局部晚期宫颈癌新辅助化疗分子疗效研究

Study on the molecule mechanisms efficacy of neoadjuvant chemotherapy in Middle and advanced cervix cancer

目的探讨新辅助化疗(neoadjuvant chemotherapy,NACT)方案治疗局部晚期宫颈癌(locally advanced cancerLACC)分子疗效,为临床遴选治疗方案及评价疗效的分子标志物提供理论依据。方法选取局部晚期宫颈鳞癌60例作为研究对象,随机分成3组,进行2个疗程以铂类为基础的新辅助化疗,分别为TP(紫杉醇+顺铂)、FP(5-氟尿嘧啶+顺铂)及IP(异环磷酰胺+顺铂),以流式细胞术检测化疗前后的宫颈鳞癌组织中增殖细胞指数ki67的表达,TUNEL法检测肿瘤细胞的凋亡指数(AI),S-P免疫组化法进行Survivin基因表达检测,分析治疗前后细胞增殖指数、凋亡指数及Survivin表达差异。结果 3组NACT前、后肿瘤体积和各分子检测指标有统计学意义;临床有效病例细胞增殖指数、survivin减低及凋亡指数升高较临床无效病例明显,P值<0.05。结论以铂类为基础的新辅助化疗能显著"降低"宫颈癌临床分期,同时能明显降低局部晚期宫颈癌肿瘤细胞增殖、增加凋亡,选取细胞增殖指数、凋亡指数及Survivin作为NACT疗效预测有一定的理论依据,值得临床推广应用。

Objective To investigate the clinical effect and molecule mechanisms efficacy of neoadjuvant chemotherapys（NACT）on locally advanced cancer（LACC）.Methods 60 patients according to the FIGO classification which had been divided into three groups received NACT with two cycles of cisplatin combined with Ifosfomide or cisplatin combined with Paclitaxol or cisplatin combined with 5-fluorouracil,meanwhile,ki67,apoptosis index（AI）and survivin were detected and assayed with flow cytometry and TUNEL at the specimens of pretreatment and post-operation.Results The clinical efficacy rates of NACT were 76.67%.The level of ki67 and survivin significantly decreased than those before NACT,but the mean AI value after NACT was increased greatly than that before NACT.In effective groups,the mean Ki67 and survivin was significantly lower in effective group than non-effective one.otherwise,the mean AI was significantly higher in effective group than non-effective one.Conclusion NACT could inhibit proliferation and increase apoptosis of tumor cell in cervical squamous carcinoma tissue.ki67 and AI and survivin are useful parameters in evaluating NACT response.