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目的观察血管生长因子(VEGF)和表皮生长因子(EGF)的改变,评价术前放化疗对中低位直肠癌的临床疗效。方法将60例经MR诊断为T3、T4期的中低位直肠癌患者随机分为两组,对照组(30例)直接手术治疗;研究组(30例)先予放疗40～45 Gy+同步XELOX方案化疗2次,放疗结束后4～5周行手术治疗。术后两组均予XELOX方案化疗,比较两组患者的病理改变、VEGF和EGF的表达、手术并发症和预后。结果与对照组相比,研究组放化疗后患者的肿瘤缩小,分期降低。研究组和对照组的根治性手术切除率分别为93.3%和73.3%,保肛率分别为70.0%和43.3%,两组相比,差异均有统计学意义(均P<0.05),但两组手术并发症差异无统计学意义(P>0.05)。病理VEGF和EGF阳性表达明显降低(33.3%:60.0%;36.7%:63.3%),3年随访局部复发率明显下降(13.3%:36.7%),差异均有统计学意义(均P<0.05)。远处转移率两组差异无统计学意义(P>0.05)。结论术前放化疗可以改变T3和T4期中低位直肠癌患者VEGF和EGF的表达,降低局部浸润和转移,进而改善手术疗效,并不增加手术难度和并发症的发生。
Objective To observe the changes of vascular endothelial growth factor (VEGF) and epidermal growth factor (EGF) and evaluate the clinical effect of preoperative radiochemotherapy on low and middle rectal cancer. Methods Sixty patients with low and middle rectal cancer diagnosed by T3 and T4 were randomly divided into two groups. The control group (30 cases) received direct surgical treatment. The study group (30 cases) received radiotherapy 40 ~ 45 Gy + synchronous XELOX regimen Chemotherapy 2 times, 4 to 5 weeks after radiotherapy surgery. Both groups were given XELOX chemotherapy after operation. The pathological changes, the expression of VEGF and EGF, the complication and prognosis of the two groups were compared. Results Compared with the control group, the study group patients with tumor shrinkage, stage reduction. The radical resection rates of the study group and the control group were 93.3% and 73.3%, respectively, and the rates of anal sphincter preservation were 70.0% and 43.3% respectively. There was significant difference between the two groups (P <0.05) There was no significant difference in the surgical complications between the two groups (P> 0.05). (33.3%: 60.0%; 36.7%: 63.3%). The local recurrence rate at 3 years follow-up was significantly decreased (13.3% vs 36.7%), the difference was statistically significant (all P <0.05) . There was no significant difference in distant metastasis between the two groups (P> 0.05). Conclusion Preoperative chemoradiotherapy can change the expression of VEGF and EGF in low and middle rectal cancer patients at stage T3 and T4, reduce the local infiltration and metastasis, and then improve the curative effect without increasing the difficulty of operation and complication.