TOPOⅠ表达和K-ras基因突变在转移性结肠直肠癌个体化治疗中的价值

Clinical values of topoisomerase Ⅰ expression and K-ras gene mutation in individualized therapies of metastatic colorectal cancer

目的:探讨DNA拓扑异构酶Ⅰ(TOPOⅠ)表达水平和K-ras基因突变的检测在转移性结肠直肠癌个体化治疗中的临床价值及意义。方法:选取2012年1月至2014年6月于我院胃肠外科接受结肠直肠癌根治性切除术,术后转移病人40例,随机分为试验组和对照组。试验组根据TOPOⅠ表达水平和K-ras基因突变检测结果行个体化治疗,对照组随机选择化疗方案。观察其临床疗效和不良反应。以Kaplan-Meier方法计算生存时间,评价客观缓解率和疾病控制率。结果:39例病人疗效可评价,试验组客观缓解率67%,疾病控制率81%,对照组客观缓解率50%,疾病控制率72%,两组比较无统计学差异(P>0.05)。试验组皮疹发生率高于对照组,而腹泻发生率低于对照组,差异有统计学意义(P<0.05)。试验组中位无进展生存期明显长于对照组(8个月比5个月,P<0.05),两组中位生存时间无明显差异(16个月比13个月,P>0.05)。结论:基于TOPOⅠ表达和K-ras基因检测的转移性结肠直肠癌个体化治疗方案可延缓病情进展,减少不良反应发生率,对提高疗效有一定应用价值。

Objective To study the clinical values of detecting topoisomerase Ⅰ（TOPOⅠ） expression and K-ras gene mutation in individualized therapies of metastatic colorectal cancer. Methods Forty patients with radical resection and postoperational metastatic colorectal cancer were randomised into 2 groups from January 2012 to June 2014 in this hospital. The patients in test group received individualized treatment following TOPO Ⅰ expression and K-ras gene mutation while the patients in control group had randomized treatment. The clinical efficacy and adverse reactions were observed.Objective response rate（ORR） and disease control rate（DCR） were evaluated and the survival was analyzed by KaplanMeier method. Results Thirty-nine patients could be evaluated. ORR and DCR were 67% and 81% in test group and 50%and 72% in control group respectively. There was no significant differences between two groups（P〉0.05）. Frequency of erythra in test group was higher than that in control group while test group had lower frequency of diarrhea（P〈0.05）.Median progression free survival was 8 months for test group and 5 months for control group（P〈0.05）, while median survival times was 16 months for test group and 13 months for control group respectively（P〉0.05）. Conclusions The individualized treatment based on detection of TOPOⅠexpression and K-ras gene can delay progress of disease, reduce adverse reactions and have some effect in metastatic colorectal cancer.