【摘要】 目的:研究局部晚期宫颈鳞癌细胞对同步放化疗应答的分子机制,探讨凋亡及Bax、Bcl-2的表达。方法:49例局部晚期宫颈鳞癌患者随机分为两组:单纯放疗(RT)组25例接受盆腔外照射和后装治疗;同步放化疗(CRT)组24例除接受放疗外,还接受3个周期的化疗(DDP+5-FU)。在治疗前和治疗过程中(RT组:放疗10Gy后;CRT组:放疗10Gy+(DDP+5-FU)×1个周期)分别活检留取标本,用TUNEL法及免疫组化检测凋亡及Bax、Bcl-2的表达。结果:RT组和CRT组完全缓解率分别为52.0%和79.2.0%(P=0.044)。在治疗前和治疗过程中,RT组和CRT组凋亡阳性率均增加,分别由24%上升到60.0%(P=0.01)和20.8%增加到87.5%(P=0.000),差异显著;治疗中CRT组较RT组增加更加明显(P=0.03)。Bax的表达亦增加,分别由24.0%上升到52.0%(P=0.021)和25.0%增加到79.2%(P=0.000),差异显著;CRT组较RT组增加的更显著(P=0.044)。两组在治疗中,凋亡的阳性率和Bax的阳性表达密切相关,CRT组较RT组相关性更强(P=0.015,r=0.827:P=0.027,r=0.523),但两组Bcl-2的表达无变化(P>0.05)。结论:局部晚期宫颈鳞癌,CRT比RT有更好的缓解率,其机制可能是化疗和放疗有协同作用,通过上调Bax通路诱导了肿瘤细胞的凋亡。更多还原

【Abstract】 Objective: To investigate the molecular mechanism of cell death after radiotherapy or radiochemotherapy of locally advanced uterine cervix cancer (UCC) and to discuss the apoptosis and expression of Bax and Bcl-2 protein. Methods: Forty-nine patients with UCC were randomized into two groups: the radiotherapy (RT) group with 25 patients who were given simple external irradiation of the pelvic cavity and after-loading therapy and, the synchronal radiochemotherapy (CRT) group with 24 patients who were given 3 cycles of chemotherapy (DDP+5-FU) besides the RT. Biopsy of the UCC was conducted before and during the treatment(group RT: after 10 Gy radiotherapy; group CRT: 10 Gy radiotherapy+{DDP+5-FU}×1 cycle). The samples obtained in the treatment were employed to determine apoptosis and the expression of Bax and Bcl-2 protein using TUNEL and immunohistochemical methods. Results: A complete response achieved 52% of the RT group and 79.2%ofCRT group, respectively (P=0.044). Before and during the treatment, the positive rates of apoptosis were increased, ranging from 24%to 60%(P=0.01) in the RT group and from 20.8% to 87.5% (P=0.000) in the CRT group, respectively. There was a significant difference between the two groups, especially during the treatment(P= 0.03). The positive rate of Bax protein was increased, too. They were 24% and 25%, before treatment, and 52% and 79.2%, after treatment, in the RT and CRT group, respectively, with a significant difference(P=0.021 and P=0.000). There was a significant correlation between the expression of Bax and apoptosis, after treatment in both groups(P=0.015,r=0.827 vs P=0.027,r=0.523). However, there was no change in the expression of Bcl-2 in the two groups (P>0.05). Conclusions: There is a better remission rate in CRT of the UCC compared to the RT. An additive or synergistic anti-cancer effect might be the mechanism of CRT, which is realized by up-regulating Bax pathway for induction of tumor-cell apoptosis.更多还原