术前子宫动脉介入化疗栓塞术对宫颈癌患者肿瘤切除率及生存质量的影响

Effects of preoperative uterine arterial chemoembolization on tumor resection rate and survival quality of patients with cervical cancer

目的观察术前子宫动脉介入化疗栓塞术对宫颈癌患者肿瘤切除率及生存质量的影响。方法将90例宫颈癌患者按治疗方法分为直接手术组和动脉介入化疗组,每组45例。观察动脉介入化疗组化疗前后肿瘤大小变化及化疗不良反应,比较2组手术情况,于手术后检测血清血管内皮生长因子(VEGF)含量及宫颈癌组织VEGF、天冬氨酸蛋白水解酶3(Caspase-3)、天冬氨酸蛋白水解酶9(Caspase-9)、肿瘤坏死因子α诱导蛋白(TNFAIP8)、过氧化物还原酶4(Prdx4)表达水平,比较2组术后1年生活质量评分及术后3年复发率、淋巴结转移率及生存率。结果化疗后,动脉介入化疗组肿瘤最大径(2.79±1.64)cm,较化疗前(5.28±0.56)cm明显缩小(P<0.05),且不良反应轻微。动脉介入化疗组较直接手术组根治性切除率明显提高(P<0.05),术后淋巴结转移率明显降低(P<0.05)。手术后,动脉介入化疗组较直接手术组血清VEGF-A、VEGF-C、VEGF-D含量明显降低,宫颈癌组织VEGF-A、VEGF-C、VEGFD、TNFAIP8、Prdx4表达水平明显降低,Caspase-3、Caspase-9表达水平明显升高,差异均有统计学意义(P<0.05)。术后3年,动脉介入化疗组较直接手术组复发率、淋巴转移率及生存率均明显降低(P<0.05)。此外,2组术后1年生活质量评分比较无差异统计学意义(P>0.05)。结论宫颈癌患者行术前子宫动脉化疗栓塞术,可有效缩小肿瘤体积,提高肿瘤根治性切除率,促进癌细胞凋亡,降低血清转移浸润指标,改善远期疗效,且未影响患者生活质量。

Objective To observe the effects of preoperative uterine arterial chemoembolization on tumor resection rate and quality of survival in patients with cervical cancer. Methods Ninety patients with cervical cancer were randomly divided into direct operation group and arterial intervention chemotherapy group,with 45 patients in each group. The tumor size and adverse effects caused by chemotherapy in arterial intervention chemotherap were observed before and after chemotherapy,and surgical results were compared between two groups. Moreover the content of serum vascular endothelial growth factor（ VEGF） and the expression levels of VEGF,aspartic proteinase 3（ Caspase-3）,aspartic proteinase 9（ Caspase-9）,tumor necrosis factor α-induced protein（ TNFAIP8） and peroxiredoxin 4（ Prdx4） in cervical cancer tissues were detected after surgery. The life quality score on 1 year after operation,3-year relapse rate,lymph node metastasis rate and 3-year survival rate after operation were observed and compared between the two groups. Results After chemotherapy,the maximal diameter of tumor was 2. 79 ± 1. 64 cm in arterial intervention chemotherapy group with mild adverse reactions,which was significantly smaller than that [（ 5. 28 ± 0. 56） cm] before chemotherapy（ P 〈 0. 05）. As compared with that in direct operation group,the radical resection rate in arterial intervention chemotherapy group was significantly increased（ P 〈 0. 05）,moreover,lymph node metastasis rate was significantly decreased（ P 〈 0. 05）. After surgery,the serum levels of VEGF-A,VEGF-C and VEGF-D were significantly decreased in arterial intervention chemotherapy group,furthermore, the expression levels of VEGF-A,VEGF-C,VEGF-D,TNFAIP8,Prdx4 in cervical cancer tissues were significantly decreased,however,the expression levels of Caspase-3 and Caspase-9 were significantly increased,as compared with those in direct operation group（ P 〈 0. 05）.On 3 years after operation,the relapse rate,lymph node metastasis rate and survival rate in arterial intervention chemotherapy group were significantly lower than those in direct operation group（ P 〈 0. 05）. In addition,there were no significant differences in life quality scores on 1 year after operation between two groups（ P 〉 0. 05）. Conclusion The preoperative uterine arterial chemoembolization can effectively decrease tumor size of patients with cervical cancer,improve tumor radical resection rate and promote cancer cell apoptosis,moreover,which can reduce the serum indexes of metastasis and infiltration of tumor,and can improve long term efficacy without affecting the life quality of patients.