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目的:探讨术前动脉灌注化疗对结直肠癌生存率的影响,评价PCNA和MVD对于其远期疗效的预测意义。方法:选择ⅡB、Ⅲ期的结直肠癌患者128例,随机分为试验组(动脉灌注新辅助化疗+手术)68例和对照组(直接手术)60例,并分别测定化疗前活检及手术切除后癌组织PCNA和MVD的表达情况,比较两组1、3和5年生存率及PCNA及MVD的表达变化。结果:试验组患者术后13、和5年生存率分别为95.3%、85.9%和44.6%,对照组分别为92.6%、75.9%和22.0%,1和3年生存率差异无统计学意义,5年生存率差异有统计学意义,P<0.05。试验组与对照组术后平均生存时间分别为48.0与40.8个月,中位生存期分别为53.0与42.0个月,差异有统计学意义,P<0.05。试验组术后局部复发和远处转移共37例,对照组共43例,差异有统计学意义,P<0.05;试验组复发转移者PCNA及MVD表达高于无复发转移者,差异有统计学意义,P<0.05。试验组生存时间≥36.0个月的患者化疗后PCNA及MVD表达明显下降,P<0.05。结论:结直肠癌动脉灌注新辅助化疗安全可行,能提高远期生存率;PCNA及MVD的检测可以作为动脉灌注新辅助化疗后远期疗效的客观评价指标。
Objective: To investigate the effect of preoperative arterial infusion chemotherapy on the survival rate of colorectal cancer and evaluate the predictive value of PCNA and MVD for its long-term efficacy. Methods: 128 patients with stage IIB and III colorectal cancer were randomly divided into trial group (arterial infusion neoadjuvant chemotherapy + surgery) in 68 cases and control group (direct surgery) in 60 cases. Preoperative biopsy and surgical resection were measured. The expression of PCNA and MVD in the post-cancer tissue was compared between the 1, 2, and 5 year survival rates and the expression changes of PCNA and MVD in the two groups. RESULTS: The postoperative 13 and 5-year survival rates were 95.3%, 85.9%, and 44.6% in the experimental group, and 92.6%, 75.9%, and 22.0% in the control group. There was no significant difference in the 1-year and 3-year survival rates. The 5-year survival rate was statistically significant, P<0.05. The average survival time of the experimental group and the control group were 48.0 and 40.8 months respectively, and the median survival time was 53.0 and 42.0 months respectively. The difference was statistically significant (P<0.05). In the experimental group, there were 37 cases of local recurrence and distant metastasis, and 43 cases in the control group. The difference was statistically significant (P<0.05). The expression of PCNA and MVD in the recurrence and metastasis of the experimental group was higher than that in the relapse-free metastasis group. The difference was statistically significant. Significance, P<0.05. In the experimental group, the expression of PCNA and MVD decreased significantly after chemotherapy in patients with ≥36.0 months of age, P<0.05. Conclusion: Neoadjuvant chemotherapy with arterial perfusion in colorectal cancer is safe and feasible, and can improve long-term survival. The detection of PCNA and MVD can be used as an objective evaluation index of long-term efficacy after neoadjuvant chemotherapy.