CAJ | 학술논문

目的探讨Ki-67在Ⅲ期宫颈鳞癌组织中的表达和变化与放疗敏感性的关系,以及化疗对放疗的增敏作用.方法 50例Ⅲ期宫颈鳞癌患者,分别采用单纯放疗(25例)和同步放化疗治疗(25例).采用免疫组化法检测放疗前和放疗10 Gy后宫颈鳞癌活检组织标本中Ki-67的表达率,分析Ki-67的表达率和下降率与放疗敏感性的关系,以及化疗对放疗的增敏作用.结果 50例患者中,Ki-67表达≥48％者25例,其中治疗后完全缓解(CR)18例,CR率为72.0％;Ki-67表达＜48％者25例,其中治疗后CR 10例,CR率为40.0％,与Ki-67表达≥48％者的CR率差异有统计学意义(P=0.023).放疗10 Gy后,Ki-67表达下降≥31％者26例,其中CR 22例,CR率为84.6％;Ki-67表达下降＜31％者24例,其中CR 6例,CR率为24.0％,与Ki-67表达下降≥31％者的CR率差异有统计学意义(P＜0.001).化疗可增加Ki-67表达＜48％者放疗后的Ki-67下降率(P=0.023);但对于Ki-67≥≥48％者,化疗并不能增加放疗后Ki-67的下降率(P =0.173).放疗敏感组患者的2年无进展生存率和总生存率分别为85.7％和92.9％,均明显高于放疗不敏感组患者(分别为18.2％和40.9％,均P＜0.05).结论放疗前和放疗10 Gy后Ⅲ期宫颈鳞癌组织中Ki-67的表达可作为预测放疗敏感性的参考指标,用于指导治疗方案的选择;同步化疗对于放疗的增敏效果不明显.
목적 탐토Ki-67재Ⅲ기궁경린암조직중적표체화변화여방료민감성적관계,이급화료대방료적증민작용.방법 50례Ⅲ기궁경린암환자,분별채용단순방료(25례)화동보방화료치료(25례).채용면역조화법검측방료전화방료10 Gy후궁경린암활검조직표본중Ki-67적표체솔,분석Ki-67적표체솔화하강솔여방료민감성적관계,이급화료대방료적증민작용.결과 50례환자중,Ki-67표체≥48％자25례,기중치료후완전완해(CR)18례,CR솔위72.0％;Ki-67표체＜48％자25례,기중치료후CR 10례,CR솔위40.0％,여Ki-67표체≥48％자적CR솔차이유통계학의의(P=0.023).방료10 Gy후,Ki-67표체하강≥31％자26례,기중CR 22례,CR솔위84.6％;Ki-67표체하강＜31％자24례,기중CR 6례,CR솔위24.0％,여Ki-67표체하강≥31％자적CR솔차이유통계학의의(P＜0.001).화료가증가Ki-67표체＜48％자방료후적Ki-67하강솔(P=0.023);단대우Ki-67≥≥48％자,화료병불능증가방료후Ki-67적하강솔(P =0.173).방료민감조환자적2년무진전생존솔화총생존솔분별위85.7％화92.9％,균명현고우방료불민감조환자(분별위18.2％화40.9％,균P＜0.05).결론 방료전화방료10 Gy후Ⅲ기궁경린암조직중Ki-67적표체가작위예측방료민감성적삼고지표,용우지도치료방안적선택;동보화료대우방료적증민효과불명현.
Objective To investigate the expression of proliferating cell nuclear antigen (Ki-67) in stage Ⅲ cervical squamous cell carcinoma (SCC) and its correlation with the effect of chemotherapy on sensitivity to radiotherapy.Methods In 50 patients with stage Ⅲ cervical squamous cell carcinoma (SCC),25 patients were treated with radiotherapy and 25 patients were treated with chemoradiotherapy.The expression of Ki-67 in the biopsy specimens of cervical SCC was detected by immunohistochemistry at diagnosis and after 10 Gy radiotherapy.The correlation of Ki-67 positive cells percentage and chemotherapy with sensitivity to radiotherapy was analyzed.Results In 25 patients with more than 48％ Ki-67 positive cells at diagnosis,the rate of complete response (CR) was 72.0％ (18/25).In 25 patients with less than 48％ Ki-67 positive cells at diagnosis,the CR rate was 40.0％ (10/25),with a significant difference between them (P =0.023).In 26 patients with more than 31％ decrease of Ki-67 positive cells after 10 Gy radiotherapy,the CR rate was 84.6％ (22/26).In 24 patients with less than 31％ decrease of Ki-67 positive cells after 10 Gy radiotherapy,the CR rate was 25.0％ (6/24),showing a significant difference between the two groups (P ＜ 0.001).In the cases of Ki-67 ＜ 48％,decrease of Ki-67 positive cells of chemoradiotherapy group after 10 Gy radiotherapy was significantly higher than that of the radiotherapy group (P =0.023).In the cases of Ki-67≥48％,no difference in the decease of Ki-67 positive cells between the chemoradiotherapy and radiotherapy groups was found (P =0.173).For the radiotherapy-sensitive patients with CR recently,the 2-year progression free survival (PFS) rate and overall survival (OS) rate were 85.7％ and 92.9％,respectively,both were significantly higher than those of radiotherapy-insensitive patients (18.2％ and40.9％,P＜0.05 for both).Conclusions In stage Ⅲ cervical SCC,the expression of Ki-67 before and after treatment with 10 Gy radiotherapy may be used as a biomarker to predict tumor response to radiation,and guide the choice of therapeutic strategies.Yet,the effect of chemotherapy as a radiosensitizer is unconspicuous.