【摘要】：目的:探究表皮生長因子受體(epidermal growth factor receptor,EGFR)對于老年食管癌患者進(jìn)行同步放化療的敏感性進(jìn)行預(yù)測,具有十分重要的臨床意義與價(jià)值。方法:選取我院2014年7月-2015年7月期間收治的老年食管鱗癌患者共60例,其中男56例、女4例,年齡65-77歲。病變部位為胸段,病變長度2.5-8cm不等,TNM分期II-III期。其中:胸上段20例,占34%(20/60),胸中段23例,占38%(23/60),胸下段17例,占28%(17/60)。II期患者30例,占50%(30/60),III期患者30例,占50%(30/60)。獲取患者腫瘤組織的病理標(biāo)本,經(jīng)免疫組織化學(xué)染色確定EGFR表達(dá)性質(zhì)。食管癌放療方案:6MV-X體外照射,靶區(qū)劑量45-60Gy,單次分割劑量2Gy/次,5次/W。均于放療開始后行同步化療。給予患者紫杉醇聯(lián)合順鉑化療方案(紫杉醇135mg/m2 d1,順鉑20mg/m2 d1-5)。同步化療每3周為一個(gè)療程,共行2個(gè)療程。療程過后,通過食管鋇及造影對患者進(jìn)行全面的復(fù)查,并且將結(jié)果分為:完全緩解、部份緩解與無緩解三類。最后比較兩組患者EGFR表達(dá)與同步放化療緩解率的關(guān)系。結(jié)果:根據(jù)免疫組織化學(xué)評分法,將60例標(biāo)本分為EGFR表達(dá)陽性41例和陰性19例,進(jìn)行了EGFR表達(dá)且結(jié)果呈現(xiàn)陽性的標(biāo)本當(dāng)中,大多數(shù)的細(xì)胞質(zhì)以及細(xì)胞膜都被染色,且均呈現(xiàn)出棕褐色。而EGFR表達(dá)且結(jié)果呈現(xiàn)陰性的一系列標(biāo)本中,絕大多數(shù)的細(xì)胞沒有發(fā)生著色現(xiàn)象。在EGFR的陽性組患者當(dāng)中,28例患者的癥狀得到了完全意義上的緩解,19例患者部份癥狀得以緩解,4例患者癥狀沒有絲毫的緩解;在EGFR的陰性組患者當(dāng)中,3例患者的癥狀得到了完全意義上的緩解,10例患者部份癥狀得以緩解,6例患者癥狀沒有絲毫的緩解;將兩組結(jié)果進(jìn)行綜合的對比分析,EGFR陽性組癥狀緩解率(68.29%)明顯高于陰性組(15.79%),且差異存在統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:老年食管癌患者EGFR陽性組同步放化療后癥狀緩解率明顯高于陰性組。老年食管癌EGFR表達(dá)水平的高低可能在預(yù)測其同步放化療敏感性中起到重要作用。
[Abstract]:Aim: to explore the sensitivity of epidermal growth factor receptor (epidermal growth factor receptor,EGFR) to concurrent radiotherapy and chemotherapy in elderly patients with esophageal carcinoma, which is of great clinical significance and value. Methods: from July 2014 to July 2015, 60 elderly patients with esophageal squamous cell carcinoma were selected, including 56 males and 4 females, aged 65 to 77 years. The lesion was located in the thoracic segment, the length of the lesion was 2.5-8cm, and the TNM stage was II-III stage. Among them, 20 cases were upper thoracic segment (34%), 23 cases were middle thoracic segment (38%), 17 cases were lower thoracic segment (28%), 30 cases were in stage II (50%), 30 cases were in stage III (30 cases), 30 cases were in stage III (30 cases), 23 cases were in middle segment (38%, 23%), 17 cases were in lower segment of chest (28%). 50% (30 / 60). The pathological specimens of tumor tissue were obtained and the expression of EGFR was determined by immunohistochemical staining. Radiotherapy regimen for esophageal cancer: 6MV-X irradiation in vitro, target dose of 45? 60 Gy, single dose of 2Gy/, 5 times / W. All patients were treated with concurrent chemotherapy after the beginning of radiotherapy. Patients were given paclitaxel plus cisplatin chemotherapy regimen (paclitaxel 135mg/m2 D1, cisplatin 20mg/m2 D1, 5). Synchronous chemotherapy was a course of treatment every 3 weeks, and 2 courses were performed. After the course of treatment, the patients were reviewed by esophageal barium and angiography, and the results were divided into three groups: complete remission, partial remission and non-remission. Finally, the relationship between the expression of EGFR and the remission rate of concurrent radiotherapy and chemotherapy was compared between the two groups. Results: according to the immunohistochemical method, 60 specimens were divided into 41 positive and 19 negative for EGFR expression. Most of the samples with positive EGFR expression were stained with cytoplasm and cell membrane. And all of them are brownish brown. In a series of samples with negative expression of EGFR, no staining was found in most of the cells. In the EGFR positive group, the symptoms of 28 patients were completely relieved, 19 patients were partially relieved, and 4 patients had no remission. In the negative group of EGFR, the symptoms of 3 patients were completely relieved, 10 patients were partially relieved, and 6 patients were not relieved. The results showed that the symptom remission rate of EGFR positive group (68.29%) was significantly higher than that of negative group (15.79%), and the difference was statistically significant (P0.05). Conclusion: the symptom remission rate of EGFR positive group was significantly higher than that of negative group. The expression level of EGFR in elderly esophageal carcinoma may play an important role in predicting the sensitivity of concurrent radiotherapy and chemotherapy.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R735.1

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