Preoperative Neoadjuvant Chemotherapy Combined with Concurrent Radiotherapy and Chemotherapy on the Prognosis and Serum Markers of Locally Advanced Rectal Cancer
YU Deng-feng,ZHANG Wen-jun,ZHANG Fu-jie
Department of Anorectal, Xinhua Hospital, Dalian University, DaLian 116021, LiaoNing, China
Abstract:
Objective To investigate the effect of FOLFOX4 combined with preoperative concurrent chemoradiotherapy on the expression of serum fatty acid synthase (FAS) and Tumor-type M2 pyruvate kinase (Tu M2-PK) in patients with locally advanced rectal cancer, and to provide a reference for the clinical treatment of rectal cancer. Methods One hundred patients with advanced rectal cancer were enrolled in the study. The randomized digital table method was used to divide patients into test group and control group, which 50 cases in each group. The test group received FOLFOX4 combined with preoperative concurrent chemoradiotherapy: 4 cycles of FOLFOX4 chemotherapy after concurrent chemoradiotherapy, total mesorectal excision after the end, and 4 cycles of FOLFOX4 chemotherapy 4 weeks after surgery. The control group received preoperative concurrent chemoradiotherapy: TME was performed 6 to 8 weeks after the end of concurrent chemoradiotherapy, and 8 cycles of FOLFOX4 chemotherapy were performed 4 weeks after surgery. The complete pathologic response rate (pCR), radical resection rate (R0 resection rate), declining rate, local recurrence rate, distant metastasis rate, overall survival rate, adverse reactions and complications were compared between the two groups. The levels of serum fatty acid synthase (FAS) and Tumor-type M2 pyruvate kinase (Tu M2-PK) were detected and compared before and after treatment. Results After treatment,the rate of decline, R0 resection rate, pCR rate in the test group (80%, 86%, 27%) were signi?cantly higher than those of the control group (48%, 64%, 6%), which with statistical signi?cance (χ2=6.182, P=0.013). The local recurrence rate and long-term metastasis rate (8%, 27%) in the test group were signi?cantly lower than those in the control group (24%, 46%) (χ2=4.581, P=0.032; χ2=4.054, P=0.044). The survival rate (OS) log-rank test showed the statistical differences between the two groups, and K-M curve showed log-rank P=0.035. The incidence of adverse reactions and postoperative complications in the test group was not statistically different from the control group, which with no statistical significance (P>0.05). After the end of FOLFOX4 chemotherapy,the serum FAS and Tu M2-PK levels in the two groups were signi?cantly lower than those in the preoperative group, and the serum FAS and Tu M2-PK levels in the test group were signi?cantly improved compared with the control group (t=9.791, 4.508, P<0.001). Conclusion FOLFOX4 combined with preoperative concurrent chemoradiotherapy for locally advanced rectal cancer can not only improve the tumor declining rate and overall survival period, but also has no obvious side effects. It can signi?cantly reduce serum FAS and Tu M2-PK levels,which inhibit tumor proliferation, invasion and metastasis.
