The Correlation Among The Sensitivity Of Induced Chemotherapy By PYM And The Expression Of Ki-67/VEGF/P16 And The Suivive Rate Of The OSCC Patients

Objective: Oral and maxillofacial malignant tumor accounts for about 3% of systemic malignant tumors. Oral squamous cell carcinoma (OSCC) is the most common malignant tumors in oral and maxillofacial region, the incidence rate of OSCC accounts more than 80% of oral cancer. Because the anatomical locationof oral cancer is very special, which is related to the beauty of appearance and importance of physiological functions, so the physical and psychological effects on patients can not be ignored .Wei-Liu Qiu believes that therapy for OSCC should use integrated sequence of treatment: induced chemotherapy→surgical operation→radiotherapy after surgery→biological therapy→rehabilitation therapy. Induction chemotherapy before surgery has the role of reducing the volume of tumor, controlling local spread and reducing local symptoms etc, so it attracts widespread attention of doctors increasingly. Since 70's in the late 20th century, Pingyangmycin (PYM) had been used widely in clinical practice and was proved to be a good chemotherapy medicine. At present, whether Induced Chemotherapy by PYM can improve the survival rate of OSCC patients remain to be seen, so this experiment carries out a exploration to it. After years of clinical work, many doctors found that induced chemotherapy has no effect on part of OSCC patients, this situation makes some patients undergo unnecessary chemotherapy and brings them unnecessary pain and economic burden. Therefore, it is necessary to exclude the patients who are insensitive to induction chemotherapy before chemotherapy. By comparing the survive rate of the OSCC patients who accepted induction chemotherapy by PYM and the ones who refused it, we explored the influence to the prognosis of OSCC patients after applied PYM to them. By exploring the relevance between the strength of Ki-67/VEGF and P16 with OSCC patients and the effect of induction chemotherapy, we want to predict the therapeutic effect before doing induction chemotherapy.In the experiment, through comparing the survive rate between the OSCC patients who accepted induction chemotherapy by PYM and the ones who refused it, we explored the influence of induction chemotherapy by PYM to the survive rate of OSCC patients. And through exploring the connection between the intensity of Ki-67/VEGF and P16 with OSCC patients and the effect of induction chemotherapy, we hope to predict the therapeutic effect before doing induction chemotherapy.Methods : Collecting the patients'data of 69 OSCC cases who accepted induction chemotherapy by PYM and 47 cases who refused it, all these OSCC patients were treated in General Hospital of Chinese People's Armed Police Forces from may, 2001 to may, 2006.All of the patients did not accept any other treatment before. The diagnosis of OSCC is conformed by preoperative pathologic biopsy and confirmed to be primary focus. The lesion is primary focal, and distant metastases are not found.Through statistical analysis by software of SPSS13.0, we explore the connection between the expression level of Ki-67, VEGF, and P16 protein and the effect of induced chemotherapy by PYM before surgery. According to the volume change of the tumor that accepted induction chemotherapy by PYM, we evaluated the effect of induced chemotherapy by PYM. According to the volume change of the tumor that accepted induction chemotherapy by PYM, we evaluated the chemotherapy effect. And we explored the difference of the survive rate between who accepted induction chemotherapy by PYM and the ones who refused it.Results:1 58 of the 69 OSCC patients are sensitive to induced chemotherapy by PYM before surgery, the efficiency rate is84.6%.2①The survive rate between the OSCC patients who accepted induction chemotherapy by PYM and the ones who refused it has no statistical difference.②The survive rate of the OSCC patients who are sensitive to induction chemotherapy by PYM is higher than the ones who are insensitive, there is statistical difference.③The survive rate of the OSCC patients who are sensitive to induction chemotherapy by PYM is higher than the ones who refused it, there is statistical difference.④The survive rate between the OSCC patients who are insensitive to induction chemotherapy by PYM and the ones who refused it has no statistical difference.3 When Ki-67 is positive, the nucleus is dyed dark brown. When VEGF is positive, the cell plasma is dyed brown. When P16 is positive, the nucleus or cell plasma is dyed brown. The result of immunohistochemical staining: The strength of Ki-67 for"+"/"++"and"+++"are respectively 24 cases (34.78%)/24 cases(34.78%)and 21 cases(30.44%);the strength of VEGF for"-"/"+"and"++"are respectively 14 cases (20.29%)/22 case(s31.88%)and 33 cases(47.83%);the strength of P16 for"-"/"+"/"++"and"+++"are respectively 38 cases (55.07%)/17 cases(24.64%)/11 cases(15.94%) and 3 cases(4.35%).4 The relevance between the intensity of Ki-67/VEGF/P16 and the effect of induction chemotherapy by PYM:①The sensitive rate of the OSCC patients whose strength of Ki-67 for"+"/"++"and"+++"are respectively 70.83%/83.33% and 100%, there is statistical difference. It indicates that the higher is intensity of Ki-67, the better is the curative effect of induction chemotherapy by PYM.②The sensitive rate of the OSCC patients whose strength of VEGF for"-"/"+"and"++"are respectively 64.29%/77.27% and 96.97%, there is statistical difference. It indicates that the higher is intensity of VEGF, the better is the curative effect of induction chemotherapy by PYM.③The sensitive rate of the OSCC patients whose strength of p16 for"-"/"+"/"++"and"+++"are respectively 73.68%/94.12%/100% and 100%, there is statistical difference except the"++"group and the"+++"group. It indicates that the higher is intensity of P16, the better is the curative effect of induction chemotherapy by PYM, but the curative effect of the"++"group and the "+++"group are the same.Conclusion:1 After accepting induced chemotherapy by PYM, the survive rate of OSCC patients who are sensitive to induced chemotherapy by PYM is improved, but the survive rate of OSCC patients who are insensitive to induced chemotherapy by PYM has no change.2 Before applying induction chemotherapy by PYM, it is necessary to exclude the OSCC patients who are not sensitive to induction chemotherapy by PYM, thus we can avoid them to accept invalid chemotherapy.3 By observing the strength of Ki-67/VEGF and P16, we can predict the curative effect of induction chemotherapy by PYM, and also can provide reference for that if the OSCC patients are suitable for induction chemotherapy by PYM after surgery.