2019 年第 5 期 第 14 卷

术前放射治疗联合新辅助化疗对进展期胃癌患者手术情况及病灶内癌基因表达的影响

Effect of preoperative radiotherapy combined with neoadjuvant chemotherapy on surgical condition and oncogene expression in patients with advanced gastric cancer

作者：阮圣辉罗斌陈华斌朱玲华姜惠芬

英文作者：

单位：317523浙江省台州市中西医结合医院普外科（阮圣辉、罗斌、陈华斌）；310016浙江大学医学院附属邵逸夫医院胃肠外科（朱玲华）；310022杭州，浙江省肿瘤医院肿瘤科（姜惠芬）

英文单位：

关键词：进展期胃癌；新辅助化疗；放射治疗；癌基因

英文关键词：

• 摘要：

• 【摘要】目的    研究术前放射治疗联合新辅助化疗对进展期胃癌患者手术情况及病灶内癌基因表达的影响。方法    选择2015年3月至2017年7月于浙江省台州市中西医结合医院诊断为Ⅲa或Ⅲb期胃癌的患者作为研究对象。采用随机数字表法将其分为观察组和对照组，每组27例。观察组接受术前放射治疗联合新辅助化疗，对照组接受术前新辅助化疗。观察手术情况，检测胃癌病灶内癌基因的表达量。结果    观察组患者的R0切除率明显高于对照组［92.6%（25/27）比66.7%（18/27）］，差异有统计学意义（P<0.05）。2组吻合口瘘发生率、切口感染发生率差异均无统计学意义（均P>0.05）。化疗后，2组手术切除的胃癌病灶组织中β-连环蛋白、细胞周期蛋白、基质金属蛋白酶9、人类表皮生长因子受体2的mRNA表达量与化疗前比较均明显降低，且观察组明显低于对照组［（0.41±0.07）比（0.68±0.08）、（0.45±0.06）比（0.71±0.10）、（0.42±0.06）比（0.63±0.07）、（0.38±0.05）比（0.61±0.08）］；2组胃动蛋白1、多肿瘤抑制蛋白、WTX基因、PTEN基因、半胱氨酸蛋白酶3的mRNA表达量与化疗前比较均明显升高，且观察组明显高于对照组［（1.89±0.22）比（1.42±0.16）、（2.23±0.31）比（1.62±0.21）、（2.03±0.28）比（1.57±0.18）、（1.94±0.21）比（1.44±0.17）、（2.09±0.32）比（1.58±0.23）］，差异均有统计学意义（均P<0.05）。结论    术前放射治疗联合新辅助化疗能够提高进展期胃癌的R0切除率并更为显著地调节癌基因表达。

• 【Abstract】Objective    To analyze the effect of preoperative radiotherapy combined with neoadjuvant chemotherapy on surgical condition and oncogene expression in patients with advanced gastric cancer. Methods    From March 2015 to July 2017, 54 patients with stage Ⅲa or Ⅲb gastric cancer in Taizhou Hospital of Integrated Traditional Chinese and Western Medicine were randomly divided into observation group and control group, with 27 cases in each group. The observation group had preoperative radiotherapy combined with neoadjuvant chemotherapy. The control group had preoperative neoadjuvant chemotherapy. Surgical outcomes were observed and the expressions of oncogenes in malignant lesions were detected. Results    R0 resection rate in observation group was significantly higher than that in control group［92.6%（25/27） vs 66.7%（18/27）］(P<0.05). Incidences of anastomotic fistula and incisional infection showed no significant difference between groups(both P>0.05). After chemotherapy, mRNA expression levels of β-catenin, CyclinD1, matrix metalloproteinase-9 and human epidermal growth factor receptor-2 in excised tumors were significantly lower than those before chemotherapy and the expression levels in observation group were significantly lower than those in control group［（0.41±0.07） vs （0.68±0.08）, （0.45±0.06） vs （0.71±0.10）, （0.42±0.06） vs （0.63±0.07）, （0.38±0.05） vs （0.61±0.08）］; mRNA expression levels of gastrokine-1, p16, WTX, PTEN and caspase-3 were significantly higher than those before chemotherapy, the levels in observation group were significantly higher than those in control group［（1.89±0.22） vs （1.42±0.16）, （2.23±0.31） vs （1.62±0.21）, （2.03±0.28） vs （1.57±0.18）, （1.94±0.21） vs （1.44±0.17）, （2.09±0.32） vs （1.58±0.23）］(all P<0.05). Conclusion    Preoperative radiotherapy combined with neoadjuvant chemotherapy can improve the R0 resection rate of advanced gastric cancer and regulate the expression of oncogenes.