辅助治疗对子宫内膜癌的疗效及对HE4、MMP-9和肿瘤标志物的影响

Effect of Different Adjuvant Therapy on Advanced Endometrial Cancer and Serum Human Epididymis Protein 4,Matrix Metalloproteinase-9 and Serum Tumor Markers

目的探讨晚期子宫内膜癌不同辅助治疗方式的疗效及其对血清人附睾蛋白4（human epididymis protein4，HE4）、基质金属蛋白酶-9（matrix metalloproteinase-9，MMP-9）和血清肿瘤标志物的影响。方法选取2011年3月～2012年2月间四川省康复医院妇产科诊治的拟行手术治疗的80例晚期子宫内膜癌患者为研究对象，依据手术后采取的放化疗辅助治疗方式的不同，将患者分为术后放疗组（27例）、术后化疗组（30例）和术后放疗＋化疗组（23例），对比观察3组患者的临床疗效及HE4、MMP-9和血清肿瘤标志物的变化。结果术后放疗组和化疗组的总体有效率分别为59．26％（16／27）和70．00％（21／30），明显低于术后放化疗组的91．30％（21／23）（P〈0．05）；而术后放疗组、化疗组和放化疗组3组患者的疾病控制率和不良反应发生率比较则无明显差别（P〉0．05）；术后放疗组、化疗组和放化疗组的总体生存时间分别为11．3个月（95％CI：9．236-13．459）、12．6个月（95％cI：10．883-14．362）和15．7个月（95％CI：13．791～17．565），LogRank检验显示术后放化疗组的总体生存时间明显高于其他两组（X^2=9．122，P=0．010）；另外，治疗前3组患者的血清肿瘤标志物CEA、NSE、CYFRA21-l、CAl25、CAl9-9和SCCAg、MMP-9和HE4的水平比较差异均无统计学意义（P〉0．05）；但治疗结束后上述各项指标均出现明显降低（P〈0．05）；而且术后放化疗组患者的降低幅度均明显高于术后化疗组和放疗组（P〈0．05）。结论术后放化疗的治疗方式能够显著抑制血清肿瘤标志物、HE4和MMP-9水平，从而促进晚期子宫内膜癌患者术后的生存时间的延长。

Objective To explore the curative effect of different adjuvant therapy on advanced endometrial cancer and their effects on serum human epididymis protein 4 （HE4） , matrix metalloproteinase - 9 （MMP - 9） and serum tumor markers. Methods Eighty ca- ses of advanced endometrial cancer patients were selected and divided into radiotherapy group （27 cases） , chemotherapy group （30 ca- ses） and radiotherapy plus chemotherapy group （23 cases） on the basis of different adjuvant chemotherapies after operation. Clinical ther- apeutic effects and serum level of HE4, MMP - 9 and serum tumor markers were compared. Result Total effective rate of the postopera- tive radiotherapy group and the chemotherapy group were 59.26% （16/27） and 70% （21/30） respectively, and the effective rate of postoperative radiotherapy plus chemotherapy group were 91.30% （21/23）, significantly higher than other groups （P 〈 O. 05）. The rate of disease control and adverse reaction showed no significant difference among three groups （ P 〉 0.05）. The overall survival time of radio- therapy group, chemotherapy group and chemotherapy plus radiotherapy group was 11.3 months （95% CI： 9. 236 - 13. 459）, 12.6 months （95% CI： 10. 883 - 14. 362） and t5.7 months （95% CI： 13. 791 - 17. 565 ）. Log Rank test showed that the overall survival time of chemotherapy plus radiotherapy group was longer than the other two groups （X^2 = 9. 122, P = O. 010）. In addition, the serum tumor markers CEA, NSE, CYFRA21 -1, CA125, CA19 -9 and SCCAg, MMP-9 and HE4 levels were not statistically significant before treatment among three groups （ P 〉 0.05 ） , hut the indicators were significantly decreased after treatments （ P 〈 O. 05 ）. The amplitude of reductions on these indicators in radiotherapy plus chemotherapy group were significantly higher than those of postoperative chemotherapy and radiotherapy group （P 〈 0.05）. Conclusion Postoperative radiotherapy plus chemotherapy treatment can significantly inhibit the se- rum levels of tumor markers, HE4 and MMP - 9, and thereby promote the extension of rehabilitation and the survival time of patients with advanced endometrial cancer.