术前新辅助化疗联合同步放化疗对局部进展期直肠癌预后及血清标志物影响

Preoperative Neoadjuvant Chemotherapy Combined with Concurrent Radiotherapy and Chemotherapy on the Prognosis and Serum Markers of Locally Advanced Rectal Cancer

目的:探讨术前同步放化疗联合氟尿嘧啶+亚叶酸钙+奥沙利铂(FOLFOX4)新辅助化疗对局部进展期直肠癌患者血清血清脂肪酸合成酶(FAS)、肿瘤型M2丙酮酸激酶(Tu M2-PK)表达的影响,为直肠癌的临床治疗方案提供参考。方法:选取100例进展期直肠癌患者为研究对象,以抽签法随机分为试验组和对照组,各50例。试验组术前同步放化疗5周后行4周期FOLFOX4新辅助化疗,结束后进行全直肠系膜切除术(TME术),术后4周再行4周期FOLFOX4化疗;对照组同步放化疗5周,结束后6~8周行TME术,术后4周行8周期FOLFOX4化疗。比较两组患者病理完全缓解率(pCR)、手术根治性切除率(R0切除率)、降期率、局部复发率、远处转移率、总生存率、不良反应以及并发症发生情况,并于治疗前后检测并比较两组患者血清脂肪酸合成酶(FAS)、肿瘤型M2丙酮酸激酶(Tu M2-PK)水平。结果:治疗后,试验组降期率、R0切除率、pCR率(80%、86%、27%)显著高于对照组(48%、64%、6%),差异均具有统计学意义(χ2=6.182,P=0.013);试验组术后随访2年的局部复发率、远期转移率(8%、27%)显著低于对照组(24%、46%)(P=4.581,P=0.032;χ2=4.054,P=0.044),两组生存率(OS)log-rank检验显示具有统计学差异,生存曲线上显示log-rank P=0.035;试验组不良反应及术后并发症发生率与对照组相比,差异均无统计学意义(P>0.05);FOLFOX4化疗结束后两组患者的血清FAS、Tu M2-PK水平相比术前均明显下降,且试验组血清FAS、Tu M2-PK水平改善程度显著优于对照组,具有统计学意义(t=9.791,4.508,P均<0.001)。结论:FOLFOX4联合术前同步放化疗治疗局部进展期直肠癌不仅可以提高肿瘤降期率以及总生存期限,可显著降低血清FAS、Tu M2-PK水平,抑制肿瘤的增殖、侵袭和转移,且无明显毒副作用。

Objective To investigate the effect of FOLFOX4 combined with preoperative concurrent chemoradiotherapy on the expression of serum fatty acid synthase(FAS)and Tumor-type M2 pyruvate kinase(Tu M2-PK)in patients with locally advanced rectal cancer,and to provide a reference for the clinical treatment of rectal cancer.Methods One hundred patients with advanced rectal cancer were enrolled in the study.The randomized digital table method was used to divide patients into test group and control group,which 50 cases in each group.The test group received FOLFOX4 combined with preoperative concurrent chemoradiotherapy:4 cycles of FOLFOX4 chemotherapy after concurrent chemoradiotherapy,total mesorectal excision after the end,and 4 cycles of FOLFOX4 chemotherapy 4 weeks after surgery.The control group received preoperative concurrent chemoradiotherapy:TME was performed 6 to 8 weeks after the end of concurrent chemoradiotherapy,and 8 cycles of FOLFOX4 chemotherapy were performed 4 weeks after surgery.The complete pathologic response rate(pCR),radical resection rate(R0 resection rate),declining rate,local recurrence rate,distant metastasis rate,overall survival rate,adverse reactions and complications were compared between the two groups.The levels of serum fatty acid synthase(FAS)and Tumor-type M2 pyruvate kinase(Tu M2-PK)were detected and compared before and after treatment.Results After treatment,the rate of decline,R0 resection rate,pCR rate in the test group(80%,86%,27%)were significantly higher than those of the control group(48%,64%,6%),which with statistical significance(χ2=6.182,P=0.013).The local recurrence rate and long-term metastasis rate(8%,27%)in the test group were significantly lower than those in the control group(24%,46%)(χ2=4.581,P=0.032;χ2=4.054,P=0.044).The survival rate(OS)log-rank test showed the statistical differences between the two groups,and K-M curve showed log-rank P=0.035.The incidence of adverse reactions and postoperative complications in the test group was not statistically different from the control group,which with no statistical significance(P>0.05).After the end of FOLFOX4 chemotherapy,the serum FAS and Tu M2-PK levels in the two groups were significantly lower than those in the preoperative group,and the serum FAS and Tu M2-PK levels in the test group were significantly improved compared with the control group(t=9.791,4.508,P<0.001).Conclusion FOLFOX4 combined with preoperative concurrent chemoradiotherapy for locally advanced rectal cancer can not only improve the tumor declining rate and overall survival period,but also has no obvious side effects.It can significantly reduce serum FAS and Tu M2-PK levels,which inhibit tumor proliferation,invasion and metastasis.