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目的:探讨DNA拓扑异构酶Ⅰ(TOPOⅠ)表达水平和K-ras基因突变的检测在转移性结肠直肠癌个体化治疗中的临床价值及意义。方法:选取2012年1月至2014年6月于我院胃肠外科接受结肠直肠癌根治性切除术,术后转移病人40例,随机分为试验组和对照组。试验组根据TOPOⅠ表达水平和K-ras基因突变检测结果行个体化治疗,对照组随机选择化疗方案。观察其临床疗效和不良反应。以Kaplan-Meier方法计算生存时间,评价客观缓解率和疾病控制率。结果:39例病人疗效可评价,试验组客观缓解率67%,疾病控制率81%,对照组客观缓解率50%,疾病控制率72%,两组比较无统计学差异(P>0.05)。试验组皮疹发生率高于对照组,而腹泻发生率低于对照组,差异有统计学意义(P<0.05)。试验组中位无进展生存期明显长于对照组(8个月比5个月,P<0.05),两组中位生存时间无明显差异(16个月比13个月,P>0.05)。结论:基于TOPOⅠ表达和K-ras基因检测的转移性结肠直肠癌个体化治疗方案可延缓病情进展,减少不良反应发生率,对提高疗效有一定应用价值。
Objective: To investigate the clinical value and significance of detection of TOPO Ⅰ and K-ras mutations in individualized treatment of metastatic colorectal cancer. Methods: From January 2012 to June 2014, we underwent radical resection of colorectal carcinoma in our department of gastrointestinal surgery. 40 patients were transferred to the experimental group and the control group randomly. The experimental group according to TOPO Ⅰ expression level and K-ras gene mutation test results of individualized treatment, the control group were randomly selected chemotherapy. Observe its clinical efficacy and adverse reactions. Survival time was calculated by Kaplan-Meier method, objective response rate and disease control rate were evaluated. Results: The curative effect of 39 patients was evaluated. The objective response rate was 67%, the disease control rate was 81%, the objective response rate was 50% and the disease control rate was 72%. There was no significant difference between the two groups (P> 0.05). The incidence of rash in the experimental group was higher than that in the control group, but the incidence of diarrhea was lower than that in the control group (P <0.05). The median progression-free survival time was significantly longer in the experimental group than in the control group (8 months vs. 5 months, P <0.05). There was no significant difference in median survival between the two groups (16 months vs. 13 months, P> 0.05). Conclusion: The individualized treatment of metastatic colorectal cancer based on TOPO Ⅰ expression and K-ras gene test can delay the progression of the disease and reduce the incidence of adverse reactions, which may be of value in improving the curative effect.