發(fā)布時(shí)間：2018-05-31 11:37

  本文選題：舌鱗狀細(xì)胞癌 + 誘導(dǎo)化療　； 參考：《廣西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:研究5-氟尿嘧啶與順鉑聯(lián)合誘導(dǎo)化療方案舌鱗狀細(xì)胞癌腫瘤組織中多藥耐藥相關(guān)蛋白1(MRP1)、多藥耐藥相關(guān)蛋白2(MRP2)、P糖蛋白(P-gp)表達(dá)情況,探討5-氟尿嘧啶與順鉑聯(lián)合(PF)化療方案誘導(dǎo)治療對(duì)舌鱗狀細(xì)胞癌多藥耐藥相關(guān)蛋白的關(guān)系及預(yù)后的影響。方法:1、收集經(jīng)病理確診為舌鱗狀細(xì)胞癌的患者82例,根據(jù)治療方式不同分為:PF誘導(dǎo)方案化療+手術(shù)治療組,單純手術(shù)治療組,每組各41例,通過回顧性分析對(duì)比兩組臨床基線資料之間的關(guān)系。2、免疫組化SP法:檢測82例舌鱗狀細(xì)胞癌組織中MRP1、MRP2、P-gp三種耐藥相關(guān)蛋白的表達(dá)情況,對(duì)比PF化療+手術(shù)治療組中化療前、后上述指標(biāo)表達(dá)的差異。3、Log-rank檢驗(yàn)、Kaplan-Meier法及COX模型分析上述三種蛋白及臨床病理相關(guān)指標(biāo)與舌鱗狀細(xì)胞癌患者預(yù)后生存時(shí)間的關(guān)系。結(jié)果:1、PF誘導(dǎo)化療+手術(shù)治療組和單純手術(shù)治療組的臨床病理參數(shù)分析結(jié)果顯示:兩組間的性別、年齡、病變部位,TNM分期,病理分級(jí),淋巴結(jié)轉(zhuǎn)移,腫瘤大小,頸清方式,復(fù)發(fā)/轉(zhuǎn)移資料匹配。兩組病例治療前活檢標(biāo)本的MRP1、MRP2、P-gp表達(dá)差異均無顯著性(P0.05),提示兩組之間具有可比性。2、PF誘導(dǎo)化療后舌鱗狀細(xì)胞癌中原發(fā)灶和區(qū)域淋巴結(jié)臨床評(píng)價(jià)CR為1例(2.4%),PR為20例(48.7%),SD為19例(46.3%),PD為1例(2.5%),依據(jù)術(shù)后病理檢查情況,達(dá)到總有效率(CR+PR)51.21%。3、PF化療組誘導(dǎo)化療前舌鱗狀細(xì)胞癌組織中P-pg、MRP1和MRP2蛋白的陽性率分別為56.09%(23/41)、60.97%(25/41)和53.65%(22/41),經(jīng)2個(gè)療程化療后TSCC組織中P-pg、MRP1和MRP2陽性率為70.73%(29/41)、78.05%(32/41)和51.22%(21/41)。其中P-pg、MRP1化療前后陽性表達(dá)率差異均有顯著性(P0.05)。4、Kaplan-Meier法、COX模型多因素結(jié)果分析顯示PF誘導(dǎo)化療+手術(shù)治療組,P-gp的表達(dá)、臨床分期是影響舌鱗狀細(xì)胞癌預(yù)后的獨(dú)立危險(xiǎn)因素。結(jié)論:1、PF誘導(dǎo)化療后舌鱗狀細(xì)胞癌組織中P-gp及MRP1蛋白表達(dá)較化療前呈上調(diào)趨勢,提示該方案可誘導(dǎo)舌鱗狀細(xì)胞癌耐藥性產(chǎn)生。2、PF誘導(dǎo)化療后,P-gp的表達(dá)、臨床分期是舌鱗狀細(xì)胞癌預(yù)后的獨(dú)立危險(xiǎn)因素。3、舌鱗狀細(xì)胞癌經(jīng)5-氟尿嘧啶與順鉑聯(lián)合誘導(dǎo)化療,可使腫瘤縮小,緩解腫瘤發(fā)展,但PF誘導(dǎo)化療方案與單純手術(shù)治療兩種方案相比,5年總體生存率無顯著性差異。
[Abstract]:Objective: to study the expression of multidrug resistance-associated protein (MRP1P) and multidrug resistance-associated protein 2MRP2P glycoprotein (P-gp) in squamous cell carcinoma of tongue (TSCC) induced by 5-fluorouracil (5-FU) and cisplatin (cisplatin). To investigate the effect of 5-fluorouracil combined with cisplatin combined with PFN on the relationship and prognosis of multidrug resistance-associated protein in tongue squamous cell carcinoma. Methods 82 cases of squamous cell carcinoma of tongue diagnosed by pathology were collected and divided into two groups according to the different treatment methods: the chemotherapy group treated with 10% PF induction regimen and the simple operation group (41 cases in each group). The relationship between the clinical baseline data of the two groups was analyzed retrospectively. Immunohistochemical SP method was used to detect the expression of MRP1T MRP2P-gp in 82 cases of tongue squamous cell carcinoma, and to compare the expression of three kinds of drug resistance-associated proteins in the PF group before chemotherapy. Kaplan-Meier method and COX model were used to analyze the relationship between the three proteins and the clinicopathological parameters and the survival time of tongue squamous cell carcinoma patients. Results the clinicopathologic parameters of the two groups were as follows: sex, age, TNM stage, pathological grade, lymph node metastasis, tumor size, cervical clearance. Recurrence / metastasis data matched. There was no significant difference in the expression of P-gp between the two groups of biopsy specimens before treatment, suggesting that there was no significant difference in the expression of P-gp between the two groups. It suggested that the clinical evaluation of the primary focus and regional lymph nodes in the squamous cell carcinoma of tongue after chemotherapy induced by 2.2PF showed that the CR was 1 case, and the PR of 20 cases was 48.7%. 19 cases with PD of 46.3% were found to be 2. 5%, according to the pathological examination after operation, The positive rates of P-pgGN MRP1 and MRP2 protein in tongue squamous cell carcinoma before induction chemotherapy were 56.09 and 53.65%, respectively. The positive rates of P-pgG MRP1 and MRP2 in TSCC tissues were 70.7329 / 411 and 51.22 / 41, respectively, and 51.22% / 41, 51.22% / 41, respectively, after two courses of chemotherapy, the positive rates of P-pgGN MRP1 and MRP2 in TSCC tissues were 70.7329 / 411) and 51.2222% / 32 / 41, respectively.The positive rates of P-pgG MRP1 and MRP2 were 70.7375 / 41 and 51.22% / 32 / 41, respectively, and the positive rates of P-pgG MRP1 and MRP2 in TSCC tissues were 70.73 / 41 and 51.22% / 21 / 41, respectively. There were significant differences in the positive expression rates of P-pgtr MRP1 before and after chemotherapy. The multivariate analysis of the Cox model showed that the expression of P-gp in the PF induced chemotherapy group was an independent risk factor for the prognosis of tongue squamous cell carcinoma (TSCC), and the clinical stage was an independent risk factor for the prognosis of tongue squamous cell carcinoma (TSCC). Conclusion the expression of P-gp and MRP1 protein in squamous cell carcinoma of tongue after chemotherapy induced by 1: 1PF showed an up-regulation trend compared with that before chemotherapy. It suggested that this regimen could induce the expression of P-gp in squamous cell carcinoma of tongue after chemotherapy. Clinical stage is an independent risk factor for the prognosis of squamous cell carcinoma of tongue. Combined chemotherapy with 5-fluorouracil and cisplatin can reduce tumor size and relieve tumor development. However, there was no significant difference in 5-year overall survival rate between PF induced chemotherapy regimen and surgical therapy alone.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R739.86

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本文編號(hào)：1959504