胸腹水细胞沉渣石蜡包埋免疫组化检测法指导晚期卵巢癌新辅助化疗研究  

Clinical research on the application of ascites and pleural effusion cell sediment paraffin embedding i mmunohistochemistry in neoadjuvant chemotherapy for advanced ovarian cancer

作　　者：李潇[1] 田保玲[1] 刘娟娟[1] 张丹晔[1] 刘水策[1] 付凌婕[1] 刘冰莹[1] 朱连成[1] 高霭松 林蓓[1] 

机构地区：[1]中国医科大学附属盛京医院妇产科,辽宁沈阳110004

出　　处：《中国实用妇科与产科杂志》2016年第9期890-895,共6页Chinese Journal of Practical Gynecology and Obstetrics

基　　金：国家自然科学基金(30872757);盛京自由研究者计划(201303)

摘　　要：目的探讨胸腹水细胞沉渣石蜡包埋免疫组化检测法在指导晚期卵巢癌新辅助化疗中的应用。方法回顾性分析2010年1月至2016年5月中国医科大学附属盛京医院收治的晚期卵巢癌患者22例,比较新辅助化疗对术前肿瘤负荷减小、术中及术后机体一般状态改善情况的影响,分析卵巢癌细胞沉渣石蜡包埋免疫组化标志物的临床意义。结果 CA125化疗后平均285.2 k U/L,较化疗前平均3454.3 k U/L明显降低(P<0.01);彩超测定腹水量(最大测量值)化疗后平均2.5 cm,较化疗前7.2 cm明显降低(P<0.05);肿瘤总负荷(影像学提示所有包块最大直径之和)由化疗前平均13.1 cm降至8.2 cm(P<0.05),患者术中及术后情况也得到明显改善。细胞沉渣石蜡包埋免疫组化标志物CA125、细胞角蛋白7(CK7)、角蛋白标志物(Ber-Ep4)呈阳性表达,间皮素(Calretinin)、间皮细胞(MC)、波形蛋白(Vimentin)及细胞角蛋白20(CK20)呈阴性表达时,高度提示肿瘤细胞为卵巢来源。结论新辅助化疗在晚期卵巢癌的综合治疗中优势作用明显,胸腹水细胞沉渣石蜡包埋免疫组化检测法可以弥补卵巢癌新辅助化疗前病理诊断依据的不足,两者的序贯应用可为晚期卵巢癌患者提供一套有效的诊断及治疗策略。Objective To explore the benefits of neoadjuvant chemotherapy for ovarian cancer, especially the value of pre-operative ascites and pleural effusion cell sediment paraffin embedding immunohistochemistry.Methods A retrospective analysis was performed in 22 patients with advanced ovarian cancer presenting to the Obstetrics and Gynecology Department of Shengjing Hospital of China Medical University between 2010 and 2016.The effect of neoadjuvant chemotherapy on reducing tumor burden and the improvement of the general condition of patients during and after surgery was examined.The clinical significance of ovarian cancer cell sediment paraffin embedding immunohistochemistry markers was analyzed. Results The mean CA125 level was significantly decreased from 3454.3 kU/L to 285.2 kU/L （P〈0.01）.The mean maximum depth of the abdominal and pelvic ascites decreased from 7.2 cm to 2.5 cm.lmaging showed that mean diameter of the tumors was 13.1 era,which decreased to 8.2 cm （P〈0.05） after NACT. The conditions of patients during and after operation were also improved significantly.When cell sediment paraffin embedding immunohistochemistry biomarkers were positive for CA125, CK7 and Bet-Ep4, and negative for MC, Calretinin, Vimentin and CK20, it was indicated that the cell originated from ovarian carcinoma.Conclusion Neoadjuvant chemotherapy has obvious advantages in the comprehensive treatment of advanced ovarian cancer.Ascites and pleural effusion cell sediment paraffin embedding can provide evidence for the pathological diagnosis of ovariancancer before neoadjuvant chemotherapy, and the sequential application may be of value for the design of effective diagnosis and treatment strategies.

关 键 词：卵巢肿瘤 细胞沉渣石蜡包埋 免疫组化 新辅助化疗 

分 类 号：R737.3[医药卫生—肿瘤]