吉西他滨增敏对宫颈癌放疗微血管密度及细胞凋亡的影响

Gemcitabine Modulates the Expression of Microvessel Density and Apoptosis in Radiotherapy of Cervical Cancer

目的 分析吉西他滨增敏对局部中晚期宫颈癌放疗微血管密度及细胞凋亡的影响。方法 将 4 7例中晚期宫颈癌患者 (Ⅱb期 ,Ⅲb期 ,Ⅳa期 )分成 2组 :A组 2 2例为放疗 +吉西他滨 (商品名 :健择 )组 ;B组 2 5例 ,行单纯放疗。每个病例在放疗前及放疗 (10Gy)后的 2 4h各取材 1次。免疫组化SP法测定微血管密度 (MVD) ,TUNEL法检测癌组织凋亡标记指数 (A LI) ,计算肿瘤消退 5 0 %所需时间 (T0 5 )。结果 ①A组MVD表达降低的程度 (16 0 0根 /mm2 )明显高于B组 (2 0 0根 /mm2 ) ,P <0 0 1;②A组诱导A LI增加 (0 5 7% )明显高于B组(0 2 4 % ) ,P <0 0 5 ;③A组T0 5 (9 0d)显著短于B组 (15 0d) ,P <0 0 5 ;④A组MVD表达降低程度与T0 5呈负相关 (r =- 0 6 2 8)。结论 吉西他滨增敏使宫颈癌放疗早期血管生成减少 ,细胞凋亡增加 ,局部肿瘤体积缩小的速度加快。

Objective To investigate the modulatory effects of gemcitabine on the expression of microvessel density (MVD) and apoptosis in radiotherapy of cervical cancer. Methods Forty-seven patients with middle-late cervical cancer (Ⅱb stage, Ⅲb stage, Ⅳa stage) were divided into two groups randomly: group A: 22 cases subject to radiotherapy plus gemcitabine; group B: 25 cases undergoing radiotherapy only. Tissue specimens were obtained from cervical tumor of all patients before radiotherapy and within 24 h after 10 Gy of radiation. Immunohistochemical staining and TUNEL were performed for MVD and apoptosis (A-LI) respectively. Results The reduction of MVD (median) in group A was significantly greater than in group B (P<0.01). The change of A-LI (median) in group A was more obvious than in group B (P<0.05). Time for the tumor to diminish a half (T0.5) in group A was shorter than that in group B (P<0.05). The decreased expression of MVD in group A was negatively correlated with T0.5 significantly. Conclusion Gemcitabine is a novel potential radiosensitizer. It can decrease the angiogenesis at the early stage of radiotherapy of cervical cancer, increase apoptosis and speed up the reduction of the local tumor size.