进展期食管癌患者接受紫杉醇联合顺铂新辅助化疗后的肿瘤标志物及癌基因评价

Evaluation of tumor markers and oncogenes in advanced esophageal cancer patients after neoadjuvant chemotherapy with paclitaxel and cisplatin

目的研究紫杉醇联合顺铂新辅助化疗对进展期食管癌患者肿瘤标志物分泌及癌基因表达的影响。方法前瞻性选择2017年3月至2020年1月期间重庆市巴南区人民医院收治的50例进展期食管癌患者,随机数字表法分为紫杉醇联合顺铂新辅助化疗+根治性手术的观察组、直接接受根治性手术的对照组,每组各25例。确诊时及手术前,测定2组患者血清中肿瘤标志物[癌胚抗原(CEA)、糖类抗原19-9(CA19-9)、鳞状细胞癌癌抗原(SCC-Ag)、肿瘤相关细胞角蛋白19片段(CYFRA21-1)]的含量;手术后,测定2组患者食管癌病灶内癌基因[DACH1基因、食管癌相关基因4(ECRG4)、Ras相关区域家族1A(RASSF1A)、10号染色体缺失的磷酸酶和张力蛋白同源基因(PTEN)、细胞周期蛋白D1(CCND1)、血管内皮生长因子(VEGF)、β-连环蛋白(β-catenin)、Notch1基因]的mRNA表达量。结果确诊时,2组间血清CEA、CA19-9、SCC-Ag、CYFRA21-1的含量比较,差异无统计学意义(P>0.05);手术前,观察组血清中CEA、CA19-9、SCC-Ag、CYFRA21-1的含量分别为(8.58±1.03)μg/L、(31.75±5.57)U/mL、(0.72±0.09)μg/L、(2.88±0.42)μg/L,明显低于对照组[(18.91±2.44)μg/L、(98.88±11.83)U/mL、(1.38±0.15)μg/L、(4.05±0.64)μg/L],差异有统计学意义(P<0.05)。手术后,观察组食管癌病灶内DACH1基因、ECRG4、RASSF1A、PTEN的mRNA表达量分别为0.97±0.14、1.03±0.16、1.01±0.16、0.96±0.09,明显高于对照组(0.57±0.08、0.44±0.07、0.61±0.08、0.66±0.08),CCND1、VEGF、β-catenin、Notch1基因的mRNA表达量分别为0.62±0.08、0.53±0.07、0.65±0.08、0.58±0.07,明显低于对照组(1.06±0.18、1.01±0.14、1.02±0.17、0.99±0.12),差异有统计学意义(P<0.05)。结论紫杉醇联合顺铂新辅助化疗用于进展期食管癌患者能减少肿瘤标志物的分泌、调节癌基因的表达。

Objective To study the effect of neoadjuvant chemotherapy with paclitaxel and cisplatin on tumor marker secretion and oncogene expression in patients with advanced esophageal cancer.Methods Fifty patients with advanced esophageal cancer admitted in Chongqing Banan District People's Hospital from March 2017 to January 2020 were randomly divided into two groups:the observation group treated with paclitaxel combined with cisplatin neoadjuvant chemotherapy+radical operation and the control group treated with radical operation.The levels of serum tumor markers[carcinoembryonic antigen(CEA),carbohydrate antigen 19-9(CA19-9),squamous cell carcinoma antigen(SCC-Ag)and tumor-associated cytokeratin 19 fragment(CYFRA21-1)]were measured at the time of diagnosis and before surgery,and the expression of oncogenes in esophageal cancer lesions[DACH1 gene,esophageal cancer-related gene 4(ECRG4),Ras-related region family 1A(RASSF1A),phosphatase and tensin homologous genes deleted on chromosome 10(PTEN),cyclin D1(CCND1),vascular endothelial growth factor(VEGF),β-catenin(β-catenin)]was measured after surgery.Results Before surgery,the serum levels of CEA,CA19-9,SCC-Ag,and CYFRA21-1 in the observation group were(8.58±1.03)μg/L,(31.75±5.57)U/mL,(0.72±0.09)μg/L,(2.88±0.42)μg/L,which were significantly lower than those of the control group[(18.91±2.44)μg/L,(98.88±11.83)U/mL,(1.38±0.15)μg/L,(4.05±0.64)μg/L],the differences were statistically significant(P<0.05).After surgery,the mRNA expression levels of DACH1 gene,ECRG4,RASSF1A,and PTEN in the esophageal cancer lesions of the observation group were 0.97±0.14,1.03±0.16,1.01±0.16,0.96±0.09,which were significantly higher than those of the control group(0.57±0.08,0.44±0.07,0.61±0.08,0.66±0.08),CCND1,VEGF,β-catenin,Notch1 gene mRNA expression level were 0.62±0.08,0.53±0.07,0.65±0.08,0.58±0.07,which were significantly lower than those of the control group(1.06±0.18,1.01±0.14,1.02±0.17,0.99±0.12),the differences were statistically significant(P<0.05).Conclusion Neoadjuvant chemotherapy with paclitaxel and cisplatin can reduce tumor marker secretion and regulate oncogene expression in advanced esophageal cancer patients.