术前动脉化疗栓塞对膀胱癌细胞增殖和凋亡、血管生成的影响

Cell proliferation,apoptosis and neovascularization of bladder cancer after arterial chemoembolization

目的探讨术前动脉化疗栓塞对膀胱癌细胞增殖和凋亡及肿瘤血管生成相互关系的影响及临床意义。方法分别选取术前行动脉化疗栓塞及同期单纯手术治疗的膀胱癌患者50例(观察组)、30例(对照组),采用EliVision二步法检测Ki-67的表达情况,细胞凋亡检测应用DNA末端标记法(Tunel法),计算凋亡指数(AI)、增殖指数(LI)和微血管密度计数(MVD)。比较两组患者的3年生存率和复发率。分析观察组患者化疗栓塞前后AI、LI、MVD的变化及其与患者预后的关系。结果两组患者3年生存率的差异无统计学意义(P>0.05),观察组3年复发率显著低于对照组(P<0.01)。观察组患者栓塞后MVD及LI显著下降、AI显著升高(均P<0.01),其中高分级、浸润性及初发患者栓塞后MVD及LI明显下降、AI显著升高,复发患者仅MVD明显下降,差异均有统计学意义(P<0.05或0.01)。AI与LI、MVD呈负相关(P<0.01),LI与MVD呈正相关(P<0.01)。观察组中复发与未复发者栓塞前后MVD的差异均有统计学意义(均P<0.05),未复发者栓塞后LI显著下降、AI显著升高(P<0.01);生存者栓塞后MVD、LI明显下降、AI显著升高,差异均有统计学意义(P<0.05或0.01)。结论细胞的增殖和凋亡状况、微血管密度可作为膀胱癌的预后评估指标。术前动脉化疗栓塞可以明显降低膀胱癌组织的LI和MVD,增高AI,调节膀胱癌的分化程度,降低复发率。

Objective To investigate the cell proliferation, apoptosis and tumor angiogenesis of bladder cancer after tran- scatherter arterial chemoembolization （TACE）. Methods The apoptosis index （AI）, proliferation index （LI） and microvessel density （MVD） of cancer tissue were examined by immunohistochemistry in 50 bladder cancer patients before and after chemoem- bolization （TACE group） and in 30 patients with surgical treatment （control group）. The 3-y survival rates and recurrence rates were compared between two groups. The correlation of cancer cell proliferation, apoptosis and MVD before and after chemoem- bolization with postoperative survival and the recurrence was analyzed. Results There was no significant difference in 3-y sur- vival rate between two groups （P 〉0.05）. The 3-year recurrence rate in TACE group was significantly lower than that in control group（P〈0.01）. AI was increased significantly after chemoembolization, while MVD and LI were decreased significantly（P〈0.01）, especially for the high grade, invasive or incipient patients. But the relapsing patients had only decline of MVD. AI was negatively correlated with MVD and LI （P〈0.01）, while LI was positively correlated with MVD （P〈0.01）. There was significant difference in MVD of cancer tissue between relapsed group and non-relapsed group both before and after chemoembolization. LI declined significantly, while AI increased significantly in non-relapsed group after chemoembolization （P〈0.01）. Conclusion The cancer cell proliferation, apoptosis and microvessel density may be used as indicators in assessing prognosis for bladder cancer. Pre- operative chemoembolization can decrease LI and MVD and increase apoptosis rate in bladder cancer tissue, resulting in the decrease of recurrence rate.