宫颈鳞癌放疗中MI、MI/AI、p53的变化与预后的关系  

The study of the change of MI,MI/AI and p53 in the radiation of cervical squamous carcinoma

作　　者：束凯俊[1] 陈传生[1] 

机构地区：[1]江苏大学附属医院肿瘤中心放疗科,江苏镇江212001

出　　处：《临床肿瘤学杂志》2006年第4期259-261,266,共4页Chinese Clinical Oncology

摘　　要：目的：评估宫颈癌细胞的增殖、增殖和凋亡的比值以及p53在放疗前、中的变化及其与预后的关系,以评估它们在放疗中的价值.方法：42例宫颈鳞癌患者,均经病理证实,其中Ⅱb期8例,Ⅲa期5例、Ⅲb期27例,Ⅳa期2例.采用外照射和腔内后装放疗相结合的方法治疗.外照射能量选6兆X线,总剂量48～50Gy/25～26次,每周5次;腔内后装放射治疗A点剂量35Gy/7次,1周2次,外照射第1周后开始,腔内放射治疗的当天不做外照射.所有患者分别在放疗前和放疗（外照射）第1周结束后（9～10Gy）的第6小时宫颈取材,采用原位末端标记法、免疫组化等方法,对增殖细胞核抗原（PCNA）、凋亡细胞及p53蛋白进行检测.结果：PCNA的阳性细胞指数（MI）在无瘤生存组（no evidence of disease简称NED组）放疗9～10Gy后比放疗前明显下降（P＜0.005）;比死亡＋带瘤生存组（alive with disease,and died of disease简称AWD＋DOD组）放疗9～10Gy后亦下降明显（P＜0.000 1）,而AWD＋DOD组放疗9～10Gy后比放疗前虽有所下降,但无显著性意义（P=0.9628）.MI/AI（凋亡指数）在放疗前NED组比AWD＋DOD组低,但无显著性意义（P=0.066 0）.放疗后NED组比放疗前明显下降（P＜0.05）,亦比AWD＋DOD组低,但无显著性意义（P=0.056 9）.p53在放疗后有明显上升（P＜0.001）,但在NED组和AWD＋DOD组之间无论放疗前、中均无显著差异.结论：放疗后MI、MI/AI明显下降与好的预后有关;p53不适合做预测因素.Objective：Through studying the change of MI,MI/AI and p.53 before and after radiotherapy ,to evaluate the prognostic value of MI, MI/AI and p53 in radiation-treated cervical carcinoma, to help choosing the proper treatment method. Methods：42 patients diagnosed by pathology as squamous cervical carcinoma consisted of 8 case in Ⅱ b stage,5 in Ⅲa stage,27 in Ⅲb stage and 2 in 1Va stage. Treatment method：external radiation used 6MV X-ray with the overall dosage of 48 -50Gy/25 - 26 fractions and internal radiation used Ir-192 after-loading machine with the dosage of point A 35Gy/7fractions. The biopsy was performed before radiation and within 6 hours after the first-week external radiation. PCNA（ Proliferating Cell Nuclear Antigen） ,apoptotic cell and p53 proteins were tested through TUNEL（ terminal deoxynucleotidy transferase-mediated dUTP nick endlabeling）, immunohistochemical method. Results： The MI（ the PCNA positive cell index）was decreased apparently after radiation with 9 - 10Gy in NED group compared to ante-radiaton and even more in AWD ＋ DOD group,but less before and after radiation in AWD ＋ DOD group. The ration of MI/AI was lower in NED group than in AWD ＋ DOD group before radiation, but there was no significant difference. During radiation course the ratio was decreased in NED compared to ante-radiation, and the value was lower in NED than in AWD ＋ DOD group, but there was no significant difference between them. The p53 increased after radiation,but there was no difference between NED and AWD ＋ DOD before and after radiation. Conclusion：The decrease of MI and ratio of MI/AI after radiation has some relation with good prognosis,p53 is not fit for prognosis.

关 键 词：宫颈癌 放射治疗 细胞增殖 细胞凋亡 P53 

分 类 号：R737.33[医药卫生—肿瘤]