直肠癌根治术前XELOX化学治疗方案对患者体液免疫及瘤组织血管内皮生长因子表达的影响

Influence of XELOX Chemotherapeutic Scheme on Humoral Immunity and VEGF Expression in Tumor Tissue before Radical Operation of Rectal Cancer

目的探讨直肠癌根治术前应用卡培他滨联合奥沙利铂(XELOX)的新辅助化学治疗(简称化疗)方案的临床疗效,以及对瘤组织血管内皮生长因子(VEGF)及体液免疫的影响。方法选择医院收治的Ⅱ期、Ⅲ期直肠癌患者80例,按随机数字表法均分为治疗组和对照组,各40例。治疗组患者术前接受XELOX化疗方案,对照组患者术前接受5-氟尿嘧啶(5-Fu)联合亚叶酸钙(de Gramont)化疗方案。采用速度散射比浊法,于化疗第1个周期前(化疗前)、第3或4个周期前(化疗中)、第9个周期(化疗后)检测患者血清免疫球蛋白(Ig G,Ig A,Ig M)的含量,采用血细胞计数仪分析全血中淋巴细胞总数、B淋巴细胞的含量,采用免疫组化法检测化疗前后患者肿瘤组织中VEGF表达情况。结果治疗组近期疗效总有效率显著高于对照组(P<0.05);两组患者化疗后血清Ig M水平、淋巴细胞总数均较化疗前显著下降(P<0.05)。两组患者化疗后肿瘤组织中VEGF表达较化疗前显著下降(P<0.05)。结论直肠癌术前采用XELOX辅助化疗方案的疗效优于de Gramont化疗方案,可抑制肿瘤组织的VEGF表达,但同时也会损伤肿瘤患者体液的免疫功能。

Objective To observe the clinical efficacy of neoadjuvant chemotherapy scheme of capecitabine plus oxaliplatin（ XELOX）and its influence on vascular endothelial growth factor（ VEGF） in tumor tissue and humoral immunity before the radicaloperation of rectal cancer. Methods 80 cases of stage Ⅱ,Ⅲ rectal cancer in our hospital were selected and randomly divided into the treatment group and the control group according to the random number table method,40 cases in each group. The treatment group received the XELOX scheme before operation,while the control group received the 5- fluorouracil combined with calcium folinate before operation. The contents of serum Ig G,Ig A and Ig M were detected before 1 cycle（ before chemotherapy）,3 or 4 cycles（ intra- chemotherapy）,9 cycles（ after chemotherapy） by using the speed scattering turbidimetry assay. The total number of lymphocytes and B lymphocytes in whole blood were detected by using the whole blood cytometry instrument. The VEGF expression in tumor tissue was detected by using the immunohistochemical method. Results The total effective rate of short term curative effect in the treatment group was significantly higher than that in the control group（ P 0. 05）; the serum Ig M level and total lymphocyte count after treatment in the two groups were significantly decreased than pre- chemotherapy（ P 0. 05）. The expression of VEGF in tumor tissue after treatment in the two groups were significantly decreased than pre- chemotherapy（ P 0. 05）. Conclusion Adopting the XELOX neoadjuvant chemotherapy scheme has better effect before operation in rectal cancer than the de Gramont chemotherapeutic scheme,which can inhibit the VEGF expression in tumor tissue,but at the same time damages the humoral immunity function.