关键词：宫颈肿瘤/放射疗法；细胞增殖；细胞凋亡；预后；增殖细胞核抗原
【摘要】 目的 研究增殖和凋亡在放射治疗宫颈癌中的预后价值。方法 回顾性分析了40例放疗未控和根据临床病理因素与之配对的40例放疗治愈的ⅡB ～ⅢB 期宫颈鳞癌患者的细胞增殖和凋亡情况。以免疫组化ABC法检测增殖细胞核抗原(proliferatingcell nuclear antigen, PCNA)，凋亡细胞用末端转移酶(TdT)介导的脱氧核苷酸切口及末端标记法(TdT-mediated biotin-dUTP nick end labeling, TUNEL)进行检测。结果 放疗治愈组的PCNA为5.38±3.21，未控组为7.50±3.16(P<0.01)；治愈组每10个高倍视野下的有丝分裂细胞数为6.33±5.15，未控组为11.33±7.50(P<0.001)；治愈组每10个高倍视野下的凋亡细胞数为20.90±8.19，未控组为27.13±17.28(P<0.05)；凋亡细胞数与分裂细胞数之比值(A/M)治愈组为4.97±3.31，未控组为3.36±2.83(P<0.05)。结论 PCNA、凋亡细胞数以及A/M可作为预测放射治疗宫颈癌预后的新指标。
Prognostic value of cellproliferation and apoptosis in uterine cervical cancer treated with radiation
ZHANG Meiqin, CAI Shumo, SHIDaren.
Department of Gynecology, CancerHospital, Shanghai Medical University, Shanghai 200032
【Abstract】 Objective Tostudy the prognostic value of cell proliferation and apoptosis in cervical cancer patientstreated with radiation. Methods A retrospective study was done in 40radiotherapy-uncontrolled cases of squamous-cell carcinoma of the cervix uteri and anequal number of cases, matched in age, clinical stage, tumor size and histologic grade,which had been cured by radiotherapy. Cell proliferation was judged by the proliferatingcell nuclear antigen (PCNA)-positively stained cell number × intensity of staining, andnumber of cells in mitosis per 10 high-power microscopic fields (HPF). Apoptotic cellswere identified by TUNEL method and the result was expressed as the number of cellsundergone apoptosis per 10 HPF. Results The average level of PCNAexpression was 5.38±3.21 in the cured patients and 7.50±3.16 in theradiotherapy-uncontrolled patients (P<0.01). The number of mitotic cells/10 HPF was6.33±5.15 in the cured patients and 11.33±7.50 in the uncontrolled patients(P<0.001). The number of apoptotic cells/10 HPF was 20.90±8.19 in the cured patientsand 27.13±17.28 in the uncontrolled patients (P<0.05). The ratio of number ofapoptotic cells to that of mitotic cells (A/M) was 4.97±3.31 in the cured and 3.36±2.83in the uncontrolled (P<0.05). Conclusion In cervical cancer, PCNAexpression, the number of cells in mitosis and that of cells in apoptosis aresignificantly increased while the A/M ratio is significantly decreased inradiotherapy-uncontrolled patients compared to those of patients cured by radiotherapy.These parameters may be of value to predict response to radiotherapy and prognosis ofpatients with cervical cancer.
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