Ⅲ期宫颈鳞癌组织中Ki-67的表达与放化疗敏感性的关系

Ki-67 expression in stage Ⅲ cervical squamous cell carcinoma and its correlation with sensitivity to chemoradiotherapy

目的 探讨Ki-67在Ⅲ期宫颈鳞癌组织中的表达和变化与放疗敏感性的关系,以及化疗对放疗的增敏作用.方法 50例Ⅲ期宫颈鳞癌患者,分别采用单纯放疗（25例）和同步放化疗治疗（25例）.采用免疫组化法检测放疗前和放疗10 Gy后宫颈鳞癌活检组织标本中Ki-67的表达率,分析Ki-67的表达率和下降率与放疗敏感性的关系,以及化疗对放疗的增敏作用.结果 50例患者中,Ki-67表达≥48％者25例,其中治疗后完全缓解（CR）18例,CR率为72.0％;Ki-67表达＜48％者25例,其中治疗后CR 10例,CR率为40.0％,与Ki-67表达≥48％者的CR率差异有统计学意义（P=0.023）.放疗10 Gy后,Ki-67表达下降≥31％者26例,其中CR 22例,CR率为84.6％;Ki-67表达下降＜31％者24例,其中CR 6例,CR率为24.0％,与Ki-67表达下降≥31％者的CR率差异有统计学意义（P＜0.001）.化疗可增加Ki-67表达＜48％者放疗后的Ki-67下降率（P=0.023）;但对于Ki-67≥≥48％者,化疗并不能增加放疗后Ki-67的下降率（P =0.173）.放疗敏感组患者的2年无进展生存率和总生存率分别为85.7％和92.9％,均明显高于放疗不敏感组患者（分别为18.2％和40.9％,均P＜0.05）.结论 放疗前和放疗10 Gy后Ⅲ期宫颈鳞癌组织中Ki-67的表达可作为预测放疗敏感性的参考指标,用于指导治疗方案的选择;同步化疗对于放疗的增敏效果不明显.

Objective To investigate the expression of proliferating cell nuclear antigen （Ki-67） in stage Ⅲ cervical squamous cell carcinoma （SCC） and its correlation with the effect of chemotherapy on sensitivity to radiotherapy.Methods In 50 patients with stage Ⅲ cervical squamous cell carcinoma （SCC）,25 patients were treated with radiotherapy and 25 patients were treated with chemoradiotherapy.The expression of Ki-67 in the biopsy specimens of cervical SCC was detected by immunohistochemistry at diagnosis and after 10 Gy radiotherapy.The correlation of Ki-67 positive cells percentage and chemotherapy with sensitivity to radiotherapy was analyzed.Results In 25 patients with more than 48% Ki-67 positive cells at diagnosis,the rate of complete response （CR） was 72.0% （18/25）.In 25 patients with less than 48% Ki-67 positive cells at diagnosis,the CR rate was 40.0% （10/25）,with a significant difference between them （P =0.023）.In 26 patients with more than 31% decrease of Ki-67 positive cells after 10 Gy radiotherapy,the CR rate was 84.6% （22/26）.In 24 patients with less than 31% decrease of Ki-67 positive cells after 10 Gy radiotherapy,the CR rate was 25.0% （6/24）,showing a significant difference between the two groups （P 〈 0.001）.In the cases of Ki-67 〈 48%,decrease of Ki-67 positive cells of chemoradiotherapy group after 10 Gy radiotherapy was significantly higher than that of the radiotherapy group （P =0.023）.In the cases of Ki-67≥48%,no difference in the decease of Ki-67 positive cells between the chemoradiotherapy and radiotherapy groups was found （P =0.173）.For the radiotherapy-sensitive patients with CR recently,the 2-year progression free survival （PFS） rate and overall survival （OS） rate were 85.7% and 92.9%,respectively,both were significantly higher than those of radiotherapy-insensitive patients （18.2% and40.9%,P〈0.05 for both）.Conclusions In stage Ⅲ cervical SCC,the expression of Ki-67 before and after treatment with 10 Gy radiotherapy may be used as a biomarker to predict tumor response to radiation,and guide the choice of therapeutic strategies.Yet,the effect of chemotherapy as a radiosensitizer is unconspicuous.