术前同步放化疗对局部晚期直肠癌临床特征和相关蛋白的影响

The Effects of Preoperative Concurrent Chemoradiotherapy on Clinical Characteristics and CEA and PDCD4 Expression with Locally Advanced Rectal Cancer

目的:探讨术前同步放化疗(PCCRT)对局部晚期直肠癌(LARC)临床特征和相关蛋白的影响。方法:98例LARC患者按照2010年国际抗癌联盟标准进行临床分期和病理分级,平行PCCRT后统计学比较各期各级LARC患者疗效、肿瘤消退程度(TRG)、临床降期率及病理完全缓解(pCR)率。Western-blotting检测不同TRG肿瘤组织敏感性癌胚抗原(CEA)和程序性细胞死亡因子4(PDCD4)蛋白水平,并分析其与TRG的相关性。结果:经PCCRT后,LARC临床Ⅱ期和病理Ⅰ级患者的有效率较高(P<0.01)。获得有益疗效的临床各期患者出现了不同程度肿瘤消退和临床降期,临床Ⅱ期降期患者肿瘤完全消退(TRG 4级)率高于其它TRG级别;且临床Ⅱ期降期患者的肿瘤完全消退率显著高于临床Ⅲ期者(P均<0.01)。不同TRG患者CEA和PDCD4水平差异均有统计学意义(P<0.01)。与TRG 0级比较,TRG 2级患者CEA表达水平降低,PDCD4表达水平显著增加;与TRG 2级患者比较,TRG 4级患者CEA表达水平明显下降,PDCD4显著增加(P均<0.01)。TRG与CEA和PDCD4表达水平分别呈显著负相关和正相关(r分别为-0.67和0.83,P均<0.01)。结论:PCCRT可使LARC部分患者临床获益,检测肿瘤相关蛋白CEA和PDCD4水平,可评估LARC对PCCRT的敏感性和疗效,有一定实践意义。

Objective： To investigate the effects of preoperative concurrent chemoradiotherapy （PCCRT） on clinical characteristics and CEA and PDCD4 expression with locally advanced rectal cancer （LARC）. Method： All pathological specimens were selected from 98 patients with LARC before and after accepted PCCRT treatments at our hoptical from February 2012 to February 2016. According to correlated standard of 2010 International Anti Cancer Association, the clinical stage and pathological degree were further developed above mentioned all specimens. With correlated statistical softwares, effective percentage of treatment, rate of clinical downstage and tumor regression grade （TRG） as well as pathologic complete response （pCR） were analyzed and compared after PCCRT in patients with LARC. The levels of carcinoembryonic antigen （CEA） and programmed cell death 4 （PDCD4）as two sensitive biological factors were detected through Western-blotting methods and analyzed the correlations with different grades of tumor regression before and after PCCRT in patients with LARC. Results： With PCCRT, the effective percentage of treatment significantly increased among patients with LARC of clinical stage Ⅱ and pathological degree Ⅰ （P of all 〈0.01, respectively）. Then there were different alterations on the TRG and clinical downstage in pa tients with LARC accepted effects of PCCRT. The cases and percentage of TRG 4 on complete response was obvious upgraded compared with that of TRG 0-3 on poor response among patients with LARC of clinical stage Ⅱ accepted effects of PCCRT （P〈0.01, respectively）. Moreover, TRG 4 patients with LARC of clinical stage Ⅱ was completed super to that of clinical stage Ⅲ （P〈0.01）. The quantitative results of CEA were increasingly degraded from high to nothing, and that of PDCD4 was gradually upgraded from little to more in tumor non-regression, bad-regression and good-regression groups （P of all 〈0.01） as well as the grades of tumor regression had significant negative correlation with expression level of CEA （r=-0.67, P〈0. 01）, and positive correlation with that of PDCD4 （r=-0.83, P〈0.01） in patients with LARC before and after PCCRT. Conclusion： The PCCRT have more clinic effects to patients with LARC. The sensitive actions were attributed to decreas or increase of expression level of CEA and PDCD4 in patients with LARC before and after PCCRT, which could be a sensitive biological factors to detect effective action in clinical practices.