| bjective:1.The change trends of carbohydrate antigen724(CA724), carcinoembryonic antigen (CEA), tumor necrosis factor-α (TNF-α),CD4+T cells and CD8+T cells before and after the surgical treatment andintraoperative interorganizational targeted injection chemotherapy (IITIC) foradvanced gastric carcinoma (AGC) were monitored dynamically and theclinical diagnosis and prognosis value of the above indicators for AGC wasassessed.2.To explore the necessity and clinical significance of IITIC instrengthen treatment for AGC surgery and provide a scientific basis for IITIC inAGC.3.To explore the basic methods and clinical significance of sentinellymph node (SLN) tracing in AGC. Methods:1.From August2011to August2012,41patients who suffered from AGC and were treated by surgery ingeneral surgical department of Sichuan Mianyang404Hospital were dividedinto group A and B randomly. There were21patients in group A and thesepatients were carried out SLN tracing, radical distal subtotal gastrectomy (D2),IITIC and Adjustive double digestive tract reconstruction surgery. There were20patients in group B and these patients were carried out SLN tracing, radicaldistal subtotal gastrectomy (D2) and Adjustive double digestive tractreconstruction surgery. Portal vein blood was drawn at the time of30minutesbefore and after the tumor’s resection and CA724, CEA as well as TNF-α weretested. Peripheral vein blood was drawn one day before surgery, one day aftersurgery,10days after surgery, one month after surgery and CA724, CEA,TNF-α, CD4+T cells, CD8+T cells were tested. Peripheral vein blood wasdrawn one day before surgery, one day after surgery,5days after surgery andwhite blood cell (WBC), alanine transaminase (ALT), creatinine (Cr) weretested. Compare the differences of these hematologic indicators above betweengroup A and group B.2.63patients who were carried out radical gastrectomy in our hospital in2008were divided into group C and group D. There were34patients in group C and these patients were carried out radical gastrectomy (D2)and IITIC, There were29patients in group D and these patients were carriedout radical gastrectomy (D2). Compare the3-year survival rate between groupC and group D.3.The measurement datum were presented as mean±standarddeviation (x±s) and the count datum were presented as rate (%). Statisticaldatum were analysed by SPSS18.0. According to the types of different datumand the statistical analysis methods they meet, repeated measures analysis ofvariance, t-test, Wilcoxon rank sum test and chi-square test were selectedrespectively. The inspection level α was0.05, P<0.05was considered asexisting statistically significance. Results:1.39patients were found existingSLNs in41AGC patients with a detection rate of95.1%(39/41).35patientswere found existing cancerometastasis in SLNs by pathological andimmunohistochemical examination, With a positive rate of89.7%(35/39).106nodes of SLNs were found and72nodes of SLNs were found existingcancerometastasis in SLNs by pathological examination.12nodes of SLNswere not found existing cancerometastasis in SLNs by pathologicalexamination but were demonstrated existing cancerometastasis in SLNs byimmunohistochemical examination.84nodes were found existingcancerometastasis in SLNs in total with a metastasis rate of79.2%(84/106).2.The levels of CA724, CEA and TNF-α in portal vein blood for patients ofgroup A were7.68±4.56U/ml,8.11±6.11ng/ml,15.43±6.45pg/ml and6.07±4.00U/ml,6.63±5.05ng/ml,10.84±4.61pg/ml at the time of30minutesbefore and after the tumor’s resection, which were demonstrated as existingstatistically significance (P<0.05). The levels of CA724, CEA and TNF-α inportal vein blood for patients of group B were6.57±3.61U/ml,7.31±7.82ng/ml,19.23±7.43pg/ml and5.08±3.35U/ml,6.89±7.59ng/ml,15.40±6.51pg/ml at the time of30minutes before and after the tumor’s resection, whichwere demonstrated as existing statistically significance (P<0.05). The difference of the levels for CA724, CEA and TNF-α in portal vein blood for patients ofgroup A and group B were1.60±1.04U/ml,1.47±1.21ng/ml,4.59±2.52pg/mland1.49±0.92U/ml,0.42±0.32ng/ml,3.83±1.60pg/ml at the time of30minutes before and after the tumor’s resection. The levels of CA724and TNF-αat the time of30minutes before and after the tumor’s resection were notdemonstrated as existing statistically significance (P>0.05), but CEA weredemonstrated as existing statistically significance (P<0.05).3.In the41patients,the level of CA724elevated accounted for56.10%(23/41), the level of CEAelevated accounted for60.98%(25/41), the level of CA724or CEA elevatedaccounted for87.80%(36/41) and the level of TNF-αelevated accounting for97.56%(40/41). The levels of CA724, CEA, TNF-α, CD4+T cells and CD8+Tcells in peripheral vein blood for patients of group A were8.75±5.35U/ml,4.97±3.09U/ml,4.25±2.77U/ml,4.92±3.65U/ml;9.56±6.95ng/ml,5.62±4.52ng/ml,2.79±1.66ng/ml,3.17±2.03ng/ml;20.55±8.54pg/ml,11.32±3.79pg/ml,8.74±2.83pg/ml,12.47±3.20pg/ml;33.95±6.48%,36.48±6.22%,44.05±7.82%,42.00±7.95%and43.10±7.33%,40.81±7.26%,33.38±5.98%,36.52±5.84%oneday before surgery, one day after surgery,10days after surgery and one monthafter surgery respectively. The levels of CA724, CEA, TNF-α, CD4+T cellsand CD8+T cells in peripheral vein blood for patients of group B were8.03±4.40U/ml,5.23±2.97U/ml,4.72±2.81U/ml,5.64±4.13U/ml;8.50±9.29ng/ml,5.57±5.34ng/ml,3.10±1.89ng/ml,3.49±1.84ng/ml;23.25±13.99pg/ml,16.18±9.26pg/ml,13.16±8.46pg/ml,17.76±10.64pg/ml;34.50±5.75%,36.50±4.97%,43.20±4.66%,40.20±4.11%and42.50±8.20%,40.50±7.72%,34.00±5.68%,37.00±5.63%one day before surgery, one day after surgery,10days after surgery and one month after surgery respectively. The levels ofCA724, CEA, TNF-α, CD4+T cells and CD8+T cells at all time in group A orgroup B were demonstrated as existing statistically significance (P<0.05). Butthe levels of these indicators above were not demonstrated as existingstatistically significance between group A and group B (P>0.05).4.The levels of WBC, ALT and Cr in peripheral vein blood for patients of group A were7.21±1.58109/L,9.79±2.04109/L,7.53±1.30109/L;22.67±6.32U/L,47.03±16.49U/L,28.35±7.17U/L and78.97±18.72umol/L,81.82±20.27umol/L,80.20±19.38umol/L one day before surgery, one day after surgery and5days after surgery. The levels of WBC, ALT and Cr in peripheral vein bloodfor patients of group B were6.96±1.28109/L,9.63±1.78109/L,7.15±1.23109/L;22.86±4.85U/L,45.23±13.49U/L,28.69±7.41U/L and76.15±21.22umol/L,83.49±26.19umol/L,77.60±20.28umol/L one day before surgery, oneday after surgery and5days after surgery. The levels of WBC, ALT and Cr at alltime in group A or group B were demonstrated as existing statisticallysignificance (P<0.05). But the levels of these indicators above were notdemonstrated as existing statistically significance between group A and group B(P>0.05).5.The3-year survival rate for the patients of group C and group Dwere67.6%and41.4%respectively, which were demonstrated as existingstatistically significance (X2=4.374, P=0.037). Conclusions:1.Joint dynamicmonitoring of the levels for CA724, CEA, TNF-α, CD4+T cell and CD8+Tcell have an important clinical value to diagnosis, treatment effect andprognosis for AGC.2.It is safe and feasible to carry out IITIC in gastrectomyfor AGC; IITIC can increase the treatment effect to AGC surgery, which alsocan extend the survival time of patients and improve the postoperative survivalrate.3.Lymph node metastasis and micrometastasis exist in most AGC. SLNtracing can find the high-risk areas and directions of lymph node metastasis sothat IITIC can be guided scientifically. |
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