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目的探讨术前区域动脉灌注化疗(Preoperative regional intra-aterial chemotherapy,PRAC)联合放疗对低位直肠癌术后复发及P53表达的影响。方法对45例低位直肠癌病例随机分为3组,每组各15例,A组进行术前化、放疗,B组术前单纯放疗,C组术前未行任何化、放疗。采用免疫组化S-P法检测每例治疗前及手术后的P53表达。所有病例均得到12个月以上的随访。结果全部施行根治性切除术。A组治疗前后P53阳性表达分别为53.33%(8/15)和20.00%(3/15),B组分别为60.00%(9/15)和33.33%(5/15),差异有统计学意义(P<0.01);C组分别为53.33%(8/15)和40.00%(6/15),差异无统计学意义(P>0.05)。3组治疗前P53阳性表达之间无明显差异,3组术后P53阳性表达之间差异有统计学意义(P<0.01)。A组复发率6.67%(1/15),B组13.33%(2/15),C组26.67%(4/15),A组与B组的复发率均低于C组,差异有统计学意义(P<0.05)。A组保肛率40.00%(6/15),B组26.67%(4/15),C组6.67%(1/15),A组与B组的保肛率均高于C组,差异有统计学意义(P<0.05)。结论低位直肠癌采用PRAC联合放疗可以降低P53表达和减少复发率、提高保肛率,它是对低位直肠癌治疗的有效和合理的的措施。
Objective To investigate the effect of preoperative regional intra-aterial chemotherapy (PRAC) combined with radiotherapy on postoperative recurrence and P53 expression in low rectal cancer. Methods Forty-five cases of low rectal cancer were randomly divided into three groups, 15 cases in each group. Group A received preoperative radiotherapy and radiotherapy. Group B received preoperative radiotherapy alone without any chemotherapy or radiotherapy. Immunohistochemical S-P method was used to detect the expression of P53 in each case before and after the operation. All cases were followed up for more than 12 months. The results of the implementation of radical resection. The positive expression of P53 in group A before and after treatment was 53.33% (8/15) and 20.00% (3/15) respectively in group B and 60.00% (9/15) and 33.33% (5/15) in group B, respectively, with significant difference (P <0.01). The C group was 53.33% (8/15) and 40.00% (6/15) respectively, with no significant difference (P> 0.05). There was no significant difference between the three groups before P53 positive expression, P53 positive expression among the three groups was statistically significant (P <0.01). The recurrence rate was 6.67% (1/15) in group A, 13.33% (2/15) in group B, 26.67% (4/15) in group C, and the recurrence rates in group A and group B were lower than those in group C Significance (P <0.05). The anal sphincter rate was 40.00% (6/15) in group A, 26.67% (4/15) in group B and 6.67% (1/15) in group C. The anal sphincter rate in group A and group B was higher than that in group C Statistical significance (P <0.05). Conclusions PRAC combined with radiotherapy can reduce the expression of P53 and reduce the recurrence rate and improve the anal sphincter preservation rate in low rectal cancer. It is an effective and reasonable measure for the treatment of low rectal cancer.