Ki-67与宫颈癌不同辅助治疗方案的远期疗效比较

Long-Term Response of Different Adjuvant Therapies in Uterine Cervical Cancer with Ki-67

目的 研究Ki-67不同表达指数下早期宫颈癌术后不同辅助治疗方案的预后情况。方法收集ⅠB1-ⅡA期宫颈鳞癌患者156例,分为术后单纯放疗方案组（94例）和同期放化疗方案组（62例）。采用免疫组织化学法检测Ki-67表达指数,并分析其不同表达情况下2种治疗方案与无病生存期和总生存期之间的关系。结果 98例Ki-67阳性早期宫颈癌患者的无病生存期和总生存期的中位数分别为60月（95%可信区间43.3-76.7月）和62月（95%可信区间45.3-78.7月）,其中单纯放疗方案组和同期放化疗方案组的无病生存期的中位数分别为52月（95%可信区间28.9-72.3月）和69月（95%可信区间42.6-95.4月）（P=0.047）,总生存期的中位数分别为55月（95%可信区间37.7-75.1月）和71月（95%可信区间44.4-97.6月）（P=0.041）;58例Ki-67阴性早期宫颈癌患者的无病生存期和总生存期的中位数分别为72月（95%可信区间54.7-89.3月）和75月（95%可信区间59.0-91.0月）,其中单纯放疗方案组和同期放化疗方案组的中位无病生存期和总生存期差别均无统计学意义（P〉0.05）。结论 Ki-67阳性早期宫颈癌术后同期放化疗综合评价优于单纯放疗方案;Ki-67的表达能否成为早期宫颈癌术后辅助治疗方案的筛选指标之一,仍需进一步的研究证实。

Objective To investigate the prognosis of different post operative adjuvant therapies in patients of early-stage cervical cancer with different expressions of proliferating cell nuclear antigen （Ki-67）. Methods Of 156 postoperative patients with stage I B1- II A cervical squamous cell carcinoma, 94 received radiotherapy and 62 received chemoradiotherapy. The expression of Ki-67 was detected by immunohistochemistry at diagnosis. Two clinical outcomes, being disease-free survival （DFS） and overall survival （OS） after either adjuvant treatment schemes in relationship with the status of Ki-67 repression were statistically analyzed. Results For the 98 cases of early-stage cervical cancer with Ki-67 positive expression, the median DFS and OS were 60 months （ 95% confidence internal： 43.3-76.7 months） and 62 months （95% confidence internal：45.3-78. 7 months）. Of those 98 cases, ones who accepted radiotherapy and chemoradiotherapy, had median of DFS of 52 months （95% confidence internal.28.9-72.3 months） and 69 months（95% confidence internal：42.6-95.4 months） （P=0. 047）, and had median OS of 55 months （95% confidence internal.37.7-75.1 months） and 71 months（95% confidence internal：44.4-97. 6 months） （P=0. 041）. For the 58 cases of early-stage cervical cancer with Ki-67 negative expression, the median of DFS and OS were 72 months （95% confidence internal： 54.7-89.3 months） and 75 months （95% confidence internal： 59.0-91.0 months）, with no significant difference statistically in the median DFS and OS between radiotherapy and chemoradiotherapy （P〉0.05）. Conclusion For early-stage cervical cancer post-operatively, chemoradiotherapy is superior to radiotherapy in patients with Ki-67 positive expression, based on our comprehensive analysis. Whether the expression of Ki-67 after operation can be used as a screening index to choose the postoperative adjuvant therapy for patients with early-stage uterine cervical cancer needs to be further studied.