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目的探讨在局部晚期宫颈癌患者新辅助化疗(NACT)疗效观察及预测方面的价值。方法2000年3月至2008年3月在中山大学附属江门医院妇科对86例符合入选条件的Ⅰb2～Ⅱb期原发性宫颈癌患者进行新辅助化疗,根据NACT临床疗效分为NACT有效组和无效组,分析两组NACT前后肿瘤组织的细胞凋亡指数(AI)、微血管密度(MVD)、血清鳞状细胞癌抗原(SCC抗原)水平的变化及三者与NACT疗效的关系。结果NACT后有效组AI明显增加,血清SCC水平明显降低,与NACT前相比差异均有统计学意义(P=0.011,P=0.039),而MVD较NACT前降低,但差异无统计学意义(P=0.071)。有效组NACT前的AI明显高于无效组(P=0.027),MVD、SCC水平高于无效组,但差异均无统计学意义(P=0.87,P=0.357)。有效组初次NACT后血清SCC降幅明显大于无效组(P<0.001)。AI≥1.0者化疗有效率大于AI<1.0者(P=0.042),初次NACT后SCC降幅≥50%者NACT有效率大于初次NACT后SCC降幅<50%者(P=0.021)。结论AI及SCC可在一定程度上反映NACT疗效,NACT前AI及宫颈鳞状细胞癌初次NACT后SCC降幅可作为预测NACT疗效的指标。
Objective To investigate the efficacy and prognosis of neoadjuvant chemotherapy (NACT) in patients with locally advanced cervical cancer. Methods From March 2000 to March 2008, 86 cases of patients with stage Ⅰb2 ~ Ⅱb cervical cancer who underwent selective neoadjuvant chemotherapy were enrolled in the Gynecological Department of Jiangmen Hospital Affiliated to Sun Yat-sen University from March 2000 to March 2008. According to the clinical efficacy of NACT, they were divided into NACT group and ineffective The changes of apoptosis index (AI), microvessel density (MVD) and the level of serum SCC antigen in both groups before and after NACT and the relationship between them and the efficacy of NACT were analyzed. Results After NACT, the effective group AI increased significantly and the serum SCC level decreased significantly compared with that before NACT (P = 0.011, P = 0.039), but the MVD was lower than before NACT, but the difference was not statistically significant P = 0.071). The effective AI before NACT was significantly higher than that of ineffective group (P = 0.027), MVD and SCC were higher than that of ineffective group, but the difference was not statistically significant (P = 0.87, P = 0.357). In the effective group, the decrease of serum SCC after the first NACT was significantly larger than that of the ineffective group (P <0.001). The effective rate of chemotherapy with AI≥1.0 was higher than that with AI <1.0 (P = 0.042). The decline of SCC≥50% after the first NACT was higher than that of the NACT with the reduction of SCC <50% (P = 0.021) after initial NACT. Conclusions AI and SCC can reflect the efficacy of NACT to a certain extent. The decline of SCC in NACT pre-NAG and cervical NCC after NACT can be used as an index to predict NACT efficacy.