CAJ | 학술논문

目的通过局部进展期直肠癌患者术前同步放化疗前、后的凋亡相关蛋白的检测,探讨放化疗诱导直肠癌凋亡的机制并评价其疗效.方法应用免疫组化EnVision法检测术前同步放化疗前、后Bcl-XL、Bax表达,结合患者临床、病理各项指标,进行统计学分析和评价.结果术前同步放化疗后肿瘤细胞退缩明显( TRG2+ TRG3+ TRG4)患者13例,无退缩(TRG0+TRG1)患者21例,术前同步放化疗前、后Bcl-XL阳性率分别为58.8％ (20/34)和52.9％ (18/34),放化疗前、后Bcl-XL表达变化与放化疗前肿瘤大小,放疗后肿瘤细胞退缩以及手术方式之间差异有统计学意义.术前同步放化疗前、后Bax阳性率分别为32.4％( 11/34)和44.1％ (15/34),Bax表达变化与放疗后肿瘤细胞退缩间差异无统计学意义.术前同步放化疗前、后Bcl -XL/Bax比值之间差异有统计学意义(x2=9.607,P=0.048).术前同步放化疗前、后Bcl-XL/Bax比值与肿瘤细胞退缩之间差异无统计学意义.按照术前同步放化疗是否加热疗进行分层分析,发现单纯放化疗组Bcl-XL表达变化与手术方式之间差异有统计学意义(x2=13.964,P=0.007),单纯放化疗组Bax表达变化与肿瘤肌层浸润和放疗后肿瘤细胞退缩之间差异有显著性意义(x2=10.806、10.455,P＜0.05).结论术前同步放化疗可以改变Bcl-XL、Bax表达,影响直肠癌细胞凋亡和患者治疗效果,Bcl-XL表达减低和Bax表达上调在术前同步放化疗诱导直肠癌细胞凋亡中具有重要的临床作用,可有效提高直肠癌放化疗的效果.
목적 통과국부진전기직장암환자술전동보방화료전、후적조망상관단백적검측,탐토방화료유도직장암조망적궤제병평개기료효.방법 응용면역조화EnVision법검측술전동보방화료전、후Bcl-XL、Bax표체,결합환자림상、병리각항지표,진행통계학분석화평개.결과 술전동보방화료후종류세포퇴축명현( TRG2+ TRG3+ TRG4)환자13례,무퇴축(TRG0+TRG1)환자21례,술전동보방화료전、후Bcl-XL양성솔분별위58.8％ (20/34)화52.9％ (18/34),방화료전、후Bcl-XL표체변화여방화료전종류대소,방료후종류세포퇴축이급수술방식지간차이유통계학의의.술전동보방화료전、후Bax양성솔분별위32.4％( 11/34)화44.1％ (15/34),Bax표체변화여방료후종류세포퇴축간차이무통계학의의.술전동보방화료전、후Bcl -XL/Bax비치지간차이유통계학의의(x2=9.607,P=0.048).술전동보방화료전、후Bcl-XL/Bax비치여종류세포퇴축지간차이무통계학의의.안조술전동보방화료시부가열료진행분층분석,발현단순방화료조Bcl-XL표체변화여수술방식지간차이유통계학의의(x2=13.964,P=0.007),단순방화료조Bax표체변화여종류기층침윤화방료후종류세포퇴축지간차이유현저성의의(x2=10.806、10.455,P＜0.05).결론 술전동보방화료가이개변Bcl-XL、Bax표체,영향직장암세포조망화환자치료효과,Bcl-XL표체감저화Bax표체상조재술전동보방화료유도직장암세포조망중구유중요적림상작용,가유효제고직장암방화료적효과.
Objective To discuss the mechanism of rectal cancer apoptosis induced by preoperative chemoradiotherapy and evaluate its effect by detection of apoptosis related proteins in locally advanced colorectal cancer patients who had received preoperative chemoradiation.Methods To detect Bcl-XL and Bax expression in rectal cancer before and after chemoradiotherapy by EnVision method,combined with patients clinical and pathological index,statistically analysis and evaluation their relationship and clinical significance.Results Patients with or without tumor shrinkage after preoperative chemoradiotherapy was 13 cases and 21 cases.While the positive rate of Bcl-XL in rectal cancer before and after chemoradiotherapy were 58.8％ ( 20/34 ) and 52.9％ ( 18/34 ),respectively. There were significant difference between Bcl-XL change before and after chemoradiation with tumor size,tumor cells shrinkage and operation pattern.The positive rate of Bax in rectal cancer before and after chemoradiotherapy were 32.4％ ( 11/34 ) and 44.1％ (15/34),respectively.There were no significant difference between Bax change before and after chemoradiotherapy with tumor cells shrinkage. There were statistically significant difference between Bax ratio (x2 =9.607,P =0.048 ) before and after chemoradiation while there were no significant difference between Bcl-XL/Bax ratio before and after chemoradiation with tumor shrinkage. According to layeredanalysis with preoperative therapy,there were statistically significant difference ( x2 =13.964,P =0.007 )between Bcl-XL change with operation pattern while the same of significant difference between Bax change with tumor infiltration and tumor shrinkage ( x2 =10.806 and 10.455,both P ＜ 0.05 ). Conclusions Preoperative chemoradiation can influence rectal cancer cell's apoptosis and treatment effect by changing Bcl-XL and Bax expression. Bcl-XL downregulation and Bax upregulation have shown important function in colorectal cancer cell apoptosis which induced by preoperative chemoradiation,it can also improve the effection of chemoradiation in rectal cancer.