Pathological Observation And Analysis Of Neoadjuvant Therapy For Rectal Cancer

ObjectiveQualitative and quantitative analysis of the curative effect of neoadjuvant therapy of rectal cancer,the difference in curative effect and the damage to tumor tissues and surrounding normal tissues from the pathological level,and provide a scientific basis for the adoption of neoadjuvant therapy for rectal cancer and the choice of chemotherapy.Research Contents1.Qualitative and quantitative analysis of the killing effect of CapeOx neoadjuvant chemotherapy combined with long-range radiotherapy on the body’s rectal cancer cells and adverse effects on normal tissues,to clarify its efficacy and degree of efficacy.Radiotherapy for rectal cancer provides clinical and pathological evidence;2.Qualitative and quantitative analysis of the killing effect of mFOLFOX6 neoadjuvant chemotherapy combined with long-term radiotherapy on the body’s rectal cancer cells and adverse effects on normal tissues,to clarify its efficacy and degree of efficacy,for clinicians and rectal cancer patients to receive mFOLFOX6 neoadjuvant chemotherapy combined with long-term Radiotherapy for rectal cancer provides clinical and pathological evidence3.Quantitative analysised and explored the relationship between tissue and nuclear morphological parameters of rectal cancer biopsy specimens before neoadjuvant therapy and the efficacy after neoadjuvant therapy;3.Qualitative and quantitative analysis and comparison of the two different neoadjuvant chemotherapy of CapeOx and mFOLFOX6 combined with long-term radiotherapy on the killing effect of rectal cancer cells and adverse effects on normal tissues,to clarify their efficacy,and choose CapeOx or mFOLFOX6 neoadjuvant chemotherapy for clinical Provide scientific basis in combination with long-term radiotherapy for rectal cancer;4.Quantitative analysis of the relationship between tissue structural parameters of rectal cancer biopsy before neoadjuvant therapy and the efficacy of neoadjuvant therapy.Materials and Methods63 cases of neoadjuvant chemoradiotherapy and pre-radiochemotherapy biopsy specimens diagnosed in Guangdong Nanfang Hospital from 2016 to 2019 were collected,50 cases of normal intestinal tissue without radiotherapy and chemotherapy were used as controls.Surgical resection specimens were evaluated using the AJCC-TRG system scoring criteria:TRG 0,TRG 1,TRG 2,TRG 3.A control group was also set up.Data acquisition and image analysis were performed using an optical microscope,micro camera and image analysis software.First use an objective micrometer to calibrate the test software,then place the HE sections under an optical microscope to capture the observation field.Each section will randomly take 5-10 relatively complete gland cavities under a 20x objective lens,and under a 40x objective lens field.Take 200 adenocarcinoma cells and 300 normal cancer cells and normal intestinal mucosal cells after neoadjuvant chemoradiotherapy in the corresponding gland cavity.Test and calculate the images with Image-Pro Plus image analysis software.The selected image analysis parameters are generalized line reference number density of cancer/cells in glands,nucleolus occurrence rate in glands and nuclear major axis,minor axis,area,perimeter,roundness,regulatory shape factor.Results1.Pathological observation and analysis of CapeOx neoadjuvant chemotherapy combined with long-term radiotherapy for rectal cancer(1)CapeOx neoadjuvant chemotherapy combined with long-term radiotherapy has varying degrees of killing effect on the body’s rectal cancer cells and has a slight damage to normal tissues,TRG 0 accounts for 23.08%,TRG1 accounts for 48.08%,TRG2 accounts for 23.08%,TRG 3 accounts for 5.77%.(2)CapeOx neoadjuvant chemotherapy combined with long-term radiotherapy for stage Ⅲ and Ⅳ rectal cancer combined with biopsy cancer tissue before neoadjuvant therapy,generalized line reference number density of cancer cells in glands and regulatory shape factor were reduced,nucleolus occurrence rate in glands and nuclear major axis,minor axis,area,perimeter were increased.Neoadjuvant therapy can reduce the cells in the glands of stage Ⅲ and stage Ⅳ rectal cancer,the nucleoli protrude,and the nuclei become larger and closer to ellipse or circle.(3)Compared with normal intestinal tissue without normal radiotherapy and chemotherapy,nucleolus occurrence rate in glands and nuclear major axis,minor axis,area,perimeter of normal tissues adjacent to cancer in patients with stage Ⅲ and Ⅳrectal cancer undergoing CapeOx neoadjuvant chemotherapy combined with long-term radiotherapy were increased,the roundness and regulatory shape factor were reduced.After neoadjuvant therapy,the nucleoli of the glandular body in normal tissues adjacent to stage Ⅲ and stage Ⅳ rectal cancer protrude,and the cell nucleus becomes larger and closer to an ellipse or circle.(4)There is no significant difference between the TRG 0,TRG 1,TRG 2,TRG 3 efficacy groups in generalized line reference number density of cancer cells in glands,nucleolus occurrence rate in glands of neoplastic adjuvant biopsy in stage Ⅲ rectal cancer.The efficacy of neoadjuvant therapy for stage Ⅲ and Ⅳ rectal cancer is TRG 0,TRG 1,TRG 2.Nuclear major axis,minor axis,area,perimeter of biopsy cancer tissues before neoadjuvant therapy show an increasing trend,the difference all are significant.In stage Ⅲ rectal cancer,the cancer cell with TRG 3 had the smallest cell nucleus before treatment,the cancer cell with TRG 2 had the largest cell nucleus before treatment,and the cancer cell with TRG 0 had the closest cell nucleus before treatment.2.Pathological observation and analysis of mFOLFOX6 neoadjuvant chemotherapy combined with long-term radiotherapy for rectal cancer(1)mFOLFOX6 neoadjuvant chemotherapy combined with long-term radiotherapy has different degrees of killing effect on the body’s rectal cancer cells,and has a slight damage to normal tissues,TRG 0 accounts for 27.27%,TRG1 accounts for 45.45%,TRG2 accounts for 18.18%,TRG 3 accounts 9.09%.(2)mFOLFOX6 neoadjuvant chemotherapy combined with long-term radiotherapy for stage Ⅲ rectal cancer combined with biopsy cancer tissue before neoadjuvant therapy,generalized line reference number density of cancer cells in glands and regulatory shape factor were reduced,nucleolus occurrence rate in glands and nuclear major axis,minor axis,area,perimeter were increased.Neoadjuvant therapy can reduce the cells in the glands of stage Ⅲ rectal cancer,the nucleoli protrude,and the nuclei become larger and closer to ellipse or circle.(3)Compared with normal intestinal tissue without normal radiotherapy and chemotherapy,generalized line reference number density of cells in glands,nucleolus occurrence rate in glands and nuclear major axis,minor axis,area,perimeter of normal tissues adjacent to cancer in patients with stage Ⅲ rectal cancer undergoing mFOLFOX6 neoadjuvant chemotherapy combined with long-term radiotherapy were increased,the roundness and regulatory shape factor were reduced.After neoadjuvant therapy,the nucleoli of the glandular body in normal tissues adjacent to stage Ⅲ and stage Ⅳ rectal cancer protrude,and the cell nucleus becomes larger and closer to an ellipse or circle.(4)The efficacy of neoadjuvant therapy for stage Ⅲ rectal cancer is TRG 0,TRG 1,and TRG 2.The nuclear major axis,minor axis,area,perimeter of the biopsy cancer tissue before neoadjuvant therapy showed an increasing trend,.The biopsy cancer tissue cell nucleus of TRG2 is the largest,and the biopsy cancer tissue cell nucleus of TRG0 is the closest to ellipse or circle.3.Pathological comparison analysis of the effects of CapeOx and mFOLFOX6 neoadjuvant chemotherapy combined with long-term radiotherapy on rectal cancer tissues and cells(1)CapeOx and mFOLFOX6 neoadjuvant chemotherapy combined with long-term radiotherapy affects rectal cancer and normal tissues and cells adjacent to the cancer;it can reduce the density of cancer cells in the gland of rectal cancer tissues,make the nucleolus more prominent,and the nucleus larger and closer to ellipse or circle;Increase the density of cells in the gland of normal tissues adjacent to the cancer,make the nucleolus more prominent,and the nucleus bigger and closer to an ellipse or circle.(2)CapeOx and mFOLFOX6 neoadjuvant chemotherapy combined with long-term radiotherapy have the same changes in rectal cancer tissue parameters.It is not clear whether the effects of these two neoadjuvant treatment programs on the function of rectal cancer tissue are different.(3)CapeOx and mFOLFOX6 neoadjuvant chemotherapy combined with long-range radiotherapy have an effect on normal tissues adjacent to cancer.MFOLFOX6 neoadjuvant chemotherapy combined with long-range radiotherapy has a greater impact on adjacent tissues.(4)CapeOx and mFOLFOX6 neoadjuvant chemotherapy combined with long-term radiotherapy have no significant difference in tumor remission,but CapeOx neoadjuvant chemotherapy is more prone to calcification in the tumor stroma.Conclusion1.CapeOx neoadjuvant chemotherapy combined with long-term radiotherapy has a definite effect on some patients with rectal cancer.Cancer cells in cancer tissues of 23.08%of patients can be killed 100%,cancer cells in cancer tissues of 71.15%of patients can be partially killed,5.77%Of patients are invalid.2.mFOLFOX6 neoadjuvant chemotherapy combined with long-term radiotherapy has a definite effect on some patients with rectal cancer.Cancer cells in cancer tissues of 27.27%of patients can be killed 100%,cancer cells in cancer tissues of 63.64%of patients can be partially killed,9.09%Of patients are invalid.3.Neoadjuvant therapy has effects on different stages of rectal cancer tissues,and has a slight effect on normal tissues adjacent to the cancer.Neoadjuvant therapy can make the cancer cells in the gland of the residual cancer tissue in the primary site become sparse and nuclear vacuolar degeneration,the nucleolar eosinophilic changes are more prominent,but the nuclear vacuolar degeneration and the number of nucleoli change and tumor regression The degree has no obvious relationship;the nuclei of cancer cells and normal tissues adjacent to the cancer become larger and close to ellipses or circles.4.CapeOx and mFOLFOX6 two neoadjuvant chemotherapy combined with long-term radiotherapy have no significant difference in the killing effect of rectal cancer.The difference between the two treatment options is that rectal cancer and normal tissues adjacent to the cancer have different degrees of response to different neoadjuvant chemotherapy regimens:(1)CapeOx neoadjuvant chemotherapy combined with long-term radiotherapy makes it easier to make cancer cells in rectal cancer tissues.Density decreases,eosinophilic nucleoli become more prominent;cancerous interstitial is more prone to calcification;(2)mFOLFOX6 neoadjuvant chemotherapy combined with long-term radiotherapy has a relatively greater impact on normal tissues adjacent to rectal cancer,and is more likely to affect normal tissues adjacent to cancer Causes mild damage.