Fyles A W, Milosevic M, Wong R, Kavanagh M C, Pintilie M, Sun A, Chapman W, Levin W, Manchul L, Keane T J, Hill R P
Department of Radiation Oncology, Ontario Cancer Institute/Princess Margaret Hospital, University of Toronto, Canada.
Radiother Oncol. 1998 Aug;48(2):149-56. doi: 10.1016/s0167-8140(98)00044-9.
Hypoxia appears to be an important factor in predicting tumor relapse following radiation therapy. This study measured oxygenation prior to treatment in patients with cervix cancer using a polarographic oxygen electrode to determine if oxygenation was an important prognostic factor with regard to tumor control and survival.
Between May 1994 and June 1997, 74 eligible patients with cervix cancer were entered into an ongoing prospective study of tumor oxygenation prior to primary radiation therapy. All patients were evaluated with an Eppendorf oxygen electrode during examination under anesthesia. Oxygenation data are presented as the hypoxic proportion, defined as the percentage of pO2 readings of <5 mm Hg (abbreviated as HP5).
The HP5 ranged from 2 to 99% with a median of 52%. With a median follow-up of 1.2 years, the disease-free survival (DFS) rate was 69% for patients with HP5 of < or =50% compared with 34% for those with HP5 of >50% (log-rank P = 0.02). Tumor size above and below the median of 5 cm was also significantly related to DFS (P = 0.0003) and patients with bulky hypoxic tumors had a significantly lower DFS (12% at 2 years) than either bulky oxygenated or non-bulky oxygenated or hypoxic tumors (65%, P = 0.0001).
Hypoxia and tumor size are significant adverse prognostic factors in a univariate analysis of disease-free survival in patients with cervix cancer. A high risk group of patients with bulky hypoxic tumors have a significantly higher probability of relapse and death.
缺氧似乎是预测放射治疗后肿瘤复发的一个重要因素。本研究使用极谱氧电极在宫颈癌患者治疗前测量氧合情况，以确定氧合是否是肿瘤控制和生存方面的重要预后因素。
1994年5月至1997年6月期间，74例符合条件的宫颈癌患者纳入一项正在进行的原发性放射治疗前肿瘤氧合的前瞻性研究。所有患者在麻醉下检查时用Eppendorf氧电极进行评估。氧合数据以缺氧比例表示，定义为pO2读数<5 mmHg的百分比（简称为HP5）。
HP5范围为2%至99%，中位数为52%。中位随访1.2年，HP5≤50%的患者无病生存率（DFS）为69%，而HP5>50%的患者为34%（对数秩检验P = 0.02）。肿瘤大小高于或低于5 cm中位数也与DFS显著相关（P = 0.0003），大体积缺氧肿瘤患者的DFS显著低于大体积富氧或小体积富氧或缺氧肿瘤患者（2年时为12%对65%，P = 0.0001）。
在宫颈癌患者无病生存的单因素分析中，缺氧和肿瘤大小是显著的不良预后因素。大体积缺氧肿瘤的高危患者组复发和死亡概率显著更高。
