术前调强放疗对四肢软组织肉瘤细胞增殖和凋亡的影响

The effect of prepoperative intensity modulated radiation therapy on cell proliferation and apoptosis in the limb soft tissue sarcoma

目的探讨术前调强放射治疗(IMRT)对四肢软组织肉瘤细胞增殖与凋亡的影响。方法选取新疆医科大学附属肿瘤医院骨与软组织科2012年1月-2013年12月术前IMRT+手术的软组织肉瘤患者23例。收集每例患者的活检及手术后石蜡组织块,自身IMRT前、后对照。采用免疫组织化学染色检测Ki-67的表达,用增殖指数(PI)表示;应用TUNEL法测定肿瘤细胞凋亡,用凋亡指数(AI)表示。比较IMRT前、后及不同临床分期对PI、AI和AI/PI的影响。结果 IMRT后PI明显低于IMRT前(P<0.05);IMRT后AI明显高于IMRT前(P<0.05);IMRT后AI/PI明显高于IMRT前(P<0.05);IMRT前Ⅲ期患者的PI和AI明显高于Ⅱb期,IMRT后Ⅲ期患者的PI低于Ⅱb期,AI高于Ⅱb期,差异均有统计学意义(P均<0.05);调强放疗后Ⅱb期和Ⅲ期的AI/PI与调强放疗前比较差异均有统计学意义(P均<0.05),但IMRT前和IMRT后不同临床分期AI/PI比较差异无统计学意义。结论 IMRT可以诱导软组织肉瘤细胞的凋亡,抑制软组织肉瘤细胞的增殖。AI/PI在IMRT前、后的变化可以评价术前放疗的疗效。

Objective To investigate the effect oi preoperative intensity-modulated radiation therapy（IMRT） on proliferation and apoptosis in limbs soft tissue sarcoma.Methods The 23 limbs soft tissue sarcoma patients in treatment of preoperative IMRT ＋ surgery between January 2012 and December 2013 in department of Bone and soft tissue oncology of the affiliated tumor hospital in Xinjiang Medical University were selected and analyzed by self-contrast study.The expression of Ki-67 was detected by immuncr histochemical technique,indicated with the proliferation index（PI） and apoptosis index（AI） was detected by TUNEL.Results PI after IMRT was significantly lower than that before IMRT（P〈0.05）;AI after IMRT was significantly higher than that before IMRT（P〈0.05）;AI/PI after IMRT was significantly higher than that before IMRT（P〈0.05）.Before IMRT,PI and AI in stage Ⅲ were significantly higher than stage Ⅱ b;after IMRT,PI in stage Ⅲ was below than that in stage Ⅱ b,while AI in stage Ⅲ was higher than that in stage TJ b,in which the differences were statistically significant（P〈0.05）;in clinical staging Ⅱb and Ⅲ,the differences of AI/PI before and after IMRT were statistically significant（P〈0.05）;before and after IMRT,the differences of AI/PI in different clinical stages were not statistically significant（P〈0.05）.Conclusion IMRT can induce apoptosis of soft tissue sarcoma cells and inhibit the proliferation,and AI/PI ratio can evaluate the effect of preoperative IMRT in limbs soft tissue sarcoma.