CAJ | 학술논문

目的观察食管癌同期放化疗中肿瘤组织病理反应与血清血管内皮生长因子(VEGF)表达水平的相关性及其对疗效和预后的影响.方法 46例年龄≤75岁,KPS评分≥80,首次治疗的食管癌患者,同期行放化疗.放化疗前及放化疗第4周胃镜活检,放化疗前、放化疗第4周及放疗结束后1周作食管X射线钡剂造影,检测血清中VEGF表达水平,分析肿瘤组织病理反应与血清VEGF表达水平的相关性及两者对疗效和预后的影响.结果治疗后重度反应组、中度反应组和轻度反应组中分别有18例(85.7％)、7例(53.8％)及6例(50.0％)患者的血清VEGF水平较治疗前下降,3组比较差异有统计学意义(x2=6.072,P＜0.05).重度反应组、中度反应组、轻度反应组近期疗效有效率分别为90.5％、38.5％、33.3％,3组比较差异有统计学意义(x2=14.289,P＜0.05)；重度反应组与轻度反应组总生存期(OS)差异无统计学意义.治疗后血清VEGF水平下降及上升的患者中,分别有22人(71.0％)、6人(40.0％)近期疗效评价为有效,两组比较差异有统计学意义(x2=4.070,P＜0.05).结论放化疗过程中的病理反应程度与血清VEGF水平变化可预测食管癌患者的治疗疗效,监测治疗中病理反应和VEGF水平变化对临床个体化治疗有指导意义.
목적 관찰식관암동기방화료중종류조직병리반응여혈청혈관내피생장인자(VEGF)표체수평적상관성급기대료효화예후적영향.방법 46례년령≤75세,KPS평분≥80,수차치료적식관암환자,동기행방화료.방화료전급방화료제4주위경활검,방화료전、방화료제4주급방료결속후1주작식관X사선패제조영,검측혈청중VEGF표체수평,분석종류조직병리반응여혈청VEGF표체수평적상관성급량자대료효화예후적영향.결과 치료후중도반응조、중도반응조화경도반응조중분별유18례(85.7％)、7례(53.8％)급6례(50.0％)환자적혈청VEGF수평교치료전하강,3조비교차이유통계학의의(x2=6.072,P＜0.05).중도반응조、중도반응조、경도반응조근기료효유효솔분별위90.5％、38.5％、33.3％,3조비교차이유통계학의의(x2=14.289,P＜0.05)；중도반응조여경도반응조총생존기(OS)차이무통계학의의.치료후혈청VEGF수평하강급상승적환자중,분별유22인(71.0％)、6인(40.0％)근기료효평개위유효,량조비교차이유통계학의의(x2=4.070,P＜0.05).결론 방화료과정중적병리반응정도여혈청VEGF수평변화가예측식관암환자적치료료효,감측치료중병리반응화VEGF수평변화대림상개체화치료유지도의의.
Objective To observe the relation between pathologic tumor response to concurrent chemo-radiotherapy and the serum VEGF level,and to explore its corresponding influence on the efficacy and prognosis in patients with esophageal carcinoma.Methods Totally 46 cases of patients with esophageal cancer who received concurrent chemo-radiotherapy were enrolled.The gastroscopy and pathologic examination were conducted before and 4 weeks afterwards.Meanwhile,the serum VEGF level and X-ray barium of esophageal image were measured before,4 weeks later and after the radiotherapy.The relation between the tumor pathologic response and the changes of the serum VEGF level and its influence on the efficacy and prognosis were analyzed.Results There were 18 cases (85.7％),7 cases (53.8％)and 6 cases (50.0％) whose serum VEGF level dropped in the severe,moderate and mild group,respectively,and significant differences among these groups(x2 =6.072,P ＜ 0.05).There were 19 cases (90.5％),5 cases (38.5％) and 4 cases (33.3％) whose response measured as effective in the severe,moderate and mild group,respectively,and significant differences among these groups (x2 =14.289,P ＜0.05)).The 2-year survival rates of the severe,there was no statistically difference between the severe and mild group on OS.There were 22 cases (71.0％),6 cases(40.0％) and 4 cases (33.3％) whose response measured as effective in the serum VEGF level drop and increase group,respectively,and significant differences between these groups (x2 =14.289,P ＜ 0.05)).Conclusions The tumor pathologic response during chemo-radiotherapy and the changes of the serum VEGF lever may predict the curative effect of chemo-radiotherapy in the patients with esophageal cancer.To monitor the tumor pathologic response and the changes of the serum VEGF levels may be valuable for individualized treatment for esophageal cancer patients.