宫颈鳞状细胞癌化疗前后Bcl-2、VEGF变化与疗效的关系

Relationship between the changes of Bel-2 and VEGF and the therapeutic effects before and after SIP chemotherapy for cervical squamous cell carcinoma

目的探讨奈得铂(S)、异环磷酰胺(I)、硫酸培洛霉素(P)并用(SIP疗法)化疗与宫颈鳞状细胞癌组织中Bcl-2、VEGF变化的关系。方法以2000年1月至2002年9月日本北里大学病院妇产科收治的48例宫颈鳞状细胞癌患者为研究对象,采用SIP疗法治疗1～2个疗程,MRI判断疗效;采用免疫组化法检测有效组与无效组化疗前后组织标本中Bcl-2、VEGF阳性表达率。结果有效组化疗前后Bcl-2阳性表达率分别为67%(19/28)和35%(10/28),差异有统计学意义(χ2=5.7931,P<0.05)。无效组化疗前后阳性表达率分别为30%(6/20)、40%(8/20),差异无统计学意义(χ2=0.4396,P>0.05);有效组在化疗前Bcl-2阳性表达率为67%,明显高于无效组30%(χ2=6.6997,P<0.05)。有效组化疗前后VEGF阳性表达率分别为89%(25/28)和42%(12/28),差异有统计学意义(χ2=13.4623,P<0.05)。无效组化疗前后VEGF阳性表达率差异无统计学意义(χ2=2.8490,P>0.05)。有效组在化疗前VEGF阳性表达率(89%)明显高于无效组(55%)(χ2=7.3143,P<0.05)。结论化疗前高表达的Bcl-2、VEGF预示着宫颈鳞状细胞癌采用SIP化疗有效;1疗程结束后组织标本中Bcl-2、VEGF的快速降低对是否需要继续进行多疗程化疗有提示作用。

Objective To determine whether or not Bcl-2 and VEGF obtained from biopsy specimens were useful as predictors of NAC response. Methods Totally 48 cases of cervical carcinoma were treated with 1 to 2 courses of SIP therapy. The response to SIP was measured by magnetic resonance imaging（MRI）. The biopsy specimens from 48 patients with cervical carcinoma before and after SIP therapy were evaluated for Bcl-2 and VEGF proteins expressions by LSAB immunohistochemistry. Results In chemotherapy-effective patients, the expression rates of Bcl-2 protein before and after chemotherapy were 67% （19/28 ）and 35 % （10/28）, respectively （χ^2 = 5. 7931, P 〈 0. 05 ） ; in non-chemotherapy effective patients,the expression rates of Bcl-2 protein before and after chemotherapy were 30% （6/20） and 40% （8/20）, respectively（χ^2 =0. 4396,P 〉0. 05） ; in chemotherapy effective patients,the expression rates of VEGF protein before and after chemotherapy were 89% （25/28） and 42% （ 12/28）, respectively（ χ^2 = 13. 4623, P 〈 0. 05 ） ; in chemotherapy noneffective patients,the expression rates of VEGF protein before and after chemotherapy were 55% （11/20）and 80% （16/ 20）, respectively（ χ^2 = 2. 8490,P 〉 0. 05 ）. Conclusion NAC with Nedaplatin, ifosfamide and peplomycin is effective for patients with locally advanced squamous cell carcinoma of cervix. Alterations of Bcl-2 and VEGF can be predictors for NAC.