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目的研究术前新辅助放化疗对食管肿瘤病理形态学改变及对食管癌细胞增殖的影响,并探讨二者之间的关系。方法选择40例食管鳞癌初治患者,治疗前经食管镜活检病理确诊,行新辅助放化疗加根治性手术治疗,术后常规进行手术标本病理学检查,免疫组化染色分别检测治疗前活检标本和手术标本Ki-67表达的标记指数。结果放化疗后重度反应者12例(30.0%),中度反应20例(50.0%),轻度反应8例(20.0%)。显著有效率30.0%,总有效率80.0%。放化疗前、后食管鳞癌组织中Ki-67表达的标记指数差异有统计学意义(P<0.01);重、中度放化疗反应组放化疗前、后Ki-67标记指数的差异有统计学意义(P<0.01);轻度反应组放化疗前Ki-67标记指数与放化疗后存在差异,但差异无统计学意义(P>0.05)。结论多数食管癌患者接受新辅助放化疗后仍有肿瘤病灶存在,约20%的患者肿瘤组织退缩不明显。放化疗前后食管鳞癌组织中Ki-67表达的标记指数明显下降,提示放化疗后肿瘤的增殖能力较放化疗前下降。
Objective To study the effect of neoadjuvant radiochemotherapy on esophageal neoplasm pathomorphology and esophageal cancer cell proliferation, and to explore the relationship between the two. Methods Forty patients with newly diagnosed esophageal squamous cell carcinoma were diagnosed by esophagoscopy biopsy before operation and underwent neoadjuvant chemoradiotherapy combined with radical surgery. The pathological examination of the surgical specimens was performed routinely and immunohistochemistry was used to detect the biopsy The labeling index of Ki-67 expression in specimens and surgical specimens. Results After chemoradiotherapy, 12 cases (30.0%) had severe reaction, 20 cases (50.0%) had moderate reaction and 8 cases (20.0%) had mild reaction. Significantly effective rate of 30.0%, the total effective rate of 80.0%. Before and after radiotherapy and chemotherapy, the difference of Ki-67 expression index in esophageal squamous cell carcinoma tissues was statistically significant (P <0.01). The difference of Ki-67 index before and after radiotherapy and chemotherapy in both groups was statistically significant (P <0.01). The Ki-67 index before radiotherapy and chemotherapy in mild reaction group was different from that before radiotherapy and chemotherapy, but the difference was not statistically significant (P> 0.05). Conclusion Most of esophageal cancer patients still have neoplastic lesions after neoadjuvant chemoradiation and chemotherapy, and about 20% of patients do not have obvious shrinkage. Before and after radiotherapy and chemotherapy in esophageal squamous cell carcinoma Ki-67 expression index decreased significantly, suggesting that the radiotherapy and chemotherapy tumor proliferation than before chemotherapy decreased.