宫颈癌新辅助化疗前后耐药基因的表达及其与化疗疗效的关系

Expression of multi-drug resistance genes in cervical cancer before and after neoadjuvant chemotherapy and its relationship with the effect of chemotherapy

目的:探讨术前新辅助化疗对宫颈癌组织耐药基因蛋白表达的影响及其与新辅助化疗临床疗效的关系。方法:收集2010年1月至2014年6月在贵阳医学院附属医院行术前TP方案化疗并手术治疗的98例宫颈癌患者临床资料,对其宫颈活检组织及化疗后手术标本蜡块采用免疫组织化学检测P-gp、GST-π和Topo-Ⅱ的表达,比较化疗前、后表达差异及与新辅助化疗临床疗效的关系。结果:经术前化疗后,P-gp、GST-π的阳性表达分别由71.43%、64.29%增高到80.61%、74.49%,前后比较差异具有统计学意义(P<0.01)。Topo-Ⅱ的阳性表达由化疗前的48.98%降为28.57%,前后差异具有统计学意义(P<0.01),P-gp、GST-π和Topo-Ⅱ的表达与患者的临床病理参数间无明显相关(P>0.05)。新辅助化疗前,GST-π在无效组中的阳性表达水平高于有效组,差异有统计学意义(P<0.05),但P-gp和Topo II阳性表达水平在不同疗效组差异无统计学意义(P>0.05)。结论:耐药基因蛋白P-gp、GST-π和TopoⅡ的表达不受宫颈癌临床病理特征的影响,新辅助化疗可以诱导宫颈癌耐药基因蛋白表达的改变,监测其表达对于选择药物、判断预后以及指导治疗具有参考价值,GST-π表达状态有可能成为预测TP方案化疗效果的参考指标。

Objective To explore the impact of preoperative neoadjuvant chemotherapy on the expressions of multi-drug resistance genes in patients with cervical cancer and its relationship with the effect of chemotherapy. Methods Ninety-eight cervical cancer patients with TP regimen selected to perform preoperative chemotherapy were enrolled in the Affiliated Hospital of Guiyang Medical College between January 2010 and June 2014. Immunohistochemisty （En vision method） was used to determine the expressions of P-gP, GST-π and TopoII of the same patients before and after neoadjuvant chemotherapy and explore the relationship with the effect of chemotherapy. Results The positive expression rates of P-gp and GST-π were 71.43% and 64.29% before chemotherapy and 80.61%and 74.49%after chemotherapy, respectively. The former two had significant differences （P〈0.01）. The positive expression rates of TopoII was 48.98%before chemotherapy and 28.57%after chemotherapy , respectively, showing significant differences （P 〈 0.01）. The expressions of P-gp, GST-π and TopoⅡ gene were not affected by the clinical and pathological features of cervical cancer （P 〉 0.05）. Before neoadjuvant chemotherapy, the positive expression of GST-π in the ineffective group was statistically higher than that in the effective group （P〈0.05）. The positive expressions of P-gp and Topo II showed no statistical significance between＆amp;nbsp;the effective group and the ineffective group （P 〉 0.05）. There was significant correlation in the expressions of P-gp, GST-π and TopoⅡ（P 〈 0.05） before and after neoadjuvant chemotherapy. Conclusions The expression of P-gp, GST-πand TopoⅡgene may not be affected by the clinical and pathological features of cervical cancer, but may change expressions of multi-drug resistance genes in cervical cancer by neoadjuvant chemotherapy. Monitoring their expression has a guiding significance for drug selection, prognostic judgment, and the following treatment regimen decision. The GST-π, expression level can be used as a biological parameter to predict the effect of TP regimen neoadjuvant chemotherapy.