Caspase-9蛋白表达水平对预测直肠癌术前放化疗敏感性的临床意义  

Clinical Significance of Casepase-9 Protein Levels in Predicting Preoperative Chemoradiotherapy Sensitivity of Rectal Carcinoma

作　　者：艾毅钦[1,2,3] 汪勇[3] 赵川[4] 马丽菊[5] 张静[3] 叶岚[1,2,3] 

机构地区：[1]昆明医科大学第三附属医院 [2]云南省肿瘤医院放疗科,云南昆明650118 [3]昆明医科大学第一附属医院放疗科,云南昆明650032 [4]昆明医科大学第一附属医院病理科,云南昆明650032 [5]昆明医科大学第一附属医院临床实验中心,云南昆明650032

出　　处：《昆明医科大学学报》2014年第10期70-75,共6页Journal of Kunming Medical University

基　　金：云南省教育厅科学研究基金资助项目(2011Y186)

摘　　要：目的探讨Caspase-9蛋白与直肠癌术前放化疗后病理反应程度的关系,评价其表达水平对预测直肠癌术前放化疗敏感性的价值.方法收集昆明医科大学第三附属医院2008年7月至2013年6月接受术前放化疗并行手术的直肠腺癌患者43例,免疫组织化学方法检测放化疗前活检标本及手术后切除标本中Caspase-9蛋白水平,分析其放化疗前后表达水平的变化及活检组织中Caspase-9蛋白水平与术后病理反应程度的关系.结果直肠癌术前放化疗后病理反应良好,有效率达71.1%,其中,病理完全缓解率达30.2%;放化疗前后Caspase-9蛋白表达水平有差异(P<0.01),放化疗后,Caspase-9蛋白表达水平明显下降;放化疗前Caspase-9蛋白表达水平与术后病理反应程度存在相关性(P<0.05),放化疗前Caspase-9蛋白表达水平得分高者,术后病理缓解程度好;放化疗前Caspase-9蛋白表达水平与生存存在相关性(P<0.05),放化疗前Caspase-9蛋白表达得分<3.78者,生存超过2 a的机会增大.术后病理缓解程度与生存无相关性(P>0.01).结论放化疗前直肠癌活检组织中Caspase-9蛋白表达水平可作为术前放化疗敏感性的预测因子.且放化疗前直肠癌活检组织中Caspase-9蛋白表达有可能预测预后.术后病理缓解程度对预测预后价值不大,有待增加临床病例数进一步观察.Objective To evaluate the role of Caspase-9 protein in predicting preoperative chemoradiotherapy sensitivity of rectal carcinoma by investigating its correlation with pathologic response in patients who have received preoperative chemoradiotherapy. Methods The biopsy specimens before chemoradiotherapy and surgical specimens were obtained from 43 cases of rectal adenocarcinoma who accepted preoperative chemoradiotherapy from July 2008 to June 2013. Immunohistochemical staining was used to test the protein expression levels of Caspase-9,and the relationship between Caspase-9 protein expression levels and postoperative pathological response was analyzed. Results The effective rate of preoperative chemoradiotherapy was as high as71.1%,amongthem,thepathologicalcompleteresponseratewas30.2%.Theexpression levels of Caspase-9 protein were significantly different between before and after chemoradiotherapy（P〈0.001）. Caspase-9 protein expression was significantly downregulated after chemoradiotherapy. Meanwhile Caspase-9 protein expression level before chemoradiotherapy was related to both postoperative pathological response（P〈0.05） and survival rate（P〈0.05）. The postoperative pathological response was better in patients with higher level of Caspaes-9 protein, while the chances of surviving more than 2 years increased in patients with Caspaes-9 protein scores less than 3.78. The was no correlation between survival rate and pathological response（P〉0.05）.Conclusions The Caspase-9 protein levels can predict the sensitivity to preoperative chemoradiotherapy of rectal carcinoma. In additon, it may also predict prognosis of rectal carcinoma,while the pathological response rate need more clinical cases to investigate its value in predicting prognosis.

关 键 词：直肠肿瘤 术前放疗 放疗敏感性 CASPASE-9 预测 

分 类 号：R730.4[医药卫生—肿瘤]