术前5-FU化疗对结直肠癌患者血液微转移的影响

摘要

Objective:To investigate the expression of tumor - associated marker of cytokeratin20( CK20 )mRNA in colorectal cancer patients with and without pre - operative chemotherapy. Methods: All 30 patients with pathological proved colorectal cancer were randomized into two groups before operation. Patients in group one were given pre -operative chemotherapy[ CF 200mg ivgtt d, - d3 + ( 5 - FU )500mg ivgtt d, - d3 ]and underwent surgery in d4 , while patients in group two received surgery only. CK20mRNA in peripheral blood were detected by Taq Man reverse tran-sciptase polymerase chain reaction( RT - PCR ) before and after chemotherapy and operation. Drainage blood from portal vein was also examined after laparotomy. Peripheral blood from 15 healthy people was examined as normal control. Results: CK20mRNA was negative in healthy people. The positive rates of CK20mRNA in peripheral blood was 80% . The level of CK20mRNA was positively correlated with primary tumor( T ), regional lymph nodes( N ), distant metastasis( M )and TNM staging and cancer embolus. The levels of CK20mRNA in peripheral blood decreased after chemotherapy compared with the level before chemotherapy( P = 0.055 ); Though the decrement is not significantly. Change of the level of CK20mRNA in peripheral blood after surgery had no statistical significance. Patients whose level of CK20mRNA in drainage blood in chemotherapy group was lower than that in the another group( P = 0. 04 ). Conclusion: CK20mRNA in peripheral blood can be used not only as marker in the detection of tumor micrometasta-ses in colon and rectal cancer, but in evaluating chemotherapy response.%目的 检测术前5-FU化疗及手术对结直肠癌患者血液CK20mRNA含量的影响,并探讨其临床意义.方法 收集本院普通外科2009年5月至2010年12月病理证实的结直肠癌患者30例,随机分为对照组与术前化疗组各15例.术前化疗方案:CF 200mg ivgtt d1-d3、5-FU 500mg ivgtt d1-d3,化疗结束次日进行手术.两组患者均取术前(化疗组为化疗前1日及术前)、术中癌灶回流至门静脉血,术后首日清晨空腹外周静脉血各5ml;另设15份健康体检者外周血标本作为正常人群对照.以实时定量RT-PCR法检测血标本中CK20mRNA含量.结果 15例健康体检者中,CK20mRNA均未检出;30例结直肠癌患者治疗前外周血指标检出率如下:CK20mRNA为80.0%,其含量与肿瘤浸润深度(T)、淋巴结转移(N)、远处转移(M)、术后病理分期(TNM)、脉管或淋巴管癌栓正相关(P<0.05),而与分化程度、神经侵犯、性别、年龄无关.化疗组患者化疗前后CK20mRNA(P=0.055)含量降低,但差异不具有显著性意义.对照组手术前后外周血中CK20mRNA含量差异无统计学意义.比较两组患者术中血与术前外周血中CK20mRNA含量,化疗组指标降低病例数多于对照组,且CK20mRNA含量的变化具显著意义(P=0.004).结论 外周血CK20mRNA为结直肠癌微转移检测的敏感指标.就观察术前化疗效果而言,CK20mRNA有明显下降.术前5-FU化疗可以降低外周血及回流入门静脉血中微转移的程度,提示对TNM II、III期结直肠癌患者开展规范新辅助化疗研究的必要性.