新辅助化疗联合腹腔镜手术对结肠癌cT4bN0M0及cT4bN1～2M0患者临床疗效及血清miR-141、TSGF水平的影响

摘要

目的 探讨新辅助化疗联合腹腔镜手术对结肠癌cT4bN0M0及cT4bN1～2M0患者的临床疗效,并观察其对血清miR-141、肿瘤特异性生长因子(rumor specific growth factor,TSGF)水平的影响.方法 选取江汉大学附属医院普外科2015年12月至2017年1月收治的结肠癌cT4bN0M0及cT拈N1～2M0患者81例为研究对象,随机分为对照组(n=40)和研究组(n=41),并选取同期健康体检者40例为健康组.对照组实施腹腔镜手术治疗,研究组在腹腔镜手术治疗前进行FOL-FOX化疗方案治疗,比较两组患者手术时间、术中出血量、住院时间和手术治疗情况,两组KPS (Kamofsky,KPS)评分以及三组miR-141、TISGF变化.结果 研究组患者KPS评分改善率(75.61％)明显高于对照组(52.50％),差异有统计学意义(P＜0.05).治疗后两组患者KPPS评分均显著高于同组治疗前,治疗后研究组KPS评分显著高于对照组KPS评分,差异均有统计学意义(均P＜0.05).研究组术中出血量、住院时间显著少于对照组,根治性切除率显著高于对照组,差异均有统计学意义(均P＜ 0.05).两组患者治疗前血清miR-141、TSGF水平均显著高于健康组,两组患者治疗后上述指标水平显著低于治疗前,对照组治疗后上述指标水平显著高于研究组及健康组,差异均有统计学意义(均P＜ 0.05),研究组治疗后miR-141、TSGF水平与健康组差异无统计学意义(P＞0.05).结论 对于结肠癌cT4bN0M0及cT4bN1～2M0患者,新辅助化疗联合腹腔镜手术较单纯腹腔镜手术治疗在临床疗效及术后生活质量方面有一定的优势,有助于降低miR-141及TSGF表达水平.%Objective To investigate the clinical efficacy of neoadjuvant chemotherapy combined with laparoscopic surgery for patients with colon cancer of cT4bN0M0 and cT4bN1～2M0,and to investigate its effect on serum levels of miR-141 and Tumor Specific Growth Factor (TSGF).Methods 81 patients with cT4bN0M0 and cT4bN1～2M0 colon cancer were recruited from the Department of General Surgery of the Affiliated Hospital of Jianghan University from December 2015 to January 2017.They were randomly assigned to control group (n =40) and treatment group (n =41).40 cases of healthy subjects were recruited as healthy group.The control group received laparoscopic operation treatment.The treatment group received FOL-FOX chemotherapy before laparoscopic surgery.Operation time,intraoperative bleeding,hospitalization time and indices of the surgical treatment,KPS (Karnofsky,KPS) score were compared between the two groups of patients.Changes of miR-141 and TSGF were compared among the three groups.Results KPS score improvement rate in the treatment group (75.61％) was significantly higher than the control group (52.50％) (P ＜ 0.05).Mter treatment,the KPS scores in the two groups increased and the KPS score in the treatment group was significantly higher than that in the control group (P ＜ 0.05).The amount of bleeding and hospitalization time in the treatment group were significantly less and the radical resection rate significantly higher than that in the control group (P ＜ 0.05).Before treatment,were significantly higher than those in the healthy group.After treatment,serum levels of miR-141 and TSGF in the control and treatment groups decreased significantly.Levels in the control group were significantly higher than those in the treatment group and healthy group (all P ＜ 0.05).There was no significant difference in serum levels of miR-141 and TSGF between the treatment group and healthy group after treatment (P ＞ 0.05).Conclusion In patients with cT4bN0M0 and cT4bN1～2M0 colon cancer,compared with laparoscopic surgery alone,neoadjuvant chemotherapy combined with laparoscopic surgery has advantages in clinical efficacy and postoperative quality of life,and helps to reduce serum levels of miR-141 and TSGF.