基质金属蛋白酶及微血管密度和子宫内膜癌的关系

基质金属蛋白酶及其抑制剂在子宫内膜癌的侵袭和转移中发挥着重要的作用。肿瘤的新生血管对肿瘤的发生、发展、转移及预后有着重要作用。微血管密度是衡量血管生成的定量指标。基质金属蛋白酶抑制剂可抑制血管的生成和MMPs对细胞外基质的降解。现将他们与子宫内膜癌的关系综述如下。     

The activity of letrozole in patients with advanced or recurrent endometrial cancer and correlation with biological markers – a study of the National Cancer Institute of Canada Clinical Trials Group

A multicenter phase II trial was conducted to define the activity of letrozole in postmenopausal women with recurrent or advanced endometrial carcinoma, who had no more than one prior line of progestins and never had chemotherapy (except adjuvant). Archival paraffin-embedded tumor samples were retrieved to determine the expression level of estrogen (ER) and progesterone receptor (PgR), p53, HER-2, bcl-2 and PTEN protein, and phosphorylation status of protein kinase B (PKB/Akt). Thirty-two eligible patients were treated with letrozole at 2.5 mg daily continuously, of whom 10 (31%) had prior progestins. Of the 28 patients evaluated for response, one complete and two partial responses were noted; overall response was 9.4% (95% confidence interval 2-25%). Eleven patients had stable disease for a median duration of 6.7 months (range 3.7-19.3 months). Amongst 22 patients who had tumor blocks available, the proportion showing positive expression of the following markers includes: PgR (86%), ER (86%), PTEN (82%), phosphorylated PKB/Akt (59%), bcl-2 (45%), p53 (32%), and HER-2 (0%). None of these markers correlated with response to letrozole or disease progression. In conclusion, letrozole is well tolerated but has little overall activity in this cohort of women with endometrial cancer.     

雌激素对内膜癌细胞中FAK基因转录的影响

目的定量观察雌激素刺激后内膜癌细胞的焦点粘连激酶（Focal—adhesion kinase，FAK）转录水平。方法不同浓度的17β-雌二醇体外刺激雌激素敏感的内膜癌细胞株RL95—2。加用三苯氧胺或ICI 182，780雌激素拮抗剂的细胞及未加雌激素的细胞设为阴性对照。经不同作用时间后，采用实时RT—PCR方法测定处理后的细胞内FAK的mRNA水平。结果在给予不同浓度的雌激素共培养1d或5d后，细胞的FAK基因的转录水平对比阴性对照细胞无明显改变。结论雌激素对内膜癌细胞的FAK转录可能无显著影响。FAK基因在内膜癌组织中的过度表达的机理需要进一步深入研究。     

腹腔镜手术治疗子宫恶性肿瘤的应用价值

目的 研究腹腔镜下广泛全子宫切除术、盆腔淋巴结切除术治疗早期子宫恶性肿瘤的应用价值.方法 回顾性分析34例经腹腔镜和30例开腹手术治疗的临床Ⅰ～Ⅱ期子宫恶性肿瘤患者的临床资料,比较两组的手术时间、术中出血量、并发症、术后恢复情况及淋巴结切除数目等.结果 两组的手术时间、并发症发生率无显著性差异.腹腔镜组的术中出血量为247.13±127.62ml,明显少于同期开腹手术者(904.51±428.37ml,P＜0.01).腹腔镜组淋巴结切除数为23.2±5.8个,多于开腹组淋巴结切除数(16.5±3.8,P＜0.01).术后胃肠功能恢复时间,腹腔镜组为26.4±8.3h,开腹组为54.6±13.5h,两组间有显著性差异(P＜0.01).术后随访11个月两组均未见复发病例.结论 腹腔镜下广泛全子宫切除术、盆腔淋巴结切除术获得满意的效果,近期疗效肯定,远期疗效尚需进一步随访分析.     

子宫内膜息肉的宫腔镜诊断和治疗价值

目的：阐明官腔镜对子宫内膜息肉的诊断和治疗价值。方法：对行宫腔镜检查的1676例患者中360例子宫内膜息肉进行研究分析，对其中的56例行经宫颈子宫内膜息肉电切术(TCRP)，术后3个月常规复查。结果：子宫内膜息肉的患病率为21．5％(360／1676)，绝经后子宫出血患者阳性病例为186例，其中子宫内膜息肉43例(23．1％)。结论：(1)子宫内膜息肉的临床特征以不规则阴道出血为主，绝经期则以绝经后出血为主；(2)绝经后妇女体内仍有雌激素持续作用；(3)宫腔镜是子宫内膜息肉诊断和治疗的首选方法。     

丙氨瑞林治疗子宫内膜癌病人的性激素及有丝分裂指数的变化

目的：观察丙氨瑞林对子宫内膜癌的治疗作用。方法：对诊刮确诊的１７例子宫内膜癌病人，予丙氨瑞林７００μｇ，ｉｍ，ｑｄ×７ｄ，用药前后作性激素测定及组织学检查。结果：绝经妇女用药后血中ＦＳＨ和ＬＨ下降（Ｐ＜０．０１和＜０．０５），雌二醇、孕酮及睾丸酮变化不明显。其中１３例内膜样腺癌用药后有丝分裂指数明显下降（Ｐ＜０．０１），有丝分裂指数变化与癌周内膜之反应有关。呈增生反应癌周内膜癌组织有丝分裂指数下降值明显高于呈萎缩状态癌周内膜。结论：丙氨瑞林治疗子宫内膜癌后能降低ＦＳＨ和ＬＨ水平，对子宫内膜癌尤其是雌激素依赖性内膜癌有一定疗效。