Gasińska A, Urbański K, Jakubowicz J, Klimek M, Biesaga B, Wilson G D
Laboratory of Radiation Biology, Centre of Oncology, Kraków, Poland.
Radiother Oncol. 1999 Jan;50(1):77-84. doi: 10.1016/s0167-8140(98)00135-2.
Proliferative rate and DNA ploidy status were evaluated by flow cytometry in cervical cancer patients, prior to radiotherapy, to assess their importance as prognostic factors to predict survival rates.
Between 1987 and 1995, a total of 260 patients with squamous cell carcinoma (SCC) of the cervix, FIGO stages IB-IIIB were analysed. Tumour samples were incubated with bromodeoxyuridine (BrdUrd) in vitro to measure their total labelling index (totLI) and LI (totLI for diploid and anLI for aneuploid tumours). Proliferation was also assessed by S-phase fraction (SPF) analysis of the DNA profile. Patients had intracavitary therapy (three applications, each of 16 Gy to point A) and XRT of 40-50 Gy given over 4-5 weeks.
The cervical tumours were characterized by a high proliferation rate which varied within each clinical stage of disease. The totLI ranged from 1.1 to 33.1% with median value of 9.6% whilst the LI ranged from 1.1 to 37.1% with a median value of 10.9%. Univariate analysis identified patient's age (cut-offpoint < or = 50&greater; years) and to a lesser extent proliferation (cut-off point, median totLI=9.6%) as significant prognostic factors for 5-year survival. The median survival time for younger patients ( < or = 50 years) with tumours of low proliferation (totLI < or = 9.6%) tumours was 17.5 months compared with 56 months in the faster proliferating tumours (P=0.0354). In the older patient sub-group, proliferation rate had no influence on survival. The median LI value was not a useful parameter in survival. Cox multivariate analysis showed that patient age ( < or = 50 years) and low proliferation of the tumour cells (totLI < or = 9.6) were unfavourable prognostic factors for cervical cancers treated with radiotherapy. DNA ploidy was not significant in this series.
These data suggest that further improvements in therapy might be gained by selection of alternative treatments strategies such as neoadjuvant chemotherapy or radiation sensitizers in younger patients with more slowly proliferating tumours.
通过流式细胞术对宫颈癌患者放疗前的增殖率和DNA倍体状态进行评估，以确定其作为预测生存率的预后因素的重要性。
分析1987年至1995年间共260例国际妇产科联盟（FIGO）分期为IB-IIIB期的宫颈鳞状细胞癌患者。肿瘤样本在体外与溴脱氧尿苷（BrdUrd）孵育，以测量其总标记指数（totLI）和标记指数（二倍体肿瘤的totLI和非整倍体肿瘤的anLI）。还通过DNA图谱的S期分数（SPF）分析评估增殖情况。患者接受腔内治疗（分三次，每次给A点16 Gy）以及在4至5周内给予40 - 50 Gy的外照射放疗（XRT）。
宫颈肿瘤的特点是增殖率高，且在疾病的每个临床分期内有所不同。总标记指数（totLI）范围为1.1%至33.1%，中位数为9.6%；而标记指数（LI）范围为1.1%至37.1%，中位数为10.9%。单因素分析确定患者年龄（分界点≤50岁）以及在较小程度上的增殖情况（分界点，totLI中位数 = 9.6%）是5年生存率的重要预后因素。低增殖（totLI≤9.6%）肿瘤的年轻患者（≤50岁）的中位生存时间为17.5个月，而增殖较快的肿瘤患者为56个月（P = 0.0354）。在老年患者亚组中，增殖率对生存无影响。中位LI值在生存方面不是一个有用的参数。Cox多因素分析表明，患者年龄（≤50岁）和肿瘤细胞低增殖（totLI≤9.6）是接受放疗的宫颈癌的不良预后因素。在本系列中DNA倍体无显著意义。
这些数据表明，对于肿瘤增殖较慢的年轻患者，通过选择替代治疗策略，如新辅助化疗或放射增敏剂，可能会进一步改善治疗效果。
