新辅助介入化疗可显著促进局部晚期宫颈癌治疗
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摘要
本研究选择自2011年1月至2016年1月间在我院妇产科收治并确诊的90例肿瘤直径大于4 cm的Ⅰb～Ⅱb期宫颈癌患者作为研究对象,随机分为A组、B组和对照组,每组30例,A组患者手术前采用动脉介入新辅助化疗,B组患者手术前采用静脉介入新辅助化疗,对照组患者仅采用手术治疗,并对3组疗效及副作用进行了分析,采用免疫组化法检测治疗前后3组患者MMP-2、Fas和FasL细胞因子的表达情况,以探讨新辅助介入化疗在局部晚期宫颈癌治疗中的疗效。研究结果表明:A组(有效率=83.33%)和B组(有效率=73.33%)疗效显著高于对照组(p<0.05),并且A组疗效显著高于B组(χ~2=2.116, p=0.045);Ⅰb期有效率显著高于Ⅱa和Ⅱb,Ⅱa显著高于Ⅱb,鳞癌患者的化疗有效率显著高于腺癌,低分化宫颈癌患者有效率显著低于中分化和高分化(p<0.05);A组中共有14例出现化疗副作用,B组共有11例出现副作用,两组差异无统计学意义(p>0.05);MMP-2和FasL治疗后的阳性率在A组和B组中均较治疗前显著下降,而A组和B组中Fas阳性率治疗后较治疗前显著升高(p<0.05),而对照组中MMP-2、Fas和FasL治疗前后的阳性率差异均无统计学意义(p>0.05)。本研究的结论初步说明:新辅助介入化疗在局部晚期宫颈癌治疗中的效果显著,MMP-2、Fas和FasL细胞因子与宫颈癌肿瘤细胞密切相关。
In this research, 90 cervical cancer patients treated and identified in our hospital from January 2011 to January 2016 were selected as subjects, in stages from Ib to IIb with tumor diameter greater than 4 cm, which were randomly divided into group A, group B and control group, and each group included 30 cases. Group A patients were treated with arterial interventional neoadjuvant chemotherapy before surgery; Group B patients were treated with venous interventional neoadjuvant chemotherapy before surgery, and the patients in the control group were only treated with surgery. The efficacy and side effects of the three groups were analyzed. The expression situation of MMP-2, Fas and FasL cytokines in three groups before and after treatment were detected by immunohistochemistry to explore the clinic effect of neoadjuvant interventional chemotherapy in the treatment of locally advanced cervical cancer. The results showed that the effective rate of group A(83.33%) and group B(73.33%)was significantly higher than that of the control group(p<0.05), and the effect of group A was significantly higher than that of group B(χ~2=2.116, p=0.045). The effective rate in Ib stage was significantly higher than that of IIa and IIb, while IIa was significantly higher tha n that of IIb, and the effective rate of chemotherapy in patients with squamous carcinoma wa s significantly higher than that of adenocarcinoma, and the efficiency of poorly differentiated cervicalcancer patients was significantly lower than that of middle differentiation and high differentiation(p<0.05). In group A, there were 14 cases of chemotherapy side effects, group B had a total of 11 cases of that, and there was no significant difference between the two groups(p>0.05). The positive rate of MMP-2 and Fas L in group A and group B after treatment were lower than those before treatment, while the positive rate of Fas in group A and group B after treatment was significantly higher than those before treatment(p<0.05), and there were no significant difference of the positive rate of MMP-2, Fas and Fas L in control group before and after treatment(p>0.05). The study preliminarily concluded that neoadjuvant interventional chemotherapy would be effective in the treatment of locally advanced cervical cancer, and cytokines of MMP-2, Fas and Fas L might be closely related to cervical cancer tumor cells.
In this research, 90 cervical cancer patients treated and identified in our hospital from January 2011 to January 2016 were selected as subjects, in stages from Ib to IIb with tumor diameter greater than 4 cm, which were randomly divided into group A, group B and control group, and each group included 30 cases. Group A patients were treated with arterial interventional neoadjuvant chemotherapy before surgery; Group B patients were treated with venous interventional neoadjuvant chemotherapy before surgery, and the patients in the control group were only treated with surgery. The efficacy and side effects of the three groups were analyzed. The expression situation of MMP-2, Fas and FasL cytokines in three groups before and after treatment were detected by immunohistochemistry to explore the clinic effect of neoadjuvant interventional chemotherapy in the treatment of locally advanced cervical cancer. The results showed that the effective rate of group A(83.33%) and group B(73.33%)was significantly higher than that of the control group(p<0.05), and the effect of group A was significantly higher than that of group B(χ~2=2.116, p=0.045). The effective rate in Ib stage was significantly higher than that of IIa and IIb, while IIa was significantly higher tha n that of IIb, and the effective rate of chemotherapy in patients with squamous carcinoma wa s significantly higher than that of adenocarcinoma, and the efficiency of poorly differentiated cervicalcancer patients was significantly lower than that of middle differentiation and high differentiation(p<0.05). In group A, there were 14 cases of chemotherapy side effects, group B had a total of 11 cases of that, and there was no significant difference between the two groups(p>0.05). The positive rate of MMP-2 and Fas L in group A and group B after treatment were lower than those before treatment, while the positive rate of Fas in group A and group B after treatment was significantly higher than those before treatment(p<0.05), and there were no significant difference of the positive rate of MMP-2, Fas and Fas L in control group before and after treatment(p>0.05). The study preliminarily concluded that neoadjuvant interventional chemotherapy would be effective in the treatment of locally advanced cervical cancer, and cytokines of MMP-2, Fas and Fas L might be closely related to cervical cancer tumor cells.
引文
Bay o S.,Bosch F.X.,de SanjoséS.,Munoz N.,Combita A.L.,Coursaget P.,Diaz M.,Dolo A.,van den Brule A.J.,and Meijer C.J.,2017,Risk factors of invasive cervical cancer in Mali,International Journal of Epidemiology,31(1):202-209
Huh W.K.,Ault K.A.,Chelmow D.,Davey D.D.,Goulart R.A.,Garcia F.A.,Kinney W.K.,Massad L.S.,Mayeaux E.J.,Saslow D.,Schiffman M.,Wentzensen N.,Lawson H.W.,and Einstein M.H.,2015,Use of primary high-risk human papillomavirus testing for cervical cancer screening:Interim clinical guidance,Gynecol.Oncol.,136(2):178-182
Kong L.J.,2016,The expression and clinical significance of matrix metalioproteinase-2 and matrix metalloproteinase-9 in cervical cancer,Zhongguo Zonghe Linchuang(Clinical Medicine of China),32(3):267-269(孔丽娟,2016,宫颈癌患者癌组织中基质金属蛋白酶2和9的表达及临床意义,中国综合临床,32(3):267-269)
Tang K.W.,2016,Clinical significance of FOXF1 candidate tumor suppressor genes expression in cervical cancer,Zhongguo Xiandai Yiyao Zazhi(Modern Medicine Journal of China),18(6):9-11(汤凯雯,2016,候选抑癌基因FOXF1在子宫颈癌中的表达及其临床意义,中国现代医药杂志,18(6):9-11)
Nallapalle S.R.,Daripally S.,and Prasad V.T.,2015,Promoter polymorphism of FASL confers protection against female-specific cancers and those of FAS impact the cancers divergently,Tumor Biology,36(4):2709-2724
Ying Y.,Wang Y.X.,and Wang A.J.,2016,Difference of Ki-67and P-gp expression level before and after neoadjuvant chemotherapy for locally advanced cervical cancer and its clinical significance,Zhongguo Fuyou Jiankang Yanjiu(Chinese Journal of Woman and Child Health Research),27(11):1393-1396(应瑜,王银雪,王爱娇,2016,新辅助化疗局部晚期宫颈癌前后Ki-67、P-gp表达水平及临床意义,中国妇幼健康研究,27(11):1393-1396)
Zhao G.X.,and Piao L.M.,2015,Role of the matrix metalloproteinase system in neovascularization,Zhongguo Xinxueguanbing Yanjiu(Chinese Journal of Cardiovascular Research),13(3):198-201(赵光贤,朴丽梅,2015,基质金属蛋白酶-2在血管新生过程中的研究进展,中国心血管病研究,13(3):198-201)
Huh W.K.,Ault K.A.,Chelmow D.,Davey D.D.,Goulart R.A.,Garcia F.A.,Kinney W.K.,Massad L.S.,Mayeaux E.J.,Saslow D.,Schiffman M.,Wentzensen N.,Lawson H.W.,and Einstein M.H.,2015,Use of primary high-risk human papillomavirus testing for cervical cancer screening:Interim clinical guidance,Gynecol.Oncol.,136(2):178-182
Kong L.J.,2016,The expression and clinical significance of matrix metalioproteinase-2 and matrix metalloproteinase-9 in cervical cancer,Zhongguo Zonghe Linchuang(Clinical Medicine of China),32(3):267-269(孔丽娟,2016,宫颈癌患者癌组织中基质金属蛋白酶2和9的表达及临床意义,中国综合临床,32(3):267-269)
Tang K.W.,2016,Clinical significance of FOXF1 candidate tumor suppressor genes expression in cervical cancer,Zhongguo Xiandai Yiyao Zazhi(Modern Medicine Journal of China),18(6):9-11(汤凯雯,2016,候选抑癌基因FOXF1在子宫颈癌中的表达及其临床意义,中国现代医药杂志,18(6):9-11)
Nallapalle S.R.,Daripally S.,and Prasad V.T.,2015,Promoter polymorphism of FASL confers protection against female-specific cancers and those of FAS impact the cancers divergently,Tumor Biology,36(4):2709-2724
Ying Y.,Wang Y.X.,and Wang A.J.,2016,Difference of Ki-67and P-gp expression level before and after neoadjuvant chemotherapy for locally advanced cervical cancer and its clinical significance,Zhongguo Fuyou Jiankang Yanjiu(Chinese Journal of Woman and Child Health Research),27(11):1393-1396(应瑜,王银雪,王爱娇,2016,新辅助化疗局部晚期宫颈癌前后Ki-67、P-gp表达水平及临床意义,中国妇幼健康研究,27(11):1393-1396)
Zhao G.X.,and Piao L.M.,2015,Role of the matrix metalloproteinase system in neovascularization,Zhongguo Xinxueguanbing Yanjiu(Chinese Journal of Cardiovascular Research),13(3):198-201(赵光贤,朴丽梅,2015,基质金属蛋白酶-2在血管新生过程中的研究进展,中国心血管病研究,13(3):198-201)