| Background: In recent years,many scholars have begun to explore how to reduce the local recurrence rate of local advanced rectal cancer patients and improve the prognosis of survival of a variety of models to explore.With the effect of Neoadjuvant Chemoradiotherapy(NCRT)in the treatment of breast cancer and the postoperation radiotherapy and chemotherapy for Colorectal Cancer(CRC)was positive,CRC is gradually applied in rectal cancer,and NCRT has become an important part for locally advanced rectal of multidisciplinary comprehensive treatment.But the efficacy of NCRT is still controversial.The purpose of this study is as follows: 1.To analyze the therapeutic effect of NCRT on low-grade rectal cancer in c Ⅱ-cⅢ;2.To understand the effect of NCRT on vascular endothelial growth factor(VEGF),and to analyze the effect of VEGF on NCRT sensitivity.Part Ⅰ Clinical Efficacy of Neoadjuvant Chemoradiotherapy in Middle and Low Rectal Cancer with Clinical Ⅱ-Ⅲ StageObjective: To analyze the clinical efficacy of neoadjuvant chemotherapy in middle and low rectal cancer with clinical Ⅱ-Ⅲ stage.Methods: A retrospective analysis 154 patients with rectal cancer who were hospitalized in Shaanxi Province from January 2008 to December 2011.Patients were grouped according to whether they received NCRT.The NCRT group(group A)including 62 patients,the direct surgery group(group B)including 92 patients.Statistics of the general pathological features and surgical-related information of the patients in two groups.The differences of tumor preserving rate,operative related complications,postoperative tumor recurrence rate and postoperative survival rate were analyzed.Results: In group A,8.1%(5/62)of patients reached complete remission(CR),48.4%(30/62)reached partial remission(PR),and 43.5%(27/62)reached stability(SD),none of the patients disease progression.The incidence of NCRT in group A was mainly myelosuppression and the incidence was about 4.8%(3/62).The anastomotic rate was 66.7%(24/36)in group A and 36.7% in group B,the difference was statistically significant(P<0.05).the incidence of bleeding,intestinal obstruction and anastomotic fistula in the two groups were not statistically significant(P> 0.05),However,The incidence of incisional incision and anterior resection syndrome in group A was significantly higher than that in group B(P<0.05).After analysis of the follow-up data,it was found that the 5-year overall survival rate(OS)of the two groups was not different,but the rate of 5 tumor-free survival(DFS)was higher than group B,he difference was statistically significant(P<0.05).Conclusion: 1.NCRT can decrease in tumor volume of middle and low rectal cancer with clinical Ⅱ-Ⅲ stage,reduce the local recurrence rate and improve the preserving rate.2.NCRT cannot improve the 5years OS of patients with middle and low rectal cancer with clinical Ⅱ-Ⅲ stage,but can improve the 5-years DFS.Part Ⅱ The Effect of NCRT on the Expression of VEGF in Rectal Cancer Objective: 1.The effect of NCRT on expression of VEGF in rectal cancer tissue;2.To predict the effect of VEGF on predicting NCRT sensitivity.Methods: The histopathological specimens of 62 patients with rectal cancer were collected before and after NCRT.11 cases of rectal specimens resected with benign lesion were taken as control.It was used to detect the expression of VEGF among three groups by the Immunohistochemical method.Compare the expression of VEGF among three groups and discuss the relationship between VEGF expression and NCRT sensitivity.Results: VEGF in normal colorectal mucosa was not expressed,The positive rate of VEGF in untreated NCRT rectal mucosa was 77.4%(48/62),compared with the expression of VEGF in received NCRT rectal cancer tissues was significantly different(x2=16.221,P=0.000).In NCRT-sensitive patients,the positive rate was 88.6%(39/44),and about 50%(9/18)in patients with NCRT insensitivity.NCRT sensitivity was associated with VEGF expression(r=0.483,p=0.000).Conclusion: 1.NCRT can down-regulate the expression of VEGF dramaticlly in low rectal cancer tissues;2.VEGF expression is positively correlated with NCRT sensitivity and may have a role in predicting NCRT sensitivity. |
