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目的:通过探讨细胞凋亡及Fas的表达,讨论中晚期宫颈癌放疗敏感性的机制,从而为宫颈癌的个体化、优化治疗提供理论依据。方法:选取新疆医科大学附属肿瘤医院2006年1月～2007年6月间60例中晚期宫颈癌患者,随机分为2组,单纯放疗(radiotherapy,RT)组30例给予10Gy放疗前、后取活检,放化疗(synchronal radiochemotherapy,CRT)组30例先行一次化疗再给予10Gy放疗前、后取活检,采用免疫组织化学法和脱氧核糖核酸转移酶介导的缺口末端标记(TUNEL)技术,分别检测30例单纯放疗和30例放化疗联合宫颈癌患者治疗前、后宫颈肿瘤细胞凋亡率及Fas蛋白的表达。结果:RT组和CRT组完全缓解率分别为50%和90%(P=0.0012)。在治疗过程中,RT组和CRT组凋亡阳性率均增加,分别由33.33%上升到66.67%(P=0.02)和36.67%增加到93.33%(P=0.000),差异显著,治疗中CRT组较RT组增加更加明显(P=0.02)。Fas的表达亦增加,分别由33.33%上升到70.0%(P=0.01)和26.67%增加到76.67%,差异显著(P=0.000),但两组间Fas的表达阳性率无差异(P>0.05)。两组在治疗中,凋亡的阳性率和Fas的阳性表达密切相关,CRT组较RT组相关性更强(P=0.015,r=0.755;P=0.027,r=0.423)。结论:中晚期宫颈鳞癌CRT比RT有更好的缓解率,其机制可能是化疗和放疗有协同作用,通过上调Fas蛋白诱导了肿瘤细胞的凋亡。
OBJECTIVE: To investigate the mechanism of radiosensitivity of advanced cervical cancer by exploring apoptosis and expression of Fas, so as to provide a theoretical basis for individualized and optimal treatment of cervical cancer. Methods: Sixty patients with advanced cervical cancer from January 2006 to June 2007 in Cancer Hospital of Xinjiang Medical University were randomly divided into two groups. Radiotherapy (RT) group 30 cases were given 10Gy radiotherapy before and after Thirty patients in the group of biopsy and radiotherapy (synchronal radiochemotherapy) were treated with 10Gy radiotherapy before and after radiotherapy. The biopsies were taken by immunohistochemistry and DNA nick end labeling (TUNEL) 30 cases of radiotherapy alone and 30 cases of radiotherapy and chemotherapy combined with cervical cancer before and after treatment of cervical cancer cells apoptosis rate and Fas protein expression. Results: The complete remission rates were 50% and 90% in RT and CRT groups, respectively (P = 0.0012). During the course of treatment, the positive rates of apoptosis in RT group and CRT group increased from 33.33% to 66.67% (P = 0.02) and from 36.67% to 93.33% (P = 0.000), respectively. There was significant difference between the CRT group and CRT group Compared with the RT group increased more significantly (P = 0.02). Fas expression increased from 33.33% to 70.0% (P = 0.01) and from 26.67% to 76.67% (P = 0.000), but there was no difference in the expression of Fas between the two groups (P> 0.05 ). In the two groups, the positive rate of apoptosis was closely related to the positive expression of Fas. The correlation between CRT group and RT group was more significant (P = 0.015, r = 0.755; P = 0.027, r = 0.423). Conclusions: CRT is better than RT in advanced cervical squamous cell carcinoma. The mechanism may be that chemotherapy and radiotherapy have a synergistic effect. Up - regulation of Fas protein induces the apoptosis of tumor cells.