巨块型宫颈癌术前介入化疗及预后相关因素分析

Chemoresistance-related factors for preoperative interventional chemotherapy and prognosis in bulky cervical cancer

目的 探讨巨块型宫颈癌术前化疗敏感相关因素及预后价值。方法 回顾性分析 6 8例巨块型宫颈癌或桶状宫颈 (肿瘤直径≥ 4cm) ,治疗方法为术前介入化疗 2个疗程后行广泛性全子宫切除加盆腔淋巴结清扫术 ,2 1例病理检查发现有高危因素者术后补充放疗 ;采用免疫组化法检测治疗前肿瘤组织的MDR、GST л和PCNA的表达。统计采用SPSS 8.0软件。结果 MDR阳性率为 31% ,GST л阳性率为 5 1% ,PCNA指数 >5 0 %和≤ 5 0 %各有 38例和 30例。术前化疗总有效率为 84 %。化疗疗效与MDR表达及PCNA指数高低密切相关 ,MDR(- )组化疗有效率为 91% ,而MDR(+)组仅 6 7% (P =0 .0 13)。PCNA指数 >5 0 %组的化疗有效率明显高于≤ 5 0 %组 (P =0 .0 0 1)。GST л的表达与化疗疗效无明显相关。多因素分析发现 ,宫旁浸润与淋巴结转移是独立的预后因素 ;MDR(+)组生存率较MDR(- )组低 ,但两者无显著性差异。结论 MDR和PCNA可作为预示术前化疗有效的指标 ,为临床制订合理的个体化治疗方案提供参考 ;宫旁浸润与淋巴结转移可预示预后 ;MDR与预后也相关。

Objective To identify the chemoresistant factors predicting the response to preoperative chemotherapy and clinicopathological prognosis in bulky cervical cancer. Methods 68 patients with bulky cervical carcinoma treated with two courses of intraarterial infusion of cisplatin 80mg, 5 fluorouracil(5Fu) 1500mg and AT 1258 or EADR 60mg, followed by radical hysterectomy and pelvic lymphnodenectomy at our hospital between 1996-1999 were retrospectively reviewed. Expressions of the chemoresistance related proteins, such as P glycoprotein glutathione S transferase л(GST л), and proliferating cell nuclear antigen(PCNA) in the tumor cells were examined by immunohistochemistry in previous biopsy specimens. These results were compared with the chemotherapeutic response obtained by gynecological examination and vagina ultrasonic. 68 patients were followed up. SPSS 8.0 was used. Results P glycoprotein expression rate was 31% and GST л expressioin rate was 51%. There were 38 patients whose PCNA labellings were more than 50% and 30 less than 50%. The total chemotherapeutic response rate was 84%. Chemotherapeutic response rate was significantly correlated with P glycoprotein expression( P =0.013) and PCNA labelling ( P =0.001), but not GST л expression in the tumor cells. Parautrial involvement and lymph node metastasis were independent factors for prognosis in this group. The survival rate in MDR(+) group was lower than MDR(-) group. No significant correlation between eigher the expression of GST л or PCNA. Conclusions The expression of P glycoprotein and PCNA is potentially useful for predicting the response to preoperative chemotherapy for cervical cancer. The parautrial involvement and lymph node metastasis were independent prognostic factors for the survival rate including. the expression of P glycoprotein.