Bcl-2、COX-2与宫颈癌新辅助化疗

发布时间：2018-08-26 10:25

【摘要】：目的：探讨新辅助化疗对宫颈癌的近期临床疗效；探讨Bcl-2、COX-2在宫颈癌新辅助化疗前后表达的意义及疗效预测的可行性。资料与方法：选择2011年1月至2013年12月在广州市第一人民医院确诊为宫颈癌，且同时符合新辅助化疗（NACT）适应症的患者22例。入组患者均行1疗程新辅助化疗。采用的新辅助化疗方案为TP方案，即紫杉醇135-175mg/m2（第一天，静脉化疗）+顺铂60-70mg/m2（第二天，双侧子宫动脉灌注化疗栓塞治疗）。NACT后10-14天以实体瘤缓解评价标准（RECIST）初步评价宫颈癌NACT疗效。以免疫组化SP方法检测入组宫颈癌患者行NACT前后Bcl-2、COX-2的表达情况，结果判定采用半定量标准。应用SPSS13.0统计软件进行数据处理，Bcl-2、COX-2在NACT前后的表达差异应用秩和检验；Bcl-2、COX-2在NACT前后的高表达情况、不同临床疗效的宫颈癌组织在NACT前后的Bcl-2、COX-2的表达情况及Bcl-2、COX-2在NACT前不同临床疗效的宫颈癌组织中的表达情况均应用χ2检验。以P0.05认为差异有统计学意义。结果： 1、22例宫颈癌患者经NACT后约14天，利用妇检、B超或MR等检测方法观察其化疗疗效。其中，完全缓解（CR）占9.09%（2/22），部分缓解（PR）占63.64%（14/22），疾病进展（PD）占4.55%（1/22），疾病稳定（SD）占22.72%（5/22）。总有效率（CR+PR）为72.73%（16/20），无效率（PD+SD）为27.27%（6/20）。 2、宫颈癌患者行NACT前后Bcl-2、COX-2的表达情况：经NACT后，宫颈癌组织中Bcl-2、COX-2的表达均出现明显下降，差异均有统计学意义（P均0.05）；临床有效（CR+PR）中Bcl-2、COX-2的表达在NACT后出现显著下降（P0.05）；临床无效组中Bcl-2、COX-2在NACT前后的表达差异无明显统计学意义（P0.05）。 3、不同疗效组NACT前Bcl-2、COX-2的表达差异无统计学意义（P0.05）。结论： 1、宫颈癌患者以双侧子宫动脉灌注化疗栓塞治疗作为NACT的途径临床效果明显，近期疗效良好。其毒副反应少，患者耐受良好，安全性可靠。 2、宫颈癌NACT前后Bcl-2、COX-2的表达差异有统计学意义，表明在新辅助化疗后宫颈癌组织细胞凋亡增加、增殖活性受到明显抑制，其恶性程度下降。 3、临床有效组中，，NACT前后Bcl-2、COX-2表达差异有统计学意义，而临床无效组中，NACT前后的表达无明显统计学意义，表明Bcl-2、COX-2的表达情况不仅能反映宫颈癌细胞的增殖状态，而且对评价宫颈癌患者新辅助化疗效具有肯定的临床意义，如果将Bcl-2、COX-2作为细胞标志物应用于判断临床疗效，将会更加准确。 4、对于经新辅助化疗后临床效果不明显而Bcl-2、COX-2有所降低的病例，临床上能否延长NACT疗程从而达到化疗目的、增加手术机会，这还有待于进一步的研究。 5、Bcl-2、COX-2对预测宫颈癌新辅助化疗疗效的可行性及敏感性尚不明确。
[Abstract]:Objective: to investigate the short-term clinical effect of neoadjuvant chemotherapy on cervical cancer and the significance of expression of Bcl-2,COX-2 before and after neoadjuvant chemotherapy and the feasibility of predicting curative effect. Materials and methods: from January 2011 to December 2013, 22 patients with cervical cancer diagnosed in the first people's Hospital of Guangzhou and who met the indications of neoadjuvant chemotherapy (NACT) were selected. All the patients in the group received one course of neoadjuvant chemotherapy. The new adjuvant chemotherapy regimen was TP, I. e., paclitaxel 135-175mg/m2 (first day, intravenous chemotherapy) cisplatin 60-70mg/m2 (second day, bilateral uterine artery infusion chemoembolization). 10-14 days after NACT, the therapeutic effect of NACT in cervical cancer was evaluated with (RECIST). Immunohistochemical SP method was used to detect the expression of Bcl-2,COX-2 in patients with cervical cancer before and after NACT. The difference of COX-2 expression before and after NACT was analyzed by SPSS13.0 statistical software. Rank sum test was used to test the high expression of Bcl-2 COX-2 before and after NACT. The expression of Bcl-2,COX-2 in cervical cancer tissues with different clinical efficacy before and after NACT and Bcl-2,COX-2 expression in cervical cancer tissues with different clinical efficacy before and after NACT were examined by 蠂 2 test. P0.05 thought the difference was statistically significant. Results: 1Twenty two patients with cervical cancer were treated with NACT for 14 days. Among them, complete remission (CR) accounted for 9.09% (2 / 22), partial remission (PR) accounted for 63.64% (14 / 22), disease progression (PD) accounted for 4.55% (1 / 22), disease stable (SD) accounted for 22.72% (5 / 22). The total effective rate of (CR PR) was 72.73% (16 / 20), and the ineffective rate of (PD SD) was 27.27% (6 / 20). The expression of Bcl-2,COX-2 in cervical cancer patients before and after NACT: after NACT, the expression of Bcl-2,COX-2 in cervical carcinoma was significantly decreased (P < 0. 05). The expression of Bcl-2,COX-2 in clinical effective (CR PR) was significantly decreased after NACT (P0.05); the expression of Bcl-2,COX-2 before and after NACT was not significantly different in clinical ineffective group (P0.05). 3. There was no significant difference in Bcl-2,COX-2 expression before NACT in different therapeutic groups (P0.05). Conclusion: 1. Bilateral uterine artery infusion chemoembolization was used as the approach of NACT in patients with cervical cancer. The difference of Bcl-2,COX-2 expression before and after NACT was statistically significant, which indicated that the apoptosis and proliferation activity of cervical cancer tissues were significantly inhibited after neoadjuvant chemotherapy. The degree of malignancy decreased. 3. There was significant difference in the expression of Bcl-2,COX-2 before and after NACT in the effective clinical group, but there was no significant difference in the expression before and after NACT in the ineffective group. The results indicate that the expression of Bcl-2,COX-2 can not only reflect the proliferative state of cervical cancer cells, but also have a positive clinical significance in evaluating the neoadjuvant effect of cervical cancer. If Bcl-2,COX-2 is used as a cell marker to judge the clinical efficacy, It will be more accurate. 4. For those cases whose clinical effect is not obvious after neoadjuvant chemotherapy and Bcl-2,COX-2 is reduced, can the course of NACT be prolonged to achieve the purpose of chemotherapy and increase the chances of operation? The feasibility and sensitivity of COX-2 in predicting neoadjuvant chemotherapy for cervical cancer is not clear.
【学位授予单位】：广州医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.33

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