放疗加量对T_(4)期乳腺癌改良根治术后患者血清Ki-67、Bax及Bcl-2水平的影响

Influence of Radiotherapy Plus Dosage on Serum Ki-67,Bax and Bcl-2 Levels after Modified Radical Surgery in Patients with T_(4) Breast Cancer

目的分析放疗加量对T_(4)期乳腺癌改良根治术后患者血清细胞核增殖相关抗原Ki-67、促凋亡基因Bcl-2相关X蛋白(Bax)及凋亡抑制基因Bcl-2水平的影响。方法选取2015年1月至2019年12月安徽医科大学附属宿州医院普外三科收治的106例T_(4)期乳腺癌改良根治术后患者作为研究对象,根据治疗方法不同分为常规剂量照射组和加量照射组,每组53例。其中,常规剂量照射组放疗总剂量为2 Gy分次放射的“等效生物剂量”≤50 Gy,加量照射组放疗总剂量为2 Gy分次放射的“等效生物剂量”>50 Gy,均治疗6周。观察并比较两组患者放疗前后血清Ki-67、Bax、Bcl-2水平变化,急性放射性皮肤损伤以及复发转移情况。结果血清Ki-67、Bax及Bcl-2水平的时点间和组间存在交互作用(P<0.05),放疗后,两组患者的血清Ki-67、Bcl-2水平均降低,且加量照射组低于常规剂量照射组[(14.17±6.68)ng/L比(23.58±8.09)ng/L、(1.13±0.22)μg/L比(1.47±0.26)μg/L](P<0.05);Bax水平升高,且加量照射组高于常规剂量照射组[(3.97±0.60)μg/L比(2.89±0.56)μg/L](P<0.05)。放疗过程中,常规剂量照射组患者出现放射性皮肤损伤16例,加量照射组患者出现放射性皮肤损伤24例,两组皮肤损伤情况比较差异无统计学意义(P>0.05)。随访过程中,两组局部复发、转移并复发及总复发转移率比较差异无统计学意义(P>0.05)。结论与常规放疗剂量相比,放疗加量更有利于降低Ki-67、Bcl-2水平,提高Bax水平,从而达到抑制乳腺癌细胞增殖的目的。

Objective To analyze the effects of radiotherapy plus dosage on the levels of nuclear proliferation-related antigen Ki-67,pro-apoptotic gene Bcl-2 associated X protein(Bax)and apoptotic suppressor gene Bcl-2 in serum of patients with T_(4)stage breast cancer after modified radical resection.Methods A total of 106 patients with T_(4)stage breast cancer after modified radical resection in Department Three of General Surgery,Suzhou Hospital of Anhui Medical University from Jan.2015 to Dec.2019 were included.According to different treatment methods,they were divided into a conventional dose irradiation group and a plus dose irradiation group,with 53 patients in each group.Among them,the"equivalent biological dose"of 2Gy per time was≤50 Gy in the conventional dose irradiation group,and>50 Gy in the plus dose irradiation group,and both groups were treated for 6 weeks.The changes of serum Ki-67,Bax and Bcl-2 levels,acute radiation skin injury and recurrence and metastasis before and after radiotherapy were observed and compared between the two groups.Results Serum Ki-67,Bax and Bcl-2 levels had interactions between time points and groups(P<0.05).After radiotherapy,the levels of serum Ki-67 and Bcl-2 in both groups were decreased,and the plus dose irradiation group was lower than the conventional dose irradiation group[(14.17±6.68)ng/L vs(23.58±8.09)ng/L,(1.13±0.22)μg/L vs(1.47±0.26)μg/L](P<0.05);the level of Bax increased,and the plus irradiation group was higher than the conventional irradiation group[(3.97±0.60)μg/L vs(2.89±0.56)μg/L](P<0.05).During radiotherapy,there were 16 cases of skin damage in the conventional dose group and 24 cases in the plus dose group,and there was no significant difference between the two groups(P>0.05).During the follow-up,there were no significant differences in the rates of local recurrence,metastasis with recurrence and total recurrence and metastasis between the two groups(P>0.05).Conclusion Compared with conventional radiotherapy dose,the plus dosage is more beneficial to reduce the levels of Ki-67 and Bcl-2,and increase the level of Bax,thus achieving the purpose of inhibiting the proliferation of breast cancer cells.