围手术期免疫调节治疗对直肠癌术后复发的影响  

Perioperative immunomodulatory therapy does not decrease postoperative recurrence rate of rectal cancer

作　　者：甘志明[1] 汪晓东[1] 吕东昊 刘丹[3] 李立[1] 

机构地区：[1]四川大学华西医院胃肠外科中心,四川成都610041 [2]瑞典斯德哥尔摩卡罗林斯卡学院医学流行病学和生物统计学系,瑞典斯德哥尔摩se17177 [3]四川大学华西临床医学院MCQ团队,四川成都610041

出　　处：《南方医科大学学报》2015年第4期562-566,共5页Journal of Southern Medical University

基　　金：四川省科技厅-支撑计划(2009FZ0066)

摘　　要：目的：本研究旨在探讨免疫调节治疗对直肠癌患者术后复发的影响。方法本研究前瞻性纳入2010年1月-2011年1月期间，在四川大学华西医院胃肠外科中心结直肠外科专业组接受直肠癌根治术并符合本研究条件直肠癌患者共150例，最终完成本项研究病例数为150例，分成3组A（塞来西布组）、B（甲强龙组）、C（对照组）。比较3组术后复发情况。结果 A、B、C 3组术后3 d CRP差异有统计学意义（P=0.022），均较术后1 d明显下降，且B组下降最明显。同时，A、B、C 3组术后3 d IL-6差异有统计学意义（P=0.046），均较术后1 d明显下降，且B组下降最明显。3组直肠癌中COX-2表达差异有统计学意义（P=0.017），且A组肿瘤组织COX-2表达受抑制最明显。3组术后复发率差异无统计学意义（P=0.549）。结论 COX-2选择性抑制剂塞来昔布虽然在抑制直肠癌患者术后炎症反应方面弱于糖皮质激素甲强龙，但是，其在抑制直肠癌中COX-2表达方面更优于甲强龙，同时，COX-2选择性抑制剂塞来昔布并没有明显降低直肠癌术后复发率。Objective To study the effect of perioperative immunomodulatory therapy on postoperative recurrence of rectal cancer. Methods This prospective study was conducted among 238 rectal/anal cancer patients undergoing intersphincteric resection at our center between January, 2010 and January, 2011, among whom 150 were eligible to be included and completed the study. The 150 patients were randomized in a double-blinded fashion into 3 equal groups to receive immunomodulatory therapy with 8 mg/kg celecoxib （group A）, 0.4 mg/kg Sou-Medrol （group B）, or placebo （group C）, given daily from 5 days before surgery to 5 days after surgery, and the postoperative cancer recurrence were compared. Results At 3 days after the operation, the 3 groups showed significantly different C-reactive protein （CRP） levels, which decreased obviously in all the 3 groups compared with those at 1 day following the operation （P=0.022）, especially in group B. The levels of interleukin-6 （IL-6） at 3 days after the operation also differed significantly between the 3 groups but were lower in all the 3 groups than those at 1 day after the operation （P=0.046）, and this reduction was the most obvious in group A. COX-2 expression differed significantly between the 3 groups （P=0.017）, among which group A showed the most obvious suppression of COX-2 expression. During the follow-up for a mean of 45 months, no significant difference in the recurrence rate was found between the 3 groups （P=0.549）. Conclusion With a lower efficacy than Sou-Medrol in decreasing postoperative inflammation, celecoxib produces a better effect in inhibiting COX-2 expression, but it does not lower postoperative recurrence rate of rectal cancer.

关 键 词：塞来西布 直肠癌 预后 免疫调节 复发 

分 类 号：R735.37[医药卫生—肿瘤]