Onizuka K, Migita S, Yamada H, Matsumoto I
Department of Radiology, Miyazaki Prefectural Hospital, Japan.
Fukuoka Igaku Zasshi. 1999 Feb;90(2):46-58.
The levels of 21 protein components of the sera of 45 patients with cancer of the larynx undergoing radiation therapy were determined by a single radial immunodiffusion method before and after radiation therapy. We examined the correlation between changes in serum protein fractions and the prognosis of the patients. The patients with cancer of the larynx were treated with external irradiation of 60Co gammer-rays. Total target doses were 60 Gy. The levels of the same protein components were also measured in 43 normal adult individuals as a control. All patients were observed for 5 years and 12 years following radiation therapy. In the pretreatment sera obtained from patients with cancer of the larynx, the concentrations of prealbumin (Prealb), antithrombin III (ATIII) and plasminogen (Pmg) were significantly lower than controls. However the concentrations of alpha 1-acid glycoprotein (alpha 1AG), alpha 1-antitrypsin (alpha 1AT), alpha 1-antichymotrypsin (alpha 1X), haptoglobin (Hp), fibrinogen (Fib) and hemopexin (Hx) were elevated. At the completion of radiation therapy, the alpha 1AG, alpha 1AT, alpha 1X, Hp, Fib and inter alpha trypsin inhibitor (I alpha I) were significantly elevated than those normal controls. In patients without recurrent cancer after radiation therapy, the alpha 1AT, ceruloplasmin (Cp), Fib, IgA and Hx levels measured before radiation therapy were significantly lower than those patients with recurrent cancer. In patients without recurrent cancer after radiation therapy, the alpha 1AT, Hp, Cp, IgG, and IgA levels measured after radiation therapy were reduced compared with those patients with recurrent cancer. In patients who had lived more than 5 years after radiation therapy, the alpha 1AT, Cp and Fib levels measured before radiation therapy reduced significantly compared with those who had died within 5 years. In those who had lived more than 5 years, the alpha 1AG, alpha 1AT, Hp, Fib, IgG, and IgA levels measured after radiation therapy were reduced significantly compared with those who died within 5 years. In cases of laryngeal cancer following a period of 5 to 12 years after radiation therapy, multiple regression analysis was used to determine whether increased concentrations of serum protein fractions were associated with good prognosis for the original disease. AT III, Prealb, alpha 1AG, albumin (Alb) and I alpha I before radiation therapy were positively correlated with survival, whereas Hx, Pmg, Cp, IgM, Cl inhibitor (ClInh), alpha 1AT and Fib showed negative correlations. After radiation therapy, transferrin (Tf), Cp, Prealb, AT III and I alpha I were found to be positively associated with survival, whereas IgA, IgM, Pmg, alpha 1X and alpha 1AG were negative factors. From the elevation levels of acute phase proteins (alpha 1AT, Cp) and Fib and immunoglobulins (IgA, IgM) in the serum and lower levels of Prealb and AT III before and after radiation therapy, we may predict a relatively poor prognosis in these patients of laryngeal cancer.
采用单向放射免疫扩散法，测定了45例接受放射治疗的喉癌患者放疗前后血清中21种蛋白质成分的水平。我们研究了血清蛋白组分变化与患者预后之间的相关性。喉癌患者接受60Coγ射线外照射治疗，总靶剂量为60 Gy。同时测定了43名正常成年人的相同蛋白质成分水平作为对照。所有患者在放疗后分别观察了5年和12年。在喉癌患者放疗前的血清中，前白蛋白（Prealb）、抗凝血酶III（ATIII）和纤溶酶原（Pmg）的浓度显著低于对照组。然而，α1-酸性糖蛋白（α1AG）、α1-抗胰蛋白酶（α1AT）、α1-抗糜蛋白酶（α1X）、触珠蛋白（Hp）、纤维蛋白原（Fib）和血红素结合蛋白（Hx）的浓度升高。放疗结束时，α1AG、α1AT、α1X、Hp、Fib和α1-抗胰蛋白酶抑制剂（IαI）显著高于正常对照组。放疗后无癌复发的患者，放疗前测定的α1AT、铜蓝蛋白（Cp）、Fib、IgA和Hx水平显著低于有癌复发的患者。放疗后无癌复发的患者，放疗后测定的α1AT、Hp、Cp、IgG和IgA水平低于有癌复发的患者。放疗后存活超过5年的患者，放疗前测定的α1AT、Cp和Fib水平显著低于5年内死亡的患者。存活超过5年的患者，放疗后测定的α1AG、α1AT、Hp、Fib、IgG和IgA水平显著低于5年内死亡的患者。在放疗后5至12年的喉癌病例中，采用多元回归分析确定血清蛋白组分浓度升高是否与原发病的良好预后相关。放疗前AT III、Prealb、α1AG、白蛋白（Alb）和IαI与生存率呈正相关，而Hx、Pmg、Cp、IgM、C1抑制剂（ClInh）、α1AT和Fib呈负相关。放疗后，转铁蛋白（Tf）、Cp、Prealb、AT III和IαI与生存率呈正相关，而IgA、IgM、Pmg、α1X和α1AG是负性因素。从放疗前后血清中急性期蛋白（α1AT、Cp）和Fib以及免疫球蛋白（IgA、IgM）水平升高，Prealb和AT III水平降低，我们可以预测这些喉癌患者的预后相对较差。
