进展期胃癌新辅助化疗疗效预测因子的临床研究  

Clinical study of the predictors to neoadjuvant chemotherapy in patients with advanced gastric cancer

作　　者：曲建军[1] 石毅然[1] 郝风云[2] 

机构地区：[1]山东省潍坊市人民医院肿瘤外科,261041 [2]青岛大学医学院附属医院病理科

出　　处：《中华胃肠外科杂志》2013年第3期276-280,共5页Chinese Journal of Gastrointestinal Surgery

摘　　要：目的探讨7种胃癌相关因子在mFOLFOX7方案新辅助化疗治疗进展期胃癌疗效中的预测价值。方法选取2009年8月至2011年8月间收治的53例行mFOXFOL7方案（氟尿嘧啶、奥沙利铂加亚叶酸钙）新辅助化疗的Ⅱ～Ⅲ期胃癌病例．采用免疫组织化学方法检测肿瘤组织中C-met、EGFR、HER2、Ki-67、MMP7、P53及TOPOⅡ的表达情况。应用RECIST1．1标准和病理组织学相结合做化疗疗效评估，单因素和logistic多因素回归分析各指标与化疗疗效的关系。结果本组患者新辅助化疗总有效率为52．8％（28／53），其中部分缓解52．8％（28／53），疾病稳定45．3％（24／53），疾病进展1．9％（1／53）。新辅助化疗前后各因子表达差异无统计学意义（乃O．05）。HER2阳性表达者化疗有效率（完全缓解加部分缓解）为83-3％（10／12），阴性表达者化疗有效率为43．9％（18／41），两者比较差异有统计学意义（P=0．016）。P53阳性表达者化疗有效率为35．7％（10／28），明显低于阴性表达者的72．0％（18／25，P=0．008）。HER2阳性表达同时P53阴性表达者6例，其化疗均为有效。C-met、EGFR、Ki-67、MMP7及TOPOII的表达与化疗敏感性无关（P〉0．05）。多因素分析显示，HER2和P53是新辅助化疗的独立影响因素（P〈0．05）。结论HER2和P53的表达情况对mFOLFOX7方案新辅助化疗疗效的预测有重要价值，推断两者可作为独立的影响因子在化疗前进行疗效预测。Objective To investigate the predictive value of seven gastric cancer-associated factors on neoadjuvant chemotherapy in patients with advanced gastric cancer. Methods Expressions of C-met, EGFR, HER2, Ki-67, MMPT, P53 and TOPOII were detected by immunohistochemistry in gastric cancer tissues of 53 cases before and after mFOLFOX7 neoadjuvant chemotherapy. Chemotherapy efficacy was evaluated according to RECIST 1.1 standard combined with histopathology, and the relationship between various genes and chemotherapy efficacy was analyzed by univariate and logistic multivariate regression analyses. Results The clinical response rate was 52.8%（28/53） in neoadjuvant chemotherapy, including complete response in none, partial response in 28 eases（52.8%）, stable disease in 24 cases（45.3%） and progressive disease in 1 case（1.9%）. The expressions of all the genes were not significantly different before and after neoadjuvant chemotherapy （P〉0.05）. Neoadjuvant chemotherapy efficacy was 83.3% （10/12）in the patients of HER2 positive expression and 43.9% （18/41） in the patients of HER2 negative expression. The former was significant higher than the latter （P=0.016）. Response rate of patients with P53 positive expression was 35.7% （10/28）, significantly lower than 72.0%（18/25） of those with P53 negative expression （P=0.008）. Six patients with both HER2positive expression and P53 negative expression showed better efficacy. The expressions of C-met, EGFR, Ki-67, MMP7 and TOPO Ⅱ were not associated with response to neoadjuvant chemotherapy（P〉 0.05）. HER2 and P53 were independent influencing factors of neoadjuvant chemotherapy （P〈0.05）. Conclusion Expressions of HER2 and P53 have great value in the prediction of mFOLFOX7 neoadjuvant chemotherapy efficacy, suggesting that as independent factors, HER2 and P53 may be used to predict the efficacy before chemotherapy.

关 键 词：胃肿瘤 新辅助化疗 预测因子 

分 类 号：R735.2[医药卫生—肿瘤]