| Objective: Surgery treatment of the lung cancer has a history of more than 60 years, and the methods for operation have now been basically fixed through constant alternation. The standard operation method is to dissect the lobes of lung resection plus excision of the district lymph node system; trying to avoid appeasement or incompletely cutting off. The nearby organs being invaded should be cut off at the same time while performing the lung operation, which may include parts of the heart, big blood vessels excisions and reconstruction. Because the lung cancer is a kind of whole-body disease, great majority of the lung cancer patients include some of the earlier period lung cancer patients enter hospital with not only part-area focus, but also with minor transfer problem in distant areas, which theoretically explain the fact that the great majority of the lung cancer patients need part or whole body treatments, so as to increase the curing results of lung cancer treatment and the survival rate. This is the theoretic base for neoadjuvant chemotherapy and the viewpoint on treating lung cancer with pure surgery is now out of date, which is becoming common sense among surgeons. Theories on comprehensive treatments and pre-operational adjuvant chemotherapy to non-small-cell lung cancer have widely received by surgical doctors, and have been widely used in the clinical practice.Recent studies have demonstrated the COX-2 is related to tumor occurrence, development, the transfer and prognosis; at the same time these studies have also indicated that the levels of COX-2 expression is closely related to tumor size, TNM stage, tumor pathological types, VEGF expression level and survival time. Expression of COX-2 is obviously raised on the lung cancer tissue. By restraining the COX-2 expression, the lung cancer cells'proliferation and vascularization of the tumors can be checked, and accelerate the apobiosis of the tumor cells, slow the progression of the tumor invasion and metastasis and improve the survival period of the patients. Application of COX-2 inhibitor for lung cancer treatment is in the initial stage, so there is the need to research valid alternative COX-2 inhibitors, study its relation with other comprehensive therapies for the lung cancer, and to provide the new approaches for lung cancer treatment. The objectives of this research were to study the possibility and response to toxicity of preoperative chemotherapies with the surgical operation to treat theⅢperiod lung cancer, to evaluate its effect on tumor response, and to make further study on the effect on the COX-2 expression in lung cancer tissues with neo-adjuvant chemotherapy.Methods: From Jan. 2006 to Jan. 2007, 60 patients were randomly divided into two groups, group A, preoperative neo-adjuvant chemotherapy and group B, control group without neo-adjuvant chemotherapy. Group A had 30 patients and group B had 30 cases. The patients in group A were given 2 cycles of neo-adjuvant chemotherapy. The regimens included MVP treatment of 11 cases; CAP treatment, 9 cases; EP treatment, 6 cases; VIP treatment, 4 cases. After chemotherapy10-15 days, operations were conducted. The patients in group B were firstly operated on. The tumor tissues from every patient were obtained during operations, The expression of COX-2 protein was examined in the 60 NSCLC tissues with immunohistochemical (s-p) method. In view of the preoperative X-ray and CT pictures the TNM stage of every patient was discriminated. According to postoperative pathology and surgical operation findings the TNM stage of every patient was also discriminated. The tumor response to induction chemotherapy, the tumor downstaging, the elimination resection rate and operative complications occurrence rate were analyzed. Statistical analysis was performed using SPSS13.0 software package. P<0.05 was considered significant for all statistical analyses. analysis was performed to compare using Chi-square test,ANOVA and Paired-Sample T Test.Results:1.The 30 patients in group A were given 2 cycles of neo-adjuvant chemotherapy, with PR, 13 cases; CR, 4 cases; 14 cases of the lymph node of mediastinum contraction, and with a total valid rate ( CR+ PR) of 56.7% (17/30), the resection rate of 93.33% (28/30), having no surgical operation death. In group B the resection rate was 73.33% (22/30). Among the 30 patients in group A received neo-adjuvant chemotherapy, the tumor downstaging was 43.34% (13/30). No cancer tissues were found remaining in the 3 patients chosen for postoperative pathologic examinations on the tissue specimen. The histology complete response was 10.00% (3/30). The tumor resection rate of group A were higher than group B with significant differences (p=0.038,χ2=4.320). No significant differences of blood loss, operative complications and modality were observed between group A and group B (P>0.05).2.The postoperative COX-2 expression rate was 23.33% (7/30) in group A. The postoperative COX-2 expression rate was 76.67% (23/30) in group B. Normal lung tissue (vicinity areas 3 cm from the lung tissue) was no COX-2 expression. There are significant differences in postoperative rate of COX-2 expression among group A and group B (P=0.000,χ2=17.067).Conclusions:1.The results demonstrated that the neo-adjuvant chemotherapy is safe and effective. It is helpful to tumor downstaging, to increase the resection rate of tumor. The neo-adjuvant chemotherapy does not increase the operative complications.2.Neo-adjuvant chemotherapy can repress the COX-2 expression of lung cancer tissue, can restraint the COX-2's involvement in repressing apoptosis of tumor cells, repressing the anti- tumor immunity, increasing vascularization and invasiveness of tumors etc. thus, the chemotherapy can accelerate apoptosis of tumor cells, slow the progression of the tumor invasion and metastasis, cause tumor downstaging, increase the resection rate of tumor and improve the survival time of patients3.It was observed that preoperative chemotherapy could promote tumor cell's apoptosis, enhance resection rate and increase survival time of the patients. It could effectively lower down the tumor cell's COX-2 expression, without increasing surgical operation complications at the same time. It has more positive significance than the pure surgical operation clinically, and deserves clinical extension. |
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