Konishi I, Nanbu K, Mandai M, Tsuruta Y, Kataoka N, Nagata Y, Mori T
Department of Gynecology and Obstetrics, Department of Radiology, Faculty of Medicine, Kyoto University, Sakyo-ku, Kyoto, 606, Japan.
Gynecol Oncol. 1998 Sep;70(3):365-71. doi: 10.1006/gyno.1998.5077.
To identify the clinicopathological and chemoresistant factors predicting the response to neoadjuvant chemotherapy and the patient prognosis in high-risk cervical carcinomas.
We retrospectively reviewed 47 patients with locally advanced or bulky cervical carcinoma treated with two courses of intraarterial infusion of cisplatin, doxorubicin, mitomycin C, and 5-fluorouracil (5-FU), followed by radical hysterectomy at our hospital between 1988 and 1995. Expressions of the chemoresistance-related proteins, such as P-glycoprotein, glutathione S-transferase pi (GST-pi), and proliferating cell nuclear antigen (PCNA) in the tumor cells, were examined by immunohistochemistry using pretreatment biopsy specimens. These results were compared with the chemotherapeutic response, which was evaluated by magnetic resonance imaging (MRI) and histopathology. Outcome of the patients was also studied.
Chemotherapeutic effect of either complete (CR) or partial (PR) response on MRI was obtained in 36 of the 47 (86%) patients. Poor response to chemotherapy was significantly correlated with P-glycoprotein expression (P < 0.005) and low PCNA labeling (P < 0. 05), but not GST-pi expression in the tumor cells. Independent prognostic factors for patient survival were parametrial involvement and lymph node metastasis. Neither the expression of GST-pi nor PCNA was correlated with the patient survival.
Assessment of the expression of P-glycoprotein and PCNA is potentially useful for the prediction of tumor response to neoadjuvant chemotherapy for cervical carcinomas.
确定预测高危宫颈癌新辅助化疗反应及患者预后的临床病理和化疗耐药因素。
我们回顾性分析了1988年至1995年间在我院接受两疗程顺铂、阿霉素、丝裂霉素C和5-氟尿嘧啶（5-FU）动脉内灌注治疗，随后行根治性子宫切除术的47例局部晚期或体积较大宫颈癌患者。使用预处理活检标本通过免疫组织化学检查肿瘤细胞中化疗耐药相关蛋白的表达，如P-糖蛋白、谷胱甘肽S-转移酶pi（GST-pi）和增殖细胞核抗原（PCNA）。将这些结果与通过磁共振成像（MRI）和组织病理学评估的化疗反应进行比较。还研究了患者的预后。
47例患者中有36例（86%）在MRI上获得了完全（CR）或部分（PR）反应的化疗效果。化疗反应不佳与肿瘤细胞中P-糖蛋白表达（P < 0.005）和低PCNA标记（P < 0.05）显著相关，但与GST-pi表达无关。患者生存的独立预后因素是宫旁组织受累和淋巴结转移。GST-pi和PCNA的表达均与患者生存无关。
评估P-糖蛋白和PCNA的表达可能有助于预测宫颈癌新辅助化疗的肿瘤反应。
