双侧髂内动脉TACE对宫颈癌组织survivin蛋白表达、细胞凋亡的影响及其临床意义

Express of Survivin and Effect of Apoptotic and Clinical Significance in Uterine Cervix Cancer after Pre-operational of TACE

目的通过检测宫颈癌综合治疗前后癌组织中survivin蛋白表达率和表达量及细胞凋亡情况,分析其预后因素,对比研究双侧髂内动脉化疗栓塞(TACE)对宫颈癌的近期疗效。方法60例临床分期为Ⅰb～Ⅱb期宫颈鳞癌,应用TACE、放疗、放化疗3种方法治疗,TACE组:DDP+E-ADM+5-Fu;放疗组:腔内后装A点和外照射;放化疗组:DDP+5-Fu静脉化疗,同步腔内后装A点照射。治疗后10～14d内手术治疗。应用TUNEL法和免疫组织化学S-P法和图像分析系统检测治疗前后各组细胞凋亡指数(AI)、survivin蛋白表达率和表达量,分析术后盆腔淋巴结转移率、脉管浸润率、间质浸润率、宫旁浸润率及阴道浸润率等影响临床预后的因素。结果(1)宫颈癌3种治疗方法的总有效率分别为70.00%、55.00%和55.00%,FACE组与其他两组相比,差异有统计学意义(P<0.05),巨块型(>4cm)宫颈癌的治疗有效率分别为83.34%、53.85%和58.33%,TACE组与其他两组相比,差异有高度统计学意义(P<0.01);(2)3种方法治疗后宫颈癌组织survivin蛋白的阳性表达率及表达量均明显下降,提高了细胞AI,TACE组与其他两组比差异有统计学意义(P<0.05);(3)TACE降低了盆腔淋巴结转移率、宫旁浸润率、脉管浸润率、深肌层浸润率和阴道浸润率的比例。结论双侧髂内动脉TACE降低了宫颈鳞癌组织survivin蛋白表达,提高了细胞AI,缩小了肿瘤体积,降低了预后因素的比例,提高了临床手术切除率。

Objective To investigate the expression of survivin protein and cell apoptosis in .utervin cervix cancer and analysise prognosis factor, contrast make comparative evaluation on effect of preoperation intra-arterial infusion chemotherapy on uterine cervix cancer. Methods Sixty patients in clinical stage from Ⅰ b-Ⅱ b in uterine cervix cancer were divided into three groups： intra -arterial infusion chemotherapy, radiotherapy, systemic -chemotherapy combining with radiotherapy. The therapy protocol of intra-arterial infusion chemotherapy： DDP＋E-ADM＋5-Fu; radiotherapy： intracavitary afterloading A spot and external irradiation; systemic-chemotherapy combining with radiotherapy： DDP＋5-Fu and intracavitary afterloading A spot irradiation. Operation therapy were made in the period of post-treatment from 10 to 14 d. Apoptotic cells of pretherapy and posttherapy were detected by TUNEL. Immunohistochemical stains and image analytical system were performed to examine the expression level and quantity of survivin in pretherapy and post-therapy. Factor of prognosis such as LNM, vessel infiltration, interstitial tissue infiltration, laterouterine infiltration and vagina infiltration were analyzed in three treatment groups. Results （1） The response rate in all eases of uterine cervix cancers was 70.00%, 55.00% and 55.00%, respectively; the response rate in all eases of makro-mass uterine cervix cancers （diameter 〉4 cm） was 83.34%, 53.85% and 58.33%, respectively. （2） The expression of survivin in the three groups obviously decreased and cell apoptotic index raised. In intra-arterial infusion chemotherapy proportion of LNM, vessel infiltration, interstitial tissue infiltration, latero-uterine infiltration and vagina infiltration decreased. Conclusion In intra-arterial infusion chemotherapy expression of survivin, raised cell apoptotic index, diminuted gross tumor volume decreased, proportion factor of prognosis and elevated ratio of clinical exairesis was cut down.