CAJ | 학술논문

目的：本研究旨在探讨免疫调节治疗对直肠癌患者术后复发的影响。方法本研究前瞻性纳入2010年1月~2011年1月期间，在四川大学华西医院胃肠外科中心结直肠外科专业组接受直肠癌根治术并符合本研究条件直肠癌患者共150例，最终完成本项研究病例数为150例，分成3组A（塞来西布组）、B（甲强龙组）、C（对照组）。比较3组术后复发情况。结果 A、B、C 3组术后3 d CRP差异有统计学意义（P=0.022），均较术后1 d明显下降，且B组下降最明显。同时，A、B、C 3组术后3 d IL-6差异有统计学意义（P=0.046），均较术后1 d明显下降，且B组下降最明显。3组直肠癌中COX-2表达差异有统计学意义（P=0.017），且A组肿瘤组织COX-2表达受抑制最明显。3组术后复发率差异无统计学意义（P=0.549）。结论 COX-2选择性抑制剂塞来昔布虽然在抑制直肠癌患者术后炎症反应方面弱于糖皮质激素甲强龙，但是，其在抑制直肠癌中COX-2表达方面更优于甲强龙，同时，COX-2选择性抑制剂塞来昔布并没有明显降低直肠癌术后复发率。
목적：본연구지재탐토면역조절치료대직장암환자술후복발적영향。방법본연구전첨성납입2010년1월~2011년1월기간，재사천대학화서의원위장외과중심결직장외과전업조접수직장암근치술병부합본연구조건직장암환자공150례，최종완성본항연구병례수위150례，분성3조A（새래서포조）、B（갑강룡조）、C（대조조）。비교3조술후복발정황。결과 A、B、C 3조술후3 d CRP차이유통계학의의（P=0.022），균교술후1 d명현하강，차B조하강최명현。동시，A、B、C 3조술후3 d IL-6차이유통계학의의（P=0.046），균교술후1 d명현하강，차B조하강최명현。3조직장암중COX-2표체차이유통계학의의（P=0.017），차A조종류조직COX-2표체수억제최명현。3조술후복발솔차이무통계학의의（P=0.549）。결론 COX-2선택성억제제새래석포수연재억제직장암환자술후염증반응방면약우당피질격소갑강룡，단시，기재억제직장암중COX-2표체방면경우우갑강룡，동시，COX-2선택성억제제새래석포병몰유명현강저직장암술후복발솔。
Objective To study the effect of perioperative immunomodulatory therapy on postoperative recurrence of rectal cancer. Methods This prospective study was conducted among 238 rectal/anal cancer patients undergoing intersphincteric resection at our center between January, 2010 and January, 2011, among whom 150 were eligible to be included and completed the study. The 150 patients were randomized in a double-blinded fashion into 3 equal groups to receive immunomodulatory therapy with 8 mg/kg celecoxib (group A), 0.4 mg/kg Sou-Medrol (group B), or placebo (group C), given daily from 5 days before surgery to 5 days after surgery, and the postoperative cancer recurrence were compared. Results At 3 days after the operation, the 3 groups showed significantly different C-reactive protein (CRP) levels, which decreased obviously in all the 3 groups compared with those at 1 day following the operation (P=0.022), especially in group B. The levels of interleukin-6 (IL-6) at 3 days after the operation also differed significantly between the 3 groups but were lower in all the 3 groups than those at 1 day after the operation (P=0.046), and this reduction was the most obvious in group A. COX-2 expression differed significantly between the 3 groups (P=0.017), among which group A showed the most obvious suppression of COX-2 expression. During the follow-up for a mean of 45 months, no significant difference in the recurrence rate was found between the 3 groups (P=0.549). Conclusion With a lower efficacy than Sou-Medrol in decreasing postoperative inflammation, celecoxib produces a better effect in inhibiting COX-2 expression, but it does not lower postoperative recurrence rate of rectal cancer.