Höckel M, Knoop C, Schlenger K, Vorndran B, Baussmann E, Mitze M, Knapstein P G, Vaupel P
Department of Obstetrics and Gynecology, University of Mainz, Mainz, Germany.
Radiother Oncol. 1993 Jan;26(1):45-50. doi: 10.1016/0167-8140(93)90025-4.
Experimental evidence suggests that the hypoxic fraction in a solid tumor may increase its malignant potential and reduce its sensitivity towards non-surgical treatment modalities (e.g. standard irradiation, certain anticancer agents). However, the clinical importance of tumor hypoxia remains uncertain since valid methods for the routine measurement of intratumoral O2-tensions in patients have so far been lacking. A clinically applicable standardized procedure has been established which enables the determination of intratumoral oxygen tensions in advanced cervical cancers by use of a computerized polarographic needle electrode histography system. Tumor oxygenation as measured by this method represents a novel tumor feature which can be individually determined for each tumor and which is independent from other known oncological parameters. The results of an interim analysis of an open prospective clinical trial to evaluate the prognostic significance of tumor oxygenation based on the survival data of the first 31 patients are presented. Fifteen patients have been treated by primary radiation, 11 patients received multimodality therapy including irradiation. After a median follow-up of 19 months (range 5-31 months), Kaplan-Meier-life table analysis showed significantly lower survival and recurrence-free survival for patients with a median pO2 of < or = 10 mmHg compared to those with better oxygenated tumors (median pO2 > 10 mmHg). The Cox proportional hazards model revealed that the median pO2 and the clinical stage according to the FIGO are independent, highly significant predictors of survival and recurrence-free survival. We conclude from these preliminary results that tumor oxygenation as determined with this standardized procedure appears to be a new independent prognostic factor influencing survival in advanced cancer of the uterine cervix.
实验证据表明，实体瘤中的缺氧部分可能会增加其恶性潜能，并降低其对非手术治疗方式（如标准放疗、某些抗癌药物）的敏感性。然而，肿瘤缺氧的临床重要性仍不确定，因为目前仍缺乏在患者中常规测量瘤内氧张力的有效方法。现已建立了一种临床适用的标准化程序，该程序可通过使用计算机化极谱针电极组织成像系统来测定晚期宫颈癌的瘤内氧张力。通过这种方法测量的肿瘤氧合是一种新的肿瘤特征，可针对每个肿瘤单独测定，且独立于其他已知的肿瘤学参数。本文展示了一项开放前瞻性临床试验的中期分析结果，该试验基于前31例患者的生存数据评估肿瘤氧合的预后意义。15例患者接受了原发放疗，11例患者接受了包括放疗在内的多模式治疗。中位随访19个月（范围5 - 31个月）后，Kaplan - Meier生存表分析显示，中位pO2≤10 mmHg的患者与氧合较好的肿瘤患者（中位pO2>10 mmHg）相比，生存率和无复发生存率显著更低。Cox比例风险模型显示，中位pO2和国际妇产科联盟（FIGO）分期是生存和无复发生存的独立、高度显著的预测因素。基于这些初步结果，我们得出结论，用这种标准化程序测定的肿瘤氧合似乎是影响晚期宫颈癌生存的一个新的独立预后因素。
