中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2013年
48期
3852-3856
,共5页
邱继刚%沈达明%黄春锦%唐健雄
邱繼剛%瀋達明%黃春錦%唐健雄
구계강%침체명%황춘금%당건웅
结直肠肿瘤%分子诊断技术%个体化医学%ERCC1蛋白
結直腸腫瘤%分子診斷技術%箇體化醫學%ERCC1蛋白
결직장종류%분자진단기술%개체화의학%ERCC1단백
Colorectal neoplasms%Molecular diagnostic techniques%Individualized medicine%ERCC1 protein,human
目的 探讨药物相关分子核苷酸切除修复交叉互补基因1(ERCC1)和DNA拓扑异构酶Ⅰ(TOPO Ⅰ)的表达在转移性结直肠癌个体化治疗中的临床价值.方法 选取复旦大学附属华东医院普外科2009年6月至2011年12月结直肠癌伴远处转移的手术患者共90例,随机数字表法完全随机分为试验组和对照组,各45例,两组性别、年龄及TNM分期均具有可比性.术后试验组根据检测结果行个体化化疗,对照组随机选择化疗方案.应用免疫组织化学染色对两组患者肿瘤组织中ERCC1和TOPOⅠ的表达进行检测,以Kaplan-Meier方法计算术后累积生存期,Log-Rank检验比较组间差异;x2分析或Fisher's精确概率分析比较疗效差异.结果 试验组与对照组间ERCC1及TOPOⅠ的表达情况差异均无统计学意义(x2=0.46、0.30,均P＞0.05).试验组中位生存时间281 d,受益比51.1％ (23/45);对照组中位生存时间246 d,受益比44.4％(20/45);差异也均无统计学意义(均P＞0.05).预期药物耐受组(ERCC1高表达或TOPOⅠ低表达)的中位生存时间196 d,受益比4/14;预期药物敏感组(ERCC1低表达或TOPOⅠ高表达)的中位生存时间304 d,受益比51.3％ (39/76);预期药物敏感组较耐药组中位生存期长,受益比高(均P＜O.05).结论 肠癌组织中药物相关分子的表达与患者的疗效密切相关,ERCC1低表达者使用奥沙利铂或TOPOⅠ高表达者使用伊立替康可延长生存,提高疗效.利用药物相关分子检测来指导用药,对提高转移性结直肠癌患者的疗效有一定的应用价值.
目的 探討藥物相關分子覈苷痠切除脩複交扠互補基因1(ERCC1)和DNA拓撲異構酶Ⅰ(TOPO Ⅰ)的錶達在轉移性結直腸癌箇體化治療中的臨床價值.方法 選取複旦大學附屬華東醫院普外科2009年6月至2011年12月結直腸癌伴遠處轉移的手術患者共90例,隨機數字錶法完全隨機分為試驗組和對照組,各45例,兩組性彆、年齡及TNM分期均具有可比性.術後試驗組根據檢測結果行箇體化化療,對照組隨機選擇化療方案.應用免疫組織化學染色對兩組患者腫瘤組織中ERCC1和TOPOⅠ的錶達進行檢測,以Kaplan-Meier方法計算術後纍積生存期,Log-Rank檢驗比較組間差異;x2分析或Fisher's精確概率分析比較療效差異.結果 試驗組與對照組間ERCC1及TOPOⅠ的錶達情況差異均無統計學意義(x2=0.46、0.30,均P＞0.05).試驗組中位生存時間281 d,受益比51.1％ (23/45);對照組中位生存時間246 d,受益比44.4％(20/45);差異也均無統計學意義(均P＞0.05).預期藥物耐受組(ERCC1高錶達或TOPOⅠ低錶達)的中位生存時間196 d,受益比4/14;預期藥物敏感組(ERCC1低錶達或TOPOⅠ高錶達)的中位生存時間304 d,受益比51.3％ (39/76);預期藥物敏感組較耐藥組中位生存期長,受益比高(均P＜O.05).結論 腸癌組織中藥物相關分子的錶達與患者的療效密切相關,ERCC1低錶達者使用奧沙利鉑或TOPOⅠ高錶達者使用伊立替康可延長生存,提高療效.利用藥物相關分子檢測來指導用藥,對提高轉移性結直腸癌患者的療效有一定的應用價值.
목적 탐토약물상관분자핵감산절제수복교차호보기인1(ERCC1)화DNA탁복이구매Ⅰ(TOPO Ⅰ)적표체재전이성결직장암개체화치료중적림상개치.방법 선취복단대학부속화동의원보외과2009년6월지2011년12월결직장암반원처전이적수술환자공90례,수궤수자표법완전수궤분위시험조화대조조,각45례,량조성별、년령급TNM분기균구유가비성.술후시험조근거검측결과행개체화화료,대조조수궤선택화료방안.응용면역조직화학염색대량조환자종류조직중ERCC1화TOPOⅠ적표체진행검측,이Kaplan-Meier방법계산술후루적생존기,Log-Rank검험비교조간차이;x2분석혹Fisher's정학개솔분석비교료효차이.결과 시험조여대조조간ERCC1급TOPOⅠ적표체정황차이균무통계학의의(x2=0.46、0.30,균P＞0.05).시험조중위생존시간281 d,수익비51.1％ (23/45);대조조중위생존시간246 d,수익비44.4％(20/45);차이야균무통계학의의(균P＞0.05).예기약물내수조(ERCC1고표체혹TOPOⅠ저표체)적중위생존시간196 d,수익비4/14;예기약물민감조(ERCC1저표체혹TOPOⅠ고표체)적중위생존시간304 d,수익비51.3％ (39/76);예기약물민감조교내약조중위생존기장,수익비고(균P＜O.05).결론 장암조직중약물상관분자적표체여환자적료효밀절상관,ERCC1저표체자사용오사리박혹TOPOⅠ고표체자사용이립체강가연장생존,제고료효.이용약물상관분자검측래지도용약,대제고전이성결직장암환자적료효유일정적응용개치.
Objective To explore the clinical values of detecting drug related molecules excision repair cross complementing 1 (ERCC1) and top-oisomerase Ⅰ (TOPO Ⅰ) in individualized therapies of metastatic colorectal cancer.Methods From June 2009 to December 2011,90 patients at Huadong Hospital with metastatic colorectal cancer were randomly separated into 2 groups after operation.Each group had 45 patients without difference in gender,age or TNM stage.The expressions of ERCC1 and TOPOⅠ in cancer tissues were detected by immunehistochemical staining.The testing group received individualized chemotherapies following the expression results while the control group had random chemotherapies.The survival difference between two groups was analyzed by log-rank test and Kaplan-Meier analysis.And curative effect was analyzed by x2 or Fisher's analysis.Results The expressions of ERCC1 and TOPOⅠ had no statistical significance between two groups (both P ＞ 0.05).In the testing group,the median survival time was 281 days and the beneficial ratio 51.1％ (23/45) versus 246 days and 44.4％ (20/45) respectively in the control group.The inter-group comparisons of survival (P =0.235) and curative effect (x2 =0.04,P ＞ 0.05) showed no statistical significance.In the estimated drug tolerated group (ERCC1 high expression or TOPOⅠ low expression),the median survival time was 196 days and the beneficial ratio 4/14 versus 304 days and 51.3％ (39/76) in the estimated drug sensitive group.The inter-group comparisons of survival and curative effect (both P ＜ 0.05) had statistical significance.The median survival time and beneficial ratio significantly increased in estimated drug sensitive group than those in estimated drug tolerated group.Conclusions The expression of drug related molecule in colorectal cancer tissue is significantly associated with curative effect in patients.Patients with down-regulated ERCC1 on Oxaliplatin or up-regulated TOPO Ⅰ on Irinotecan have longer survival and better curative effect.And chemotherapies guided by drug related molecule detection may boost curative effects in metastatic colorectal cancer.
