[Influence and significance of preoperative intraarterial infusion chemotherapy combined with radiotherapy on survivin, p53 and Bax expression in low rectal carcinoma].
OBJECTIVE
Recently, neoadjuvant therapy has attracted more attention, but the influence of preoperative intraarterial infusion chemotherapy (PRAC) combined with radiotherapy on Survivin expression in rectal carcinoma is unclear. This study was to investigate the effect of PRAC or radiotherapy on Survivin, P53, and Bax expression in low rectal cancer.


METHODS
A total of 60 patients with low rectal carcinoma were randomized into 3 groups: 19 received PRAC combined with preoperative radiotherapy (radiochemotherapy group), 15 received preoperative radiotherapy alone (radiotherapy group), and 26 received operation alone (control group). PRAC was performed using Seldinger technique. Preoperative radiotherapy was performed with a total dose of 20 Gy in 5 days, and superadded 30 Gy after operation. Control group received postoperative radiotherapy with a total dose of 50 Gy. The expression of Survivin, P53, and Bax was examined by immunohistochemistry.


RESULTS
After neoadjuvant therapy, there was no significant difference in the positive rates of Survivin, P53, and Bax among the 3 groups. In radiochemotherapy group, the positive rate of Survivin was reduced from 63.16% before neoadjuvant therapy to 26.32% after operation (P<0.05), and the overexpression rate of P53 was reduced from 57.89% to 26.32% (P<0.05). In radiotherapy group, the overexpression rate of Survivin was reduced from 53.33% to 13.33% (P<0.05), but there was no significant change in the positive rate of P53. The positive rate of Bax was slightly increased after operation in above 2 groups. In these 2 groups, the median survival time was significantly longer in the patients with reduced Survivin expression than in those with increased Survivin expression (50.05 months vs. 42.61 months, P<0.01). Survivin expression was not obviously related to Bax and P53 expression (P>0.05).


CONCLUSIONS
Neoadjuvant therapy could decrease the levels of P53 and Survivin expression, might enhance the level of Bax expression, and consequently accelerate cancer cell apoptosis and achieve a better short-term curative effect on low rectal cancer.
Gan
Jia-Liang
JL
Department of Colon, Rectum & Anus Surgery, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, 530021, P. R. China. gjl259@126.com
Guo
Yun
Y
Tang
Zong-Jiang
ZJ
Gao
Feng
F
Tang
Wei-Zhong
WZ
Liu
Xiao-Jian
XJ
D000230:Adenocarcinoma / Q000378:metabolism / Q000601:surgery / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017209:Apoptosis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007261:Infusions, Intra-Arterial; D051034:Inhibitor of Apoptosis Proteins; D008297:Male; D008869:Microtubule-Associated Proteins / Q000378:metabolism*; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009363:Neoplasm Proteins / Q000378:metabolism*; D011300:Preoperative Care; D011446:Prospective Studies; D011882:Radiotherapy, High-Energy; D012004:Rectal Neoplasms / Q000378:metabolism / Q000601:surgery / Q000628:therapy*; D000077022:Survivin; D016159:Tumor Suppressor Protein p53 / Q000378:metabolism*; D051028:bcl-2-Associated X Protein / Q000378:metabolism*
C107489:BIRC5 protein, human; D051034:Inhibitor of Apoptosis Proteins; D008869:Microtubule-Associated Proteins; D009363:Neoplasm Proteins; D000077022:Survivin; D016159:Tumor Suppressor Protein p53; D051028:bcl-2-Associated X Protein