國立臺灣大學醫學院外科李章銘2006-07-262018-07-112006-07-262018-07-112005-07-31http://ntur.lib.ntu.edu.tw//handle/246246/24556對食道癌的病患接受術前化學與放射治療併用的臨床反應，目前仍存在著極大的個 體差異，但是到目前為止，並沒有一個很好的因子，可以作為預測此反應之依據，本計 畫在去年收集了121 位食道癌接受術前化學與放射治療併用後接受食道切除之病患，我 們研究了EGFR 此基因之基因多型性與此種反應之關聯性，我們應用PCR 的方式來偵測 EGFR 的基因型，此基因型之測定是由病患在術前抽取血球的DNA 而後經過PCR 放大 反應測試，我們將病患分成兩種不同的族群，一個是良好的反應，也就是說病患在接受 化學與放射治療併用之後，腫瘤已經完全消失了，或是在顯微鏡底下，看到殘存的癌組 織；第二組是不良反應，也就是在肉眼就有明顯的腫瘤組織，或是腫瘤組織繼續在增長。 在我們過去一年的研究當中，這些病患有47 位佔所有病患的38.8%歸類為好的反應，而 另外74 位病患(佔61.2%)歸類為不良反應者，我們發覺EGFR 的基因型是預測這些化學 與放射治療反應唯一有意義的因子，跟其他基因型相對而言，如果EGFR 病患擁有兩個 以上的常見基因型者，也就是說，他有大於19 個CA 以上的基因型，則他的臨床反應就 會比較傾向於不良反應(69.5%：53.2%；OR 值=2.03；95%信賴區間落在0.97-4.23；p=0.061) 所以在我們的觀察，EGFR 基因多型性也許可以當做一個預測術前化學與放射治療 在食道癌病患的反應預測因子，如此可以幫助我們在臨床上偵測哪些病患是不良反應 者，而避免不必要的治療與副作用，而可以及早接受絶對的手術治療。Variation in response to concurrent neoadjuvant chemoirradiation exists for the patients of esophageal cancer. There are no reliable markers to predict the individual response for such patients. A polymorphic CA repeat was found at the 5’-regulatory sequence in the intron 1 of the EGFR gene, which influence the transcription activity of the gene. In this study, we investigate whether this genetic polymorphism can modulate the response to concurrent chemoirradiation for patients of esophageal cancer. We conducted a prospective study including 121 patients with esophageal cancer who received concurrent neoadjuvant chemoirradiation followed by esophagectomy in National Taiwan University Hospital between 1996 and 2002. The EGFR genotype was determined by polymerase chain reaction (PCR) amplification of leukocyte DNA obtained before surgery. The response was classified as 1):good response which included patients with pathologically complete remission or remained with microscopically residual tumor; and 2): poor response which include grossly visible or progressively growing tumor after treatment. Results: There were 47 (38.8 %) patients classified as good and 74 (61.2 %) as poor responders in this study. We found the EGFR genotype were the single one factor influencing the response to concurrent neoadjuvant chemoirradiation. As compared to patients with other genotypes, those who with two long allele (> 19 CA) were more likely to poorly respond to treatment (69.5% vs. 53.2%; OR (95% CI)= 2.03 (0.97-4.23); p=0.061). Conclusion: EGFR genetic polymorphism might serve as a valuable predictor for the response to concurrent chemoirradiation in patients of esophageal cancer, which help patients of esophageal cancer of poor responders to chemoirradiation avoid unnecessary treatment before surgery.application/pdf150518 bytesapplication/pdfzh-TW國立臺灣大學醫學院外科[SDGs]SDG3reporthttp://ntur.lib.ntu.edu.tw/bitstream/246246/24556/1/932314B002254.pdf