法收集60例采用BAI治疗的NSCLC患者术前、术后的影像学资料并评价近期疗效;采用酶联免疫吸附法(ELISA)检测BAI治疗前、后患者血清中ERCC1、VEGF和SE-CAD水平的变化。结果经过2个周期的BAI治疗,60例NSCLC患者的有效率(RR)为61.7%;其中鳞癌患者的RR为78.4%,腺癌患者为34.8%,差异有统计学意义(P<0.05)。经BAI治疗后1周及1个月,血清ERCC1水平较治疗前均增高,差异有统计学意义(P<0.05);治疗前血清ERCC1低浓度组(<75.43pg/ml)的RR为71.1%,明显高于高浓度组(>75.43pg/ml)的45.5%,差异有统计学意义(P<0.05);而血清VEGF及SE-CAD治疗后的表达水平均较治疗前明显下降(P<0.05)。主要的毒副反应包括骨髓抑制、胃肠道反应及胸痛,而肝、肾功能损害的发生率均较低。结论 BAI是治疗局部晚期NSCLC一种安全、有效的方法,患者血清中ERCC1、VEGF和SE-CAD的表达水平有可能作为其疗效和预后的判断指标。

Objective To explore the efficacy of bronchial arterial chemotherapy （BAI） in treatment of non-small cell lung cancer（NSCLC） and the correlations with changes of serum excision repair cross complementing 1 （ERCC1） ,vascular endotbelial growth factor（VEGF） and soluble E-cadherin（SE-CAD） levels in patients with NSCLC before and after intervention therapy. Methods Image data of 60 NSCLC patients in the preoperative and postoperative were collected and to evaluate the short-time curative effects and the lev- els of serum ERCC1, VEGF and SE-CAD were detected by ELISA before and after treatment in 60 patients with NSCLC treated by BAI. Results After 2 cycles＇ treatment of BAI, the size of patients＇ tumor has been controlled in various degrees with an effective rate of 61.7%, and the effective rate of squamous cell carcinoma and adenoearcinoma was 78.4% and 34. 8% （ P 〈 0. 05 ）. The expressions of serum ERCC1 after one week and one month increased significantly compared with pre-treatment（P 〈0. 05）. The effective rate of patients who had low serum ERCC1 after treatment of BAI was 71.1% and high serum ERCC1 was 45.5% of patients. Serum level of VEGF and SE-CAD decreased significantly compared with pre-treatment（P 〈0. 05）. The main toxic reactions were myelosupression, gastrointestinal reaction and stethalgia,and hepatic and kidney function lesion was with low occurrence rate. Conclusion BAI is one of safe and effec- tive methods towards locally advanced NSCLC. Levels of serum ERCC1, VEGF and SE-CAD may be used as indicators of efficacy and prognosis.