抗肿瘤药物对慢性放射性肠损伤影响的病理学研究

The pathological study of the effects of antitumor drugs on chronic radiation bowel injury

目的从病理学角度探讨抗肿瘤药物对宫颈癌慢性放射性肠损伤组织的影响。方法回顾性分析2016年8月至2023年4月期间安徽医科大学第一附属医院宫颈癌慢性放射性肠损伤患者的临床病理资料。根据RTOG/EORTC评分标准对49例患者的放射性肠损伤临床症状进行评分和严重程度分级。根据药物治疗方案分为抗血管生成药物治疗组和无抗血管生成药物治疗组,紫杉类药物化疗组和无紫杉类药物化疗组。采用病理学半定量评分系统评估患者的慢性放射性肠损伤程度,分别比较对应亚组间微血管计数、狭窄血管计数、狭窄血管比例、病理总分、溃疡、炎症、水肿、坏死和纤维化指标的差异。并使用Cox分析慢性放射性肠损伤患者发生严重并发症的独立危险因素。结果抗血管生成药物治疗组的狭窄血管计数、狭窄血管比例、溃疡和炎症程度均高于无抗血管生成药物治疗组,差异有统计学意义(P均<0.05);而抗血管生成药物治疗组的微血管计数和纤维化程度均低于无抗血管生成药物治疗组,差异有统计学意义(P均<0.05)。紫杉类药物化疗组与无紫杉类药物化疗组间的病理学指标比较,差异无统计学意义(P均>0.05)。Cox多因素分析显示,抗血管生成药物不是慢性放射性肠损伤患者发生严重并发症的独立危险因素(P>0.05)。结论抗血管生成药物加重了宫颈癌慢性放射性肠损伤组织的血管狭窄、溃疡和炎症,但减轻了纤维化。紫杉类药物对宫颈癌慢性放射性肠损伤组织无明显影响。

Objective To explore the effect of antitumor drugs on chronic radiation bowel injury tissues of cervical cancer from the per⁃spective of pathology.Methods The clinicopathological data of patients with chronic radiation bowel injury from cervical cancer in the First Affiliated Hospital of Anhui Medical University between August 2016 and April 2023 were retrospectively analyzed.The clinical symptoms of radiation bowel injury in 49 patients were scored and graded in severity according to the RTOG/EORTC scoring criteria.They were divided into the anti-angiogenic drug treatment group,no anti-angiogenic drug treatment group,and paclitaxel chemotherapy group and no paclitaxel che⁃motherapy group according to the drug treatment regimen.The degree of chronic radiation bowel injury in patients was assessed using a semi⁃quantitative scoring system for pathology,and the differences in microvessel count,stenosis count,stenosis proportion,total pathology score,ul⁃ceration,inflammation,edema,necrosis,and fibrosis indexes were compared between corresponding subgroups,respectively.Cox analysis was also used to analyze the independent risk factors for serious complications in patients with chronic radiation bowel injury.Results The ste⁃notic vessel count,stenotic vessel ratio,ulceration and inflammation in the antiangiogenic drug treatment group were higher than those in the no antiangiogenic drug treatment group,and the differences were statistically significant(all P<0.05);whereas the microvessel count and fibrosis in the antiangiogenic drug treatment group were lower than those in the no antiangiogenic drug treatment group,and the differences were statis⁃tically significant(all P<0.05).Comparison of pathological indexes between the paclitaxel chemotherapy group and the no-paclitaxel chemo⁃therapy group showed no statistically significant difference(P all>0.05).Cox multifactorial analysis showed that antiangiogenic drugs were not an independent risk factor for the occurrence of serious complications in patients with chronic radiation bowel injury(P>0.05).Conclusion Anti-angiogenic drugs exacerbated stenosis,ulceration and inflammation,but attenuated fibrosis in chronic radiation bowel injury tissues in cer⁃vical cancer.Paclitaxel drugs have no significant effect on chronic radiation bowel injury tissues in cervical cancer.