血管生长因子和表皮生长因子的改变对中低位直肠癌术前放化疗的临床疗效分析

目的观察血管生长因子(VEGF)和表皮生长因子(EGF)的改变,评价术前放化疗对中低位直肠癌的临床疗效。方法将60例经MR诊断为T3、T4期的中低位直肠癌患者随机分为两组,对照组(30例)直接手术治疗;研究组(30例)先予放疗40～45 Gy+同步XELOX方案化疗2次,放疗结束后4～5周行手术治疗。术后两组均予XELOX方案化疗,比较两组患者的病理改变、VEGF和EGF的表达、手术并发症和预后。结果与对照组相比,研究组放化疗后患者的肿瘤缩小,分期降低。研究组和对照组的根治性手术切除率分别为93.3%和73.3%,保肛率分别为70.0%和43.3%,两组相比,差异均有统计学意义(均P<0.05),但两组手术并发症差异无统计学意义(P>0.05)。病理VEGF和EGF阳性表达明显降低(33.3%:60.0%;36.7%:63.3%),3年随访局部复发率明显下降(13.3%:36.7%),差异均有统计学意义(均P<0.05)。远处转移率两组差异无统计学意义(P>0.05)。结论术前放化疗可以改变T3和T4期中低位直肠癌患者VEGF和EGF的表达,降低局部浸润和转移,进而改善手术疗效,并不增加手术难度和并发症的发生。

Clinical effect of preoperative chemoradiotherapy on the treatment of mid and low rectal cancer

Objective To evaluated the effects of preoperative chemoradiotherapy on the mid and low rectal cancer.Methods sixty cases of mid and low rectal cancers(TNM stage Ⅲ and Ⅳ) that examined preoperatively by nuclear magnetic resonance imaging(MR) were enrolled in this study and divided randomly into the control group and the treatment group.Thirty cases of control group were operated directly without preoperation chemoraditherapy.The other 30 cases of treatment group were firstly treated twice with preoperative radiotherapy(40-45 Gy) combined with chemotherapy(oxaliplatin combined with Xeloda,XELOX) and were operated 4 to 5weeks later.All 60 cases were treated with chemotherapy(XELOX) after operation.The pathologic changes,expression of vascular endothelial growth factor(VEGF) and endothelial growth factor(EGF),complications and follow up results of these two group were compared.Results The VEGF and EGF reduced and its T stage degrade in the treatment group compared with those in the control group.The resection rate(93.3%vs 73.3%,) and the sphincter preserving rate(70.0%vs43.3%) increased in the treatment group compared with those in the control group.There were significant difference(P<0.05).The positive expression rate of VEGF and EGF were decreased apparently in the treatment group(33.3% vs 60.0%,36.7% vs 63.3%).There was not significant difference in the incidence of postoperative complications between the 2 groups.The 3-year local recurrence rate has significant difference between the 2 groups(13.3%vs 36.7%).Conclusions Preoperative chemoradiotherapy can change the positive expression rate of VEGF and EGF,reducing local infiltration and metastasis in the mid and low rectal cancer(TNM stage Ⅲ and IV) without increasing the difficulty of operation and the incidence of postoperative complications.