进展期胃癌患者腹腔镜根治术前辅助化疗对血清PADI4、cAT、VEGF及IGF-1表达的影响

Effect of preoperative adjuvant chemotherapy combined with laparoscopic radical gastrectomy on serum PADI4 and cAT expression in patients with advanced gastric cancer

目的探究术前辅助化疗联合腹腔镜胃癌根治术治疗进展期胃癌的疗效及对血清肽酰基精氨酸脱亚氨酶(PADI4)、瓜氨酸化抗凝血酶(cAT)、血管内皮生长因子(VEGF)和类胰岛素增长因子1(IGF-1)表达的影响。方法选取铁岭市中心医院普通外科2014年9月—2016年9月收治的进展期胃癌患者90例,随机数字表法分成研究组和对照组各45例,对照组给予腹腔镜根治术,研究组在术前给予新辅助化疗。观察2组围手术期情况,研究组化疗前后临床分期变化、2组手术前后血清PADI4、cAT、VEGF及IGF-1表达情况,比较术后1年存活率和复发率及不良反应发生率。结果 2组手术时间、术中出血量、胃肠道功能恢复时间、下床活动时间、术后肛门排气时间等比较差异无统计学意义(P> 0. 05),而研究组总切除率、淋巴结清扫数目显著高于对照组(χ~2=4. 860,t=5. 207,P <0. 05)。研究组新辅疗后,患者临床病理分期均得到显著改善(χ~2=39. 130,P <0. 01)。研究组的客观缓解率为64. 4%(29/45),显著高于对照组的42. 3(19/45)(χ~2=4. 460,P <0. 05)。术后3个月,研究组患者血清PADI4、cAT、VEGF、IGF-1表达显著低于对照组(t=28. 500、16. 745、3. 411、3. 753,P <0. 01)。研究组患者术后1年存活率显著高于对照组,复发率显著低于对照组(χ~2=4. 410、4. 860,P <0. 05)。2组患者不良反应发生率比较差异无统计学意义(χ~2=0. 090,P>0. 05)。结论术前辅助化疗联合腹腔镜胃癌根治术治疗进展期胃癌效果显著,并能显著改善患者血清PADI4、cAT、VEGF、IGF-1表达水平。

Objective To explore the curative effect of neoadjuvant chemotherapy combined with laparoscopic radical gastrectomy for advanced gastric cancer and influence on the serum peptidyiarginine deiminase (PADI4) and citrullinated antithrombin (cAT) expression. Methods Ninety patients selected from September 2014 to September 2016 with advanced gastric cancer were randomly divided into observation group (n = 45) and control group (n = 45). The control group was treated with laparoscopic radical operation,the observation group was given preoperative neoadjuvant chemotherapy on basis of control group. The changes of clinical stages before and after chemotherapy,the postoperative expression of serum PADI4,cAT,VEGF and IGF-1,1 year survival rate,recurrence rate and adverse reaction rate were compared between the two groups. Results There was no significant difference between the two groups in the operation time,gastrointestinal function recovery time,the time of postoperative anal exhaust and the number of cases of blood transfusion during operation (t = 1. 885,t =1. 800,t = 1. 437,t = 1. 046,all P > 0. 05). The total excision rate and lymph node dissection in the study group were significantly higher than those in the control group (χ^2= 4. 860,t = 5. 207,all P < 0. 05). Before chemotherapy,there was no significant difference in clinical staging between the two groups (χ^2= 0. 070,P > 0. 05),and the clinicopathologic stages in the study group were significantly improved after the new adjuvant therapy (χ^2= 39. 130,P < 0. 01). The readmission rate of the observation group after chemotherapy was 64. 4% (29/45),which was significantly higher than that of the control group (42. 3%) (19/45) (χ^2= 4. 460,P < 0. 05). After operation,the expression of PADI4,cAT,VEGF and IGF-1 in the observation group was significantly lower than that in the control group (t = 28. 500,t = 16. 745,t = 3. 411,t = 3. 753,all P < 0. 01).The 1 year survival rate in the observation group was significantly higher than that in the control group,and the recurrence rate was significantly lower in the observation group than in the control group (χ^2= 4. 410,χ^2= 4. 860,all P < 0. 05). There was no significant difference in the incidence of side effects between the two groups (χ^2= 0. 090,P > 0. 05). Conclusion Preoperative adjuvant chemotherapy combined with laparoscopic radical gastrectomy is effective in the treatment of advanced gastric cancer,and significantly improve the serum levels of PADI4 and cAT.