摘要
目的研究EOF新辅助化疗联合腹腔镜下D2根治术对局部进展期胃癌疗效及可溶性E黏钙蛋白(sE-cad)及肿瘤坏死因子受体相关因子-6(TRAF-6)水平的影响。方法选取2011年8月—2012年11月河南省中医院收治的局部进展期胃癌患者120例,根据随机数字表法将患者分为EOF新辅助化疗+腹腔镜下D2根治术组(观察组)和腹腔镜下D2根治术组(对照组),每组60例。分析EOF化疗方案的疗效及不良反应,比较两组患者手术情况、术后情况、随访及预后情况,以及治疗前后血清sE-cad及TRAF-6水平。结果①两组患者在性别、年龄、BMI、肿瘤部位及直径、肿瘤病理学分型、UICC分期等资料的比较,差异无统计学意义(P>0.05);②观察组近期临床总有效率,肿瘤控制率高于对照组,差异有统计学意义(P <0.05);③观察组和对照组不良反应发生率分别为53.3%和58.3%,两者差异无统计学意义(P>0.05);④治疗后,两组患者血清sE-cad及TRAF-6水平均较治疗前下降,且观察组低于对照组,差异有统计学意义(P <0.05);⑤随访及预后情况:120例患者中最短随访58 d,最长1 780 d,中位生存时间682 d;截止2017年12月,观察组中失访5例,死亡32例,生存23例。对照组中失访7例,死亡39例,生存14例,两组生存率比较,差异有统计学意义(P <0.05)。结论对局部进展期胃癌,EOF化疗+腹腔镜下D2根治术较单纯的腹腔镜下D2根治术效果更好,且能够降低sE-cad及TRAF-6水平,改善患者预后,值得临床推广应用。
Objective To study the efficacy of EOF neoadjuvant chemotherapy combined with total laparoscopic D2 radical surgery on locally advanced gastric cancer and the expression of sE-cad and TRAF6.Methods A total of 120 patients with locally advanced gastric cancer admitted to our hospital from August 2011 to November 2012 were enrolled and divided into EOF neoadjuvant chemotherapy + total laparoscopic D2 radical surgery group(observation group) and total laparoscopic D2 radical surgery(control group) according to the random digital table method(60 cases in each group). Short term and long term Survival data, serum soluble sE-cad and TRAF6 were monitored and compared in both gourp. Results ① There were no differences in gender, age, BMI,tumor location and diameter, tumor pathology, and UICC staging(P > 0.05). ② The total effective rate and the tumor control rate of the observation group weres higher than the control group. The difference was statistically significant(P < 0.05); ③ Comparison of adverse reactions: The incidence of adverse reactions in the control group and control group were 53.3% and 58.3%, respectively, and the difference was not statistically significant(P > 0.05). ④ After treatment, the serum levels of sE-cad and TRAF6 were lower in both groups than those before treatment. Additionally,they were detected with a lower level in the observation group. The difference was statistically significant(P < 0.05)⑤ Follow-up and prognosis: the shortest follow-up of 88 patients was 58 days, the longest was 1780 days, and the median survival time was 682 days. As of December 2017, 5 patients were lost to follow-up,32 died and 23 cases survived in observation group. In the control group, 7 cases were lost to follow-up, 39 cases died and 14 cases survived. The difference in survival rate was statistically significant(P < 0.05). 【Conclusions】 EOF chemotherapy plus total laparoscopic D2 radical surgery can effectively improve the prognosis of patients with D2 radical resection,and can effectively reduce the levels of sE-cad and TRAF6, reduce the invasiveness of tumors and improve the prognosis of patients. It is worthy of clinical application.
引文
[1]左婷婷,郑荣寿,曾红梅,等.中国胃癌流行病学现状[J].中国肿瘤临床,2017,44(1):52-58.
[2]KARIMI P,ISLAMI F,ANANDASABAPATHY S,et al.Gastric cancer:Descriptive epidemiology,risk factors,screening,and prevention[J].Cancer Epidemiol Biomarkers Prev,2014,23(5):700-713.
[3]R?TZER V,HARTLIEB E,VIELMUTH F,et al.E-cadherin and Src associate with extradesmosomal Dsg3 and modulate desmosome assembly and adhesion[J].Cellular&Molecular Life Sciences,2015,72(24):4885-4897.
[4]WALSH M C,LEE J E,CHOI Y.Tumor necrosis factor receptorassociated factor 6(TRAF-6)regulation of development,function,and homeostasis of the immune system[J].Immunological Reviews,2015,266(1):72-92.
[5]TURNER B.(2006)International union against cancer(UICC)[M].//The Statesman's Yearbook 2007.London:Palgrave Macmillan:54.
[6]EISENHAUER E A,THERASSE P,BOGAERTS J,et al.New response evaluation criteria in solid TUMORs:revised RECISTguideline(version 1.1)[J].European Journal of Cancer,2009,45(2):228-247.
[7]ATKINSON T M,RYAN S J,BENNETT A V,et al.The association between clinician-based common terminology criteria for adverse events(CTCAE)and patient-reported outcomes(PRO):a systematic review[J].Supportive Care in Cancer,2016,24(8):3669-3676.
[8]YOON H,KIM N.Diagnosis and management of high risk group for gastric cancer[J].Gut&Liver,2015,9(1):5-17.
[9]CUNNINGHAM D,ALLUM W H,STENNING S P,et al.Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer[J].The Journal of Evidence-Based Medicine,2008,355(1):11-20.
[10]CHEN M,MAY B H,ZHOU I W,et al.Meta-analysis of oxaliplatin-based chemotherapy combined with traditional medicines for colorectal cancer:Contributions of specific plants to tumor response[J].Integrative Cancer Therapies,2016,15(1):40-59.
[11]CUNNINGHAM D,STARLING N,RAO S,et al.Capecitabine and oxaliplatin for advanced esophagogastric cancer[J].N Engl JMed,2008,362(9):858-859.
[12]BUJKO K,GLIMELIUS B,VALENTINI V,et al.Postoperative chemotherapy in patients with rectal cancer receiving preoperative radio(chemo)therapy:A meta-analysis of randomized trials comparing surgery±a fluoropyrimidine and surgery+a fluoropyrimidine±oxaliplatin[J].European Journal of Surgical Oncology,2015,41(6):713-723.
[13]赵世巧,陈忠余,邓玮,等.eIF4E,CD44和E-cadherin在胃癌组织中的表达[J].广东医学,2016,37(2):230-232.
[14]李妙,周立军.TRAF6与肿瘤关系的研究进展[J].生物技术通报,2017,33(6):24-31.
[15]张自森,巴楠,张剑,等.胃癌FOLFOX4方案化疗患者预后与血清可溶性E-钙黏蛋白表达的关系[J].中华实验外科杂志,2016,33(12):2773-2775.
[16]章国良,孙元水,唐智亮,等.TRAF6表达与胃癌患者营养状况及预后的关系[J].中华肿瘤防治杂志,2017,24(14):951-954.
[17]HAN F,ZHANG L,QIU W,et al.TRAF6 promotes the invasion and metastasis and predicts a poor prognosis in gastric cancer[J].Pathology-Research and Practice,2016,212(1):31-37.
