缺氧诱导因子-1α的表达在动脉化疗栓塞治疗宫颈癌中的临床意义

Clinical Significance of Hypoxia-inducible Factor-1α Expression in Artery Chemoembolization for Cervical Cancer

目的评价缺氧诱导因子-1α的表达对动脉化疗栓塞联合术前腔内放疗治疗宫颈癌的临床意义。方法宫颈癌患者51例,其中双侧子宫动脉化疗栓塞26例(12例加用腔内放疗),双侧髂内动脉灌注化疗25例(10例加用腔内放疗)。化疗方案为以卡铂为主的联合方案,介入治疗或腔内放疗后2周进行广泛性子宫切除术和盆腔淋巴结清扫术,对治疗前的宫颈活检标本和手术后的标本共102份,用免疫组化方法测定HIF-1α的表达情况。结果宫颈癌组织中HIF-1α的阳性表达治疗前为66.7%,治疗后下降为43.1%,差异有统计学意义(P<0.01)。HIF-1α的阳性表达与FIGO分期、肿瘤分级、病理缓解有明显的相关性(P<0.05)。HIF-1α阳性表达的患者动脉化疗栓塞后的临床有效率为55.9%(19/34),低于HIF-1α阴性表达者的76.5%(13/17),但差异无统计学意义(P>0.05)。HIF-1α表达阴性的宫颈癌患者5年总生存率和无病生存率为100%、94%,均高于表达阳性者的73%、75%,前者差异有统计学意义(P<0.05)。结论HIF-1α表达可能是评价动脉化疗栓塞联合腔内放疗治疗宫颈癌临床疗效和预后的指标。

Objective To evaluate clinical significance of Hypoxia-inducible factor（HIF）-1α expression in artery chemoembolization for cervical cancer.Methods Fifty-one patients with cervical cancer were treated between August 2000 and November 2007.26 patients were performed bilateral uterine artery embolization after uterine artery injection of chemotherapeutic agents,intracavitary brachytherapy were underwent in 12 of 26 patients.25 patients were infused chemotherapy drugs by bilateral internal iliac artery transcatheter,intracavitary brachytherapy were underwent in 10 of 25 patients.All patients were treated by carboplatin-based combination chemotherapy.And then,radical hysterectomy and pelvic lymphadanectomy was performed 2 weeks after interventional therapy or intracavitary brachytherapy.HIF-1α expressions were observed by immunohistochemical methods on a total of 102 cervical cancer specimens before and after the treatment.Results The positive expression pre-treatment of HIF-1α in cervical cancer was dropped to 43.1% from 66.7%,the difference was significant.Positive pre-treatment of HIF-1α expression and FIGO stage,tumor grade and pathological response had obvious relevance.The clinical response after arterial chemoembolization in patients with positive expression of HIF-1α（55.9%,19 /34） was lower than those with negative HIF-1α expression（76.5%,13 /17）,but the difference was not statistically significant（P 0.05） .The overall survival rate of 5-year and disease-free in patients with HIF-1α negative expression before treatment were higher than those with HIF-1α positive expression（100%,94% vs 73%,75%,P 0.05）,overall survival rate difference was statistically significant.Conclusion This study indicates that HIF-1α expression may serve as clinical response and prognosis predictors in patients with cervical cancer who receive artery chemoembolization followed by intracavitary brachytherapy.