[Tumor proliferation and apoptosis after preoperative hepatic and regional arterial infusion chemotherapy in prevention of liver metastasis after colorectal cancer surgery].

OBJECTIVE

To investigate the tumor proliferation and apoptosis changes after preoperative hepatic and regional arterial infusion chemotherapy (PHRAIC) after radical colorectal cancer resection.

METHODS

Five hundred and nine patients with stage II or stage III colorectal cancer from June 2001 to June 2007 were randomly assigned to PHRAIC group (n = 256) or control group (n = 253, surgery alone). Tumor proliferation and apoptosis index were evaluated in tumor tissues of the control and PHRAIC group (pre and after intervention). The survival rates were also recorded in the two groups.

RESULTS

There was no significant differences in sex, age, tumor location, tumor size, tumor stage, tumor differentiation and follow-up time for the two groups (P > 0.05). There was no significant differences in all the evaluation factors between the control group and PHRAIC group before intervention (P > 0.05). Before and after intervention for PHRAIC group: stage 3 necrosis rate were 3.1% and 22.7%, stage 4 necrosis rate were 0 and 13.5% (P < 0.05); label index of Ki67 were 48.6 +/- 17.1 and 38.4 +/- 13.3 (P < 0.05); expression rate of Bax, bcl-2 and survivin were 48.0% vs 77.0%, 75.0% vs 43.0%, 52.0% vs 31.6%, respectively (P < 0.05); apoptosis rate were 4.3% +/- 2.2% and 16.7% +/- 6.4%(P < 0.05). In the PHRAIC group, 42.1% +/- 11.2% of the cells in the tumor tissue were in S phase before intervention and the rate fell to 21.8% +/- 10.7% after intervention (P < 0.05); and G0-G1 phase rate of the group pre and post intervention were 35.1% +/- 12.1% and 57.1% +/- 18.1% (P < 0.05). All the patients were followed-up for a mean time of 42 +/- 14 months. For patients with stage III tumor in PHRAIC group and control group, the 5-year liver metastasis rate were 18.9% and 27.3% (P = 0.033), recurrence and metastasis rate were 26.3% and 38.0 (P = 0.024), overall survival rate were 81.0% and 60.4% (P = 0.011), median survival time were 45 and 40 months (P = 0.02); no significant differences of aforementioned factors was found in patients with stage II tumors between the two groups.

CONCLUSION

The schedule of preoperative hepatic and regional arterial infusion chemotherapy before surgery can restrain proliferation, promote apoptosis and reduce liver metastasis and improve survival rate in stage III colorectal cancer.