本文選題：直腸腫瘤 + 新輔助放化療�。� 參考：《安徽醫(yī)科大學》2017年碩士論文

【摘要】：目的本研究旨在通過檢測直腸癌患者新輔助放化療前后腫瘤局部的腫瘤相關(guān)性中性粒細胞(Tumor-associated neutrophils,TANs)的浸潤情況,進而探討新輔助放化療對TANs浸潤數(shù)量的影響,以及TANs在新輔助放化療前后的浸潤數(shù)量對直腸癌患者新輔助放化療敏感性和無瘤生存率的預測價值。方法選取2010年1月至2013年5月,47例在中國人民解放軍陸軍總醫(yī)院行病理活檢診斷為直腸腺癌,且為進展期中低位直腸癌(術(shù)前評估c T3-4Nx M0,腫瘤下緣距肛緣10 cm)患者的新輔助放化療前的術(shù)前活檢石蠟病理標本和經(jīng)過新輔助放化療后行手術(shù)治療獲得的術(shù)后石蠟病理標本。選取CD15作為標記性抗體,采用光鏡結(jié)合免疫組織化學SP法檢測TANs在新輔助放化療前后腫瘤組織中的浸潤情況。由兩位對臨床結(jié)果不知情的病理學專家對新輔助放化療后的治療效果進行評價。對該47例患者進行隨訪,并利用SPSS 19.0統(tǒng)計軟件統(tǒng)計分析TANs在腫瘤組織中的浸潤情況與直腸癌患者對新輔助放化療的敏感性及其預后的關(guān)系。結(jié)果在400倍光鏡下術(shù)前活檢標本中TANs的浸潤數(shù)量平均為(43.87±4.65)個;術(shù)后病理標本中TANs的浸潤數(shù)量平均為(10.39±1.62)個。術(shù)前活檢標本中TANs的浸潤數(shù)量顯著高于術(shù)后病理標本:(43.87±4.65,N=47 VS 10.39±1.62,N=47;P≤0.05)。經(jīng)過對術(shù)后標本的組織病理學判定:yp T0-2期的患者28例,yp T3-4期的患者19例;Grade0-1的患者29例,Grade2-3的患者18例。術(shù)前活檢標本中TANs浸潤數(shù)量與新輔助放化療的反應敏感性無明顯相關(guān)性:按yp T分期(?)~2=0.430,P=0.662;按Grade分級(?)~2=0.060,P=0.806。經(jīng)過對患者獨立預后因素的分析,結(jié)果顯示新輔助放化療后術(shù)后病理標本中TANs較低的浸潤數(shù)量與良好的預后有關(guān)(3年無瘤生存率:83.9%VS 25.0%,P=0.015);同時,新輔助放化療后的yp T分期也是直腸癌患者預后的獨立預測因子。結(jié)論新輔助放化療可以顯著降低直腸癌中TANs的浸潤數(shù)量。新輔助治療后腫瘤中TANs較低的浸潤數(shù)量與良好的預后有關(guān),可以作為預后的獨立預測因子。
[Abstract]:Objective to investigate the effect of neoadjuvant radiotherapy and chemotherapy on the infiltration of TANs by detecting the tumor associated neutrophil infiltration before and after neoadjuvant radiotherapy and chemotherapy in patients with rectal cancer.And the predictive value of TANs infiltration before and after neoadjuvant chemotherapy for neoadjuvant chemosensitivity and tumor-free survival in rectal cancer patients.Methods from January 2010 to May 2013, 47 cases of rectal adenocarcinoma were diagnosed by pathological biopsy in the General Hospital of the Chinese people's Liberation Army (PLA).The paraffin paraffin biopsy specimens were obtained before neoadjuvant radiotherapy and chemotherapy in patients with advanced low rectal cancer (c T3-4Nx M0 before operation, 10 cm from the lower margin of tumor to anal margin) and after neoadjuvant radiotherapy and chemotherapy.The infiltration of CD15 in neoadjuvant tumor tissues before and after neoadjuvant radiotherapy and chemotherapy was detected by light microscopy and immunohistochemical SP method.Two pathologists who were not familiar with the clinical results evaluated the efficacy of neoadjuvant radiotherapy and chemotherapy.The 47 patients were followed up, and the relationship between the infiltration of TANs in tumor tissue and the sensitivity to neoadjuvant chemotherapy and prognosis of rectal cancer was analyzed by SPSS 19.0 statistical software.Results the average number of TANs infiltration was 43.87 鹵4.65 in preoperative biopsy specimens and 10.39 鹵1.62 in postoperative pathological specimens.The number of TANs infiltration in preoperative biopsy specimens was significantly higher than that in postoperative pathological specimens (43.87 鹵4.65) and 47 vs (10.39 鹵1.62) (P 鈮，

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