摘要目的:探讨食管鳞状细胞癌（ESCC）患者STMN1、BubR1、bcl-2、Bad表达水平与含紫杉醇方案化疗效果的相关性。方法:回顾性分析2016年9月至2021年6月山西医科大学附属汾阳医院86例接受含紫杉醇方案化疗的ESCC患者的临床资料。其中59例接受维持化疗，27例接受新辅助化疗3个疗程后接受手术治疗。采用免疫组织化学法检测化疗前肿瘤组织STMN1、BubR1、bcl-2、Bad表达水平。对患者化疗3个疗程后的影像学疗效和新辅助化疗后病理学疗效进行评价。比较各蛋白高表达组和低表达组患者影像学疗效、病理学疗效、无进展生存（PFS）的差异。结果:STMN1高表达组Ⅳ期患者比例（46.3%，19/41）、低分化患者比例（22%，9/41）、淋巴结转移率（95.1%，39/41）均高于STMN1低表达组（17.8%，8/45；4.4%，2/45；64.4%，29/45），差异均有统计学意义（均 P<0.05）。Bad高表达组Ⅳ期患者比例低于Bad低表达组，差异有统计学意义（ P<0.05）。影像学疗效评价中，STMN1、BubR1高表达组化疗敏感率（29.3%，12/41；37.9%，22/58）均低于低表达组（75.6%，34/45；85.7%，24/28），Bad高表达组化疗敏感率（65.9%，27/41）高于低表达组（42.2%，19/45），差异均有统计学意义（均 P<0.05）。bcl-2表达情况与化疗敏感率差异均无统计学意义（ P>0.05）。病理学疗效评价中，STMN1高表达组新辅助化疗后肿瘤回缩分级（TRG）评分0~1分患者比例（27.3%，3/11）低于STMN1低表达组（75.0%，12/16），差异有统计学意义（ P＝0.022）。BubR1、bcl-2、Bad高、低表达组新辅助化疗后TRG评分0~1分患者比例差异均无统计学意义（均 P>0.05）。维持化疗患者PFS率为15.2%（9/59）,中位PFS时间为6个月。Kaplan-Meier法分析显示，STMN1低表达组PFS优于高表达组（ χ2＝12.90， P<0.001）。BubR1低表达组PFS优于高表达组（ χ2＝12.04， P<0.001）。Bad高表达组PFS优于低表达组（ χ2＝9.69， P＝0.004）。bcl-2高、低表达组PFS差异无统计学意义（ χ2＝1.43， P＝0.320）。 结论:STMN1低表达、BubR1低表达、Bad高表达的ESCC患者接受含紫杉醇方案化疗效果更好，bcl-2表达情况与化疗效果无相关性。

abstractsObjective:To investigate the correlation between the expression levels of STMN1, BubR1, bcl-2 and Bad and the chemotherapy effect of paclitaxel-containing regimen in patients with esophageal squamous cell carcinoma (ESCC).Methods:The clinical data of ESCC patients who received paclitaxel-containing chemotherapy at Fenyang Hospital Affiliated to Shanxi Medical University from September 2016 to June 2021 were retrospectively analyzed. Among them, 59 cases received maintenance chemotherapy and 27 cases received surgery after 3 courses of neoadjuvant chemotherapy. The expression levels of STMN1, BubR1, bcl-2 and Bad in tumor tissues before chemotherapy were detected by immunohistochemistry. The imaging efficacy after 3 courses of chemotherapy and pathological efficacy after neoadjuvant chemotherapy were evaluated. The imaging efficacy, pathological efficacy and progression-free survival (PFS) were compared between the high expression group and the low expression group of each protein.Results:The proportion of patients with stage Ⅳ (46.3%, 19/41), the proportion of patients with low differentiation (22%, 9/41) and the incidence of lymph node metastasis (95.1%, 39/41) in STMN1 high expression group were higher than those in STMN1 low expression group (17.8%, 8/45; 4.4%, 2/45; 64.4%, 29/45), and the differences were statistically significant (all P < 0.05). The proportion of patients with stage Ⅳ in Bad high expression group was lower than that in Bad low expression group, and the difference was statistically significant ( P < 0.05). In the evaluation of imaging efficacy, the chemotherapy sensitivity rates in STMN1 and BubR1 high expression groups (29.3%, 12/41; 37.9%, 22/58) were lower than those in STMN1 and BubR1 low expression groups (75.6%, 34/45; 85.7%, 24/28), and the chemotherapy sensitivity rate of patients in Bad high expression group (65.9%, 27/41) was higher than that in Bad low expression group (42.2%, 19/45), and the difference was statistically significant (all P < 0.05). There was no statistical correlation between bcl-2 expression and chemotherapy sensitivity rate ( P > 0.05). In the evaluation of pathological efficacy, the proportion of patients with tumor regression grade (TRG) score 0-1 after neoadjuvant therapy in STMN1 high expression group (27.3%, 3/11) was lower than that in STMN1 low expression group (75.0%, 12/16), and the difference was statistically significant ( P = 0.022). There were no statistical differences in the proportions of patients with TRG score 0-1 after neoadjuvant therapy between high and low expression groups of BubR1, bcl-2 and Bad (all P > 0.05). The PFS rate was 15.2% (9/59) for patients received maintenance chemotherapy, and the median PFS time was 6 months. Kaplan-Meier analysis showed that PFS in STMN1 low expression group was better than that in STMN1 low expression group ( χ2 = 12.90, P < 0.001). PFS in BubR1 low expression group was better than that in BubR1 high expression ( χ2 =12.04, P < 0.001). PFS in Bad high expression group was better than that in Bad low expression group ( χ2 =9.69, P = 0.004). There was no statistical difference in PFS between high and low bcl-2 expression groups ( χ2 =1.43, P = 0.320). Conclusions:ESCC patients with low expression of STMN1, low expression of BubR1 and high expression of Bad have better chemotherapy effect after receiving paclitaxel-containing regimen, but there is no correlation between bcl-2 expression and chemotherapy efficacy.