非手术食管癌患者放化疗中肿瘤组织病理反应和血清血管内皮生长因子的变化及其对预后的影响  

Pathologic response and changes of serum VEGF during chemoradiotherapy may predict prognosis in non-surgical patients with esophageal carcinoma

作　　者：王坚[1] 于静萍[2] 汪建林[2] 倪新初[2] 孙志强[2] 孙威[2] 聂斌[2] 蒋敬庭[1] 孙苏平[2] 吴昌平[1] 

机构地区：[1]苏州大学附属第三医院肿瘤生物诊疗中心,常州213003 [2]南京医科大学附属常州市第二人民医院放疗科,213003

出　　处：《中华肿瘤杂志》2016年第8期589-595,共7页Chinese Journal of Oncology

基　　金：江苏省卫生厅指导性科研项目（Z201220）;常州市卫生局重大项目（ZD201105）;常州市科技支撑社会发展项目（CE20125021）;常州市科技局应用基础研究项目（CJ20159050）

摘　　要：目的 分析非手术食管癌患者放化疗中肿瘤组织病理反应和血清血管内皮生长因子（VEGF）的变化及其对预后的影响。方法 对100例经病理证实的食管癌患者进行放疗，其中同期放化疗72例，于放疗第4周行胃镜检查，并取病理活检，病理反应根据放疗后肿瘤组织病理学特点分为轻度、中度、重度反应。在放疗前、放疗第4周、放疗结束后1周测定患者血清VEGF水平，另采集30例健康体检者血清作为对照组。结果 全组1、3年生存率分别为70.8%和33.3%，1、3年无进展生存率分别为61.8%和28.2%，1、3年局部控制率分别为76.9%和50.0%。轻度、中度和重度病理反应组患者的1年生存率分别为50.0%、76.9%和78.0%，轻度反应组1年生存率低于重度反应组（P〈0.05）；轻度、中度和重度病理反应组患者的3年生存率分别为0.0%、50.0%和44.4%，轻度反应组均低于中度、重度反应组（均P〈0.05）。轻度、中度和重度病理反应组患者的1、3年无进展生存率分别为36.4%、73.1%、68.3%和0.0%、40.0%、38.9%，轻度反应组均低于中度、重度反应组（均P〈0.05）；轻度、中度和重度病理反应组患者的1、3年局部控制率分别52.9%、83.3%、83.8%和0.0%、64.3%、64.0%，轻度反应组均低于中、重度反应组（均P〈0.05）。非手术食管癌患者放疗前、放疗中和放疗后的血清VEGF水平分别为（109.6±33.7）ng/L、（101.2±24.3）ng/L和（99.5±22.9）ng/L，均高于健康对照组[（79.6±39.2）ng/L]，差异均有统计学意义（均P〈0.05）。与放疗前比较，放疗中和放疗后的血清VEGF水平呈逐渐降低趋势（P＝0.004）。血清VEGF水平增高组、稳定组和降低组患者的1、3年生存率分别为50.0%、67.4%、86.7%和15.4%、27.0%、50.0%，血清VEGF水平增高组低于降低组（P〈0.05）；血清VEGF水平增高组、稳定组和降低组患者的3年无进展生存率分别为7.7%、21.6%和46.4%，血清Objective To observe the pathological response in the tumor tissue and the changes of serum level of vascular endothelial growth factor （VEGF） in esophageal cancer patients receiving concurrent chemoradiotherapy, in order to study the impacts of these two factors on the prognosis of patients. Methods One hundred pathologically confirmed esophageal cancer patients were treated with radiotherapy including 72 patients with concurrent chemoradiotherapy. After 4 weeks, gastroseopy was performed to collect tumor biopsies for examination of pathological changes. The responses to radiotherapy were classified into three degrees： mild, moderate and intensive. Moreover, serum samples were collected from the patients prior to, at the fourth week during radiotherapy, and one week after radiotherapy, and serum VEGF level was determined. The changes of serum VEGF were classified as increased, unchanged and decreased. Serum samples from 30 heahhy subjects were collected and represented as VEGF healthy control. Results Among the eighty-nine patients evaluable, the 1- and 3-year overall survival （OS） rates were 70.8% and 33.3%, respectively; l-year and 3-year progression-free survival （PFS） rates were 61.8% and 28.2%, respectively; and 1-year and 3-year local control （LC） rates were 76.9% and 50.0%, respectively. The 1-year OS rates in the patients with mild, moderate and intensive pathological responses were 50.0%, 76.9% and 78.0%, respectively. The 1-year OS rate in the mild response group was significantly lower than that in the intensive response group （P〈0.05）. The 1-year and 3-year PFS rates in the three groups were 36.4%, 73.1%, 68.3%, and 0.0%, 40.0% and 38.9%, respectively, showing that the rate in the mild response group was significantly lower than that in the moderate and intensive response groups （P〈0.05 for both）. The PFS rate in the mild response group was significantly lower than that in the moderate and intensive response groups （P〈0.05 for both）. Moreover, the 1-year local cont

关 键 词：食管肿瘤 放射疗法 药物疗法 病理反应 血管内皮生长因子 预后 

分 类 号：R735.1[医药卫生—肿瘤]