3.0T MRI联合HMGB1表达对直肠癌新辅助治疗疗效的评估

Evaluation of neoadjuvant therapy for rectal cancer treated by 3.0T MRI combined with high mobility group protein B1 expression

目的 探讨高分辨率3.0T核磁共振(3.0T MRI)联合直肠癌组织中的高迁移率族蛋白B1(HMGB1)表达评价局部进展期直肠癌新辅助治疗疗效。方法 选择2017-11-01-2019-10-30在山东省肿瘤医院住院治疗的局部进展期直肠癌患者68例,术前行新辅助放化疗治疗,新辅助治疗前及治疗后4周均行肠镜检查及3.0T MRI检查;放化疗结束后6周行直肠癌根治术。将新辅助治疗前的MRI临床T分期与治疗后比较,分期降低为T-降期组,分期不变或升高为T-未降期组。采用高分辨率3.0T MRI和直肠癌组织中的HMGB1表达评价局部进展期直肠癌新辅助治疗疗效。结果 T-降期组39例,T-未降期组29例,病理消退等级差异有统计学意义,χ^(2)=22.311,P<0.001。新辅助治疗后4周MRI检查与治疗前比较,T和N分期趋向降低的趋势,差异有统计学意义,χ^(2)值分别为23.054和19.278,均P<0.001。HMGB1在直肠肿瘤组织中呈现高表达,主要表达于细胞核和部分细胞质。放射治疗后直肠癌组织中HMGB1表达含量降低,部分HMGB1移位细胞质,呈现核质共表达状态。经蛋白质印迹检测,放疗后4周HMGB1蛋白表达含量(0.876±0.062)比放疗前(1.183±0.101)下降,差异有统计学意义,t=-4.487,P=0.011。T-降期组HMGB1蛋白表达量为0.754±0.099,T-未降期组为1.326±0.211,差异有统计学意义,t=-4.251,P=0.013。新辅助治疗前血清CEA水平与治疗后4周及术后比较差异有统计学意义,P值分别为0.041和0.042。结论 高分辨率3.0T MRI联合直肠癌组织HMGB1表达可有效评价局部进展期直肠癌新辅助治疗疗效,为指导局部进展期直肠癌患者治疗及判断预后提供新方法。

Objective To evaluate the efficacy of neoadjuvant therapy for locally advanced rectal cancer combined with high resolution 3.0 T MRI and high mobility group protein B1(HMGB1) expression in rectal cancer tissues.Methods Totally 68 patients with locally advanced rectal cancer hospitalized in Shandong Cancer Hospital from November 1,2017 to October 30,2019 were selected.All patients received neoadjuvant radiotherapy and chemotherapy before surgery, and underwent colonoscopy and 3.0T MRI before and 4weeks after neoadjuvant therapy.Radical resection of rectal cancer was performed 6weeks after the end of radiotherapy and chemotherapy.The clinical T-stage of MRI before neoadjuvant therapy was compared with that after treatment.Those whose T-stage reduced were divided into T-descending stage group,those with T stage unchanged or ascending in T-non-descending stage group.High resolution 3.0T MRI and HMGB 1expression in rectal cancer tissues were used to evaluate the efficacy of neoadjuvant therapy for locally advanced rectal cancer.Results There were 39cases in T-descending stage group and 29cases in T-non-descending stage group,a significant difference in the grade of pathological regression between the T-descending stage group and the T-non-descending stage group(χ^(2)=22.311,P<0.001).Compared with that before treatment,MRI examination showed a decrease in T and N stages 4weeks after neoadjuvant treatment,and the difference was statistically significant.(χ^(2) values were 23.054and19.278,both P<0.001).HMGB1was highly expressed in colorectal tumors,mainly expressed in the nucleus and partly expressed in the cytoplasm.After radiotherapy,the expression of HMGB1in rectal cancer tissues decreased,and part of HMGB1was transferred into cytoplasm,presenting a state of nuclear and cytoplasmic co-expression.Western blot analysis showed that HMGB1protein expression level at 4weeks after radiotherapy(0.876±0.062)was lower than that before radiotherapy(1.183±0.101),and the difference was statistically significant(t=-4.487,P=0.011).The expression level of HMGB1protein in the T-descending stage group was 0.754±0.099,and the expression level of HMGB1protein in the T non-descending stage group was 1.326±0.211.There was a significantly statistical difference in the protein changes between the two groups(t=-4.251,P=0.013).There were statistically significant differences in serum CEA levels before neoadjuvant therapy,4weeks after treatment and after surgery(P=0.041,P=0.042).Conclusions The combination of high resolution 3.0T MRI and HMGB 1expression in rectal cancer tissue can effectively evaluate the efficacy of neoadjuvant therapy for locally advanced rectal cancer,and provide a new method to guide the treatment and prognosis of locally advanced rectal cancer.