新辅助化疗对细胞核增殖抗原和血管内皮生长因子蛋白在食管胃结合部腺癌淋巴结中表达的病理预后研究

Pathological prognosis of neoadjuvant chemotherapy on the expression of proliferation cell nuclear antigen and vascular endothelial growth factor proteins in the adenocarcinoma of gastroesophageal junction

目的探讨新辅助化疗对食管胃结合部腺癌(AGEJ)淋巴结中细胞核增殖抗原(Ki-67)和血管内皮生长因子(VEGF)蛋白表达的影响,并分析Ki-67和VEGF蛋白对新辅助化疗的病理预后影响。方法前瞻性的选取2013年1月至2016年12月在河北北方学院附属第一医院行手术治疗的503例AGEJ患者作为研究对象,按患者自主意愿分为手术组(253例)和手术联合新辅助化疗组(新辅助化疗组,250例)。比较两组患者化疗前后的Ki-67、VEGF表达及临床疗效、预后;以Ki-67、VEGF表达为分组依据,分析Ki-67、VEGF表达对新辅助化疗患者的预后影响。结果新辅助化疗的临床效果分析:新辅助化疗组客观有效(ORR)为57.2%,显著高于手术组的37.94%(χ^2=18.695,P<0.05);且新辅助化疗总生存时间(OS)、无进展生存时间(PFS)均显著高于手术组(Log Rankχ^2=17.483、9.334,P<0.05);化疗前2组患者Ki-67、VEGF高表达占比差异无统计学意义(P>0.05),化疗后新辅助化疗组Ki-67、VEGF高表达率分别为21.2%、16.8%,显著低于手术组的56.13%、28.85%(χ^2=64.618,、10.360,P<0.05)。Ki-67、VEGF表达对对新辅助化疗预后影响:Ki-67、VEGF高表达的ORR显著高于Ki-67、VEGF低表达组(χ^2=25.145、10.829,P<0.05),且Ki-67、VEGF高表达组PFS、OS显著高于Ki-67、VEGF低表达组(Log Rankχ^2=15.220、17.606,P<0.05)。结论新辅助化疗可有效改善AGEJ患者短期、长期预后。

Objective To explore the effect of neoadjuvant chemotherapy on the expression of proliferation cell nuclear antigen(Ki-67)and vascular endothelial growth factor(VEGF)proteins in adenocarcinoma of gastroesophageal junction(AGEJ)lymph nodes,and analyze the effect of ki-67 and VEGF proteins on the pathological prognosis of neoadjuvant chemotherapy.Methods Prospective 503 AGEJ patients who underwent surgery in our hospital from January 2013 to December 2016 were selected as study subjects,and were divided into surgery group(253 cases)and surgery combined with neoadjuvant chemotherapy group(250 cases)according to patients’voluntary will.Comparison of two groups before and after chemotherapy in patients with Ki-67,the expression of VEGF and clinical curative effect and prognosis;Ki-67,VEGF expression for grouping the basis,analysis of Ki-67,the influence on the prognosis of neoadjuvant chemotherapy in patients with VEGF expression.Results Clinical effect analysis of neoadjuvant chemotherapy:ORR of neoadjuvant chemotherapy group was 57.2%,significantly lower than that of surgery group 37.94%(χ^2=18.695,P<0.05).OS and PFS of neoadjuvant chemotherapy were significantly higher than those of the surgery group(Log Rankχ^2=17.483,9.334,P<0.05).Before chemotherapy,there was no statistically significant difference in the proportion of ki-67 and VEGF expression in the two groups(P>0.05),after chemotherapy,the Ki-67 and VEGF expression rates in the neoadjuvant chemotherapy group were 21.2%and 16.8%,respectively,which were significantly higher than the 56.13%and 28.85%of the surgery group(χ^2=64.618,10.360,P<0.05).The effect of Ki-67 and VEGF expression on the prognosis of neoadjuvant chemotherapy:ORR with high Ki-67 and VEGF expression was significantly higher than that of the low Ki-67 and VEGF expression group(χ^2=25.145,10.829,P<0.05),and OS and PFS of the high Ki-67 and VEGF expression group were significantly higher than that of the low Ki-67 and VEGF expression group(Log Rankχ^2=15.220,17.606,P<0.05).Conclusion Neoadjuvant chemotherapy can effectively improve the short-term and long-term prognosis of AGEJ patients,and patients with high expression of Ki-67 and VEGF may benefit more from neoadjuvant chemotherapy.