局部晚期子宫颈癌新辅助动脉化疗疗效的评价  

Evaluation of intraarterial neoadjuvant chemotherapy in locally advanced cervical carcinoma

作　　者：朱雪琼[1] 岳天孚[2] 惠京[2] 张颖[2] 王德华[2] 

机构地区：[1]温州医学院附属第二医院,浙江温州325000 [2]天津医科大学总医院,天津300052

出　　处：《实用肿瘤杂志》2002年第6期373-375,共3页Journal of Practical Oncology

摘　　要：目的　观察新辅助动脉化疗前后子宫颈癌组织中 p5 3、细胞增殖和凋亡的变化情况 ,探讨其生物学指标与化疗疗效关系 ,借以确定局部晚期子宫颈癌动脉化疗的适应证。方法　对 2 0例局部晚期子宫颈鳞癌患者进行B超选择子宫动脉灌注顺铂和阿霉素 ,分别取动脉化疗前及化疗后 3周时的子宫颈癌组织。用 TU NEL 结合形态学方法检测细胞凋亡 ,用 SABC法检测增殖细胞核抗原和 p5 3的表达。结果　局部晚期子宫颈癌 2 0例中部分缓解14例 (70 .0 % ) ,而 4例 (2 0 .0 % )患者无变化 ,2例 (10 .0 % )病灶进展。化疗前细胞增殖指数高者化疗疗效好 (P<0 .0 5 )。化疗后缓解者在化疗后细胞凋亡指数或细胞凋亡 /增殖指数均明显增高 (P<0 .0 1) ,且高于化疗后未缓解者水平。结论　新辅助动脉化疗前细胞增殖情况以及化疗后细胞凋亡或细胞凋亡Objective To investigate the changes of p53 expression,the cell proliferation and apoptosis before and after intraarterial neoadjuvant chemotherapy cervical carcinoma in patients with cervical carcinoma. Methods Our study included 20 women with locally advanced squamous cervical carcinoma who received intraarterial neoadjuvant chemotherapy via uterine artery consisting of five days of cisplatin and adriamycin. Bioptic specimens were obtained from cervical tumors before and 3 weeks after chemotherapy, and apoptotic index was estimated by a combination of histologic and Tunel assays,while proliferation index and p53 expression were detected by SABC immunohistochemical staining.Results Fourteen patients (70.0%) showed a clinical response,while 4 cases (20.0%) had no change and 2 showed progression after neoadjuvant chemotherapy. A significant relationship was observed between the proliferation index before chemotherapy and the sensitivity to chemotherapy;responder patients showed a higher frequency of positive cells than non responders ( P <0.05). No significant relationship with p53 was observed. Both apoptotic index and apoptotic/proliferation index ( P <0.01) significantly increased after chemotherapy,particularly in patients who responded to chemtherapy.Conclusion In locally advanced cervical carcinoma,pretreatment values for proliferation index and posttreatment values for apoptotic index or apoptotic/proliferation index might be useful biomarkers for predicting the efficacy of intraarterial neoadjuvant chemotherapy.

关 键 词：子宫颈癌 药物疗法 病理学 脱噬作用 P53基因 动脉内输注 治疗 

分 类 号：R737.33[医药卫生—肿瘤]