宫颈癌肿瘤标志物在新辅助化疗中的应用
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摘要
目的了解新辅助化疗对宫颈癌肿瘤标志物水平的影响,探讨肿瘤标志物在新辅助化疗效果评估中的作用。方法回顾在武汉市中心医院妇产科接受化疗和宫颈癌根治术的40例患者的临床资料,通过腹部超声和磁共振检查确定在新辅助化疗前后肿块的大小;通过淋巴细胞的病理结果判断子宫周围淋巴结转移情况。比较两轮新辅助化疗及宫颈癌根治术前后肿瘤标志物水平(癌胚抗原、血清糖类抗原125、鳞状细胞癌抗原),评估新辅助化疗疗效和宫颈癌肿瘤标志物水平的相关性。结果宫颈癌肿瘤标志物水平在化疗和手术后都明显降低,差异有统计学意义(CEA:F=11. 07,P <0. 05;SCC-Ag:F=8. 84,P <0. 05;CA125:F=10. 18,P <0. 05)。新辅助化疗能减少局部晚期子宫颈癌患者的比例(χ2=7. 17,P <0. 05)。新辅助化疗后肿瘤缩小≥1 cm的的患者,其血清肿瘤标志物水平均低于肿瘤直径缩小<1 cm的患者,其中鳞状细胞癌抗原水平差异有统计学意义(t=2. 4,P <0. 05)。但是化疗后肿瘤标志物水平不能明显反映患者淋巴转移情况。结论新辅助化疗可显著降低肿瘤标志物水平,血清肿瘤标志物水平的变化是反映新辅助化疗有效性的指标。
Objective To investigate the effect of neoadjuvant chemotherapy on tumor markers levels in cervical cancer and to explore the role of tumor markers in the evaluation of neoadjuvantchemotherapy. Methods The clinical data of 40 patients received chemotherapy and radical surgery ofcervical cancer in Wuhan Central Hospital were retrospectively analyzed. The size of the masses beforeand after neoadjuvant chemotherapy was determined with abdominal ultrasound and magneticresonance imaging,and the lymph node metastasis around the uterus was determined with thepathological results of lymphocyte. Tumor markers levels(carcino-embryonic antigen(CEA),carbohydrate antigen 125(CA125),squamous cell carcinoma antigen(SCC-Ag))before and after two rounds ofneoadjuvant chemotherapy and radical cervical cancer surgery were compared to evaluate thecorrelation between the efficacy of neoadjuvant chemotherapy and the levels of tumor markers ofcervical cancer. Results The levels of tumor markers in cervical cancer decreased significantly afterchemotherapy and surgery,the differences were statistically significant(CEA:F = 11. 07,P < 0. 05;SCC-Ag:F = 8. 84,P < 0. 05;CA125:F = 10. 18,P < 0. 05). Neoadjuvant chemotherapyreduced the ratio of locally advanced cervical cancer( χ2= 7. 17,P < 0. 05). After neoadjuvant chemotherapy,the tumor markers levels in the patients whose tumor diameter shrunk ≥ 1 cm werelower than those shrunk <1 cm,and the difference of the level of squamous cell carcinoma antigen wasstatistically significant(t = 2. 4,P < 0. 05). However,the levels of tumor markers after chemotherapycould not reflect the lymphatic metastasis of patients. Conclusion Neoadjuvant chemotherapy cansignificantly reduce the levels of tumor markers,the serum tumor markers are indicators for theeffectiveness of neoadjuvant chemotherapy.
Objective To investigate the effect of neoadjuvant chemotherapy on tumor markers levels in cervical cancer and to explore the role of tumor markers in the evaluation of neoadjuvantchemotherapy. Methods The clinical data of 40 patients received chemotherapy and radical surgery ofcervical cancer in Wuhan Central Hospital were retrospectively analyzed. The size of the masses beforeand after neoadjuvant chemotherapy was determined with abdominal ultrasound and magneticresonance imaging,and the lymph node metastasis around the uterus was determined with thepathological results of lymphocyte. Tumor markers levels(carcino-embryonic antigen(CEA),carbohydrate antigen 125(CA125),squamous cell carcinoma antigen(SCC-Ag))before and after two rounds ofneoadjuvant chemotherapy and radical cervical cancer surgery were compared to evaluate thecorrelation between the efficacy of neoadjuvant chemotherapy and the levels of tumor markers ofcervical cancer. Results The levels of tumor markers in cervical cancer decreased significantly afterchemotherapy and surgery,the differences were statistically significant(CEA:F = 11. 07,P < 0. 05;SCC-Ag:F = 8. 84,P < 0. 05;CA125:F = 10. 18,P < 0. 05). Neoadjuvant chemotherapyreduced the ratio of locally advanced cervical cancer( χ2= 7. 17,P < 0. 05). After neoadjuvant chemotherapy,the tumor markers levels in the patients whose tumor diameter shrunk ≥ 1 cm werelower than those shrunk <1 cm,and the difference of the level of squamous cell carcinoma antigen wasstatistically significant(t = 2. 4,P < 0. 05). However,the levels of tumor markers after chemotherapycould not reflect the lymphatic metastasis of patients. Conclusion Neoadjuvant chemotherapy cansignificantly reduce the levels of tumor markers,the serum tumor markers are indicators for theeffectiveness of neoadjuvant chemotherapy.
引文
[1]范克军,于兴江.宫颈癌局部治疗前新辅助化疗的效果观察[J].实用医药杂志,2014,31(12):1093-1094.
[2]王瑾. TP方案在新辅助化疗中对宫颈癌的近期疗效观察[J].河北医药,2016,38(6):837-839.
[3]李雪,孔为民.局部晚期子宫颈癌治疗的研究进展[J].中华妇产科杂志,2015(5):388-390.
[4] GONG L,LOU J Y,WANG P,et al. Clinical evaluation of neoadjuvant chemotherapy followed by radical surgery in themanagement of stage IB2–IIB cervical cancer[J]. International Journal of Gynecology&Obstetrics,2012,117(1):23-26.
[5]胡金龙,吴令英,李宁,等.Ⅰb2期和Ⅱa2期子宫颈癌新辅助治疗方式的比较分析[J].中华妇产科杂志,2012,47(6):452-457.
[6] LI R,LU S T,SI J G,et al. Prognostic value of responsiveness of neoadjuvant chemotherapy before surgery for patientswith stage IB(2)/IIA(2)cervical cancer[J]. Gynecologic Oncology,2013,128(3):524.
[7]张媛,李胜泽. Ki-67、P-糖蛋白预测宫颈癌新辅助化疗敏感性的研究进展[J].肿瘤学杂志,2014,20(12):977-981.
[8] HUANG E Y,HUANG Y J,CHANCHIEN C C,et al. Pretreatment carcinoembryonic antigen level is a risk factor for para-aortic lymph node recurrence in addition to squamous cell carcinoma antigen following definitive concurrent chemoradiother?apy for squamous cell carcinoma of the uterine cervix[J]. Radiat Oncol,2010,78(3):13.
[9] CHEN S W,LIANG J A,HUNG Y C,et al. Clinical implications of elevated pretreatment carcinoembryonicantigen in pa?tients with advanced squamous cell carcinoma of the uterine cervix[J]. Tumour Biol,2008,29:255-61.
[10]罗业琳,雷嘉,黄卓华.联合检测血清SCC、CEA、CA125、CA199在宫颈癌诊断中的价值[J].临床合理用药杂志,2016,9(5A):137-138.
[11]岳屹囡,孙绪丁,赵倩颖,等.鳞状细胞癌抗原在宫颈癌中的临床应用及其研究进展[J].中华妇幼临床医学杂志(电子版),2013,9(3):344-346.
[12]王从素,桂定清,张力忆,等.术前新辅助化疗对宫颈癌组织病理学动态变化及近远期疗效观察[J].实用癌症杂志,2017,32(6):920-923.
[2]王瑾. TP方案在新辅助化疗中对宫颈癌的近期疗效观察[J].河北医药,2016,38(6):837-839.
[3]李雪,孔为民.局部晚期子宫颈癌治疗的研究进展[J].中华妇产科杂志,2015(5):388-390.
[4] GONG L,LOU J Y,WANG P,et al. Clinical evaluation of neoadjuvant chemotherapy followed by radical surgery in themanagement of stage IB2–IIB cervical cancer[J]. International Journal of Gynecology&Obstetrics,2012,117(1):23-26.
[5]胡金龙,吴令英,李宁,等.Ⅰb2期和Ⅱa2期子宫颈癌新辅助治疗方式的比较分析[J].中华妇产科杂志,2012,47(6):452-457.
[6] LI R,LU S T,SI J G,et al. Prognostic value of responsiveness of neoadjuvant chemotherapy before surgery for patientswith stage IB(2)/IIA(2)cervical cancer[J]. Gynecologic Oncology,2013,128(3):524.
[7]张媛,李胜泽. Ki-67、P-糖蛋白预测宫颈癌新辅助化疗敏感性的研究进展[J].肿瘤学杂志,2014,20(12):977-981.
[8] HUANG E Y,HUANG Y J,CHANCHIEN C C,et al. Pretreatment carcinoembryonic antigen level is a risk factor for para-aortic lymph node recurrence in addition to squamous cell carcinoma antigen following definitive concurrent chemoradiother?apy for squamous cell carcinoma of the uterine cervix[J]. Radiat Oncol,2010,78(3):13.
[9] CHEN S W,LIANG J A,HUNG Y C,et al. Clinical implications of elevated pretreatment carcinoembryonicantigen in pa?tients with advanced squamous cell carcinoma of the uterine cervix[J]. Tumour Biol,2008,29:255-61.
[10]罗业琳,雷嘉,黄卓华.联合检测血清SCC、CEA、CA125、CA199在宫颈癌诊断中的价值[J].临床合理用药杂志,2016,9(5A):137-138.
[11]岳屹囡,孙绪丁,赵倩颖,等.鳞状细胞癌抗原在宫颈癌中的临床应用及其研究进展[J].中华妇幼临床医学杂志(电子版),2013,9(3):344-346.
[12]王从素,桂定清,张力忆,等.术前新辅助化疗对宫颈癌组织病理学动态变化及近远期疗效观察[J].实用癌症杂志,2017,32(6):920-923.