血管内皮生长因子的表达在动脉化疗栓塞联合腔内放疗治疗宫颈癌中的临床意义  

Clinical significance of vascular endothelial growth factor expression of in the treatment cervical cancer by artery chemoembolization combined with intracavitary brachytherapy

作　　者：余雷[1] 杨建勇[2] 向贤宏[2] 李鹤平[2] 李家平[2] 黄勇慧[2] 谭国胜[2] 

机构地区：[1]广西壮族自治区人民医院肿瘤科,南宁530021 [2]中山大学附属第一医院介入放射科,广州510080

出　　处：《中国临床新医学》2010年第9期834-838,共5页CHINESE JOURNAL OF NEW CLINICAL MEDICINE

摘　　要：目的评价血管内皮生长因子(VEGF)的表达对动脉化疗栓塞联合术前腔内放疗治疗宫颈癌的临床意义。方法 2000-08～2007-11收治的51例宫颈癌患者中,26例接受了双侧子宫动脉化疗栓塞,其中12例加用了腔内放疗;25例接受了双侧髂内动脉灌注化疗,其中10例加用了腔内放疗。化疗方案均以卡铂为主的联合方案。介入治疗或腔内放疗后2周进行广泛性子宫切除术和盆腔淋巴结清扫术,对治疗前的宫颈活检标本和手术后的标本共102份采用免疫组化方法测定血管内皮生长因子的表达。结果宫颈癌组织中VEGF的阳性表达由治疗前的64.7%下降为45.1%,差异具有统计学意义,治疗前VEGF的阳性表达与FIGO分期、肿瘤分级和病理缓解有明显的相关性。VEGF阳性表达的患者动脉化疗/栓塞或联合腔内放疗后的临床有效率(54.5%,18/33)低于VEGF阴性表达者(77.8%,14/18),但差异无统计学意义(P=0.105)。治疗前VEGF表达阴性的宫颈癌患者5年总生存率和无病生存率均高于表达阳性者(100%、94% vs.73%、75%,P=0.043,P=0.112),总生存率差异具有统计学意义。结论治疗前VEGF表达可能是评价动脉化疗栓塞联合术前腔内放疗治疗宫颈癌临床疗效和预后的指标。Objective To evaluate the clinical significance of expression of vascular endothelial growth factor （VEGF） expression in the treatment of cervical cancer by artery chemoembolization combined with preoperative intracavitary brachytherapy（IB）. Methods Fifty-one patients with cervical cancer were treated between August 2000 and November 2007. Twenty-six patients were performed bilateral uterine artery embolization after uterine artery injection of chemotherapeutic agents, IB were underwent in 12 of 26 patients. Twenty-five patients were infused chemotherapy drugs by bilateral internal iliac artery transcatheter, IB were undergone in 10 of 25 patients. All patients were treated by carboplatin-based combination chemotherapy, and then radical hysterectomy and pelvic lymphadanectomy was performed 2 weeks after interventional therapy or IB. VEGF expression were observed by immunohistochemical methods on a total of 102 cervical cancer specimens before and after the treatment. Results The positive expression of VEGF in cervical cancer was dropped from 64. 7% preoperation to 45.1%, the difference was significant. Preoperative positive expression of VEGF was significantly correlated with FIGO stage, tumor grade and pathological response. The clinical response after arterial chemoembelization followed by preoperative IB in patients with positive expression of VEGF（54. 5%, 18/33） was lower than those with negative VEGF expression （77.8%, 14/18）, but the difference was not statistically significant （P = 0. 105 ）. The 5-year overall survival and disease-free survival rates in patients with negative expression of VEGF before treatment were higher than those with VEGF pesitivity （ 100%, 94% vs. 73%, 75%, P = 0. 043, P = 0. 112）, overall survival rate difference was statistically significant. Conclusion The study indicates that VEGF expression before treatment may serve as clinical response and prognosis predictors in pa- tients with cervical cancer who receive artery chemoembolization combined with preopera

关 键 词：宫颈癌 动脉内输注 化学疗法 辅助 栓塞 血管内皮生长因子 预后 

分 类 号：R737.33[医药卫生—肿瘤]