鼻腔鼻窦恶性肿瘤细胞凋亡的临床意义

目的探讨肿瘤细胞自发性凋亡与鼻腔鼻窦恶性肿瘤临床病理参数及预后的关系,为临床判断预后提供依据。方法回顾性分析解放军总医院1991~2000年收治的48例原发性鼻腔鼻窦恶性肿瘤患者。所有患者均进行根治性手术,44例术后均行放疗,其中2例加行化疗。所有患者均随访3年以上,25例健在无肿瘤复发(52.1%);3例肿瘤复发或远处转移带瘤生存(6.3%);2例死于其他疾病(4.2%);14例死于原发病(29.2%),4例失访(8.3%),按死于原发病局部复发计算。TUNEL结合PI及HE染色检测肿瘤细胞自发性凋亡情况。Log-rank进行生存率的比较,Cox回归进行影响患者预后的多因素分析,以P<0.05为有统计学意义。结果48例肿瘤标本中44例(91.67%)发现凋亡细胞,早期肿瘤(T1、T2)凋亡指数高于晚期(T3、T4),两者比较有统计学意义(P<0.05)。以AI中位数2为界将48例鼻腔鼻窦肿瘤分为高AI(AI≥2)和低AI组(AI<2),高AI组(AI≥2)总生存率、无瘤生存率和局部控制率均高于低AI组(P<0.05)。结论细胞凋亡可能参与了鼻腔鼻窦恶性肿瘤的发生和发展。临床检测肿瘤治疗前的凋亡指数有可能成为临床上用来筛选具有高复发和死亡风险性的鼻腔鼻窦恶性肿瘤患者的生物学指标。

Apoptosis and its relationship with prognosis in nasal cavity and sinus malignant tumors

Objective To assess the relationship of spontaneous apoptosis between the clinicopathological parameters and prognosis in nasal cavity and sinus malignant tumors(NCSMT).Methods Clinical data of 48 patients with NCSMT treated by radical operations from 1991 to 2000 was studied retrospectively.All patients were followed up for more than 3 years.Of them,23 were female and 25 were male,aged from 20 to 71 years old.44 patients received postoperative chemotherapy.Spontaneous apoptotic cells were detected by TUNEL accompanied with HE and PI staining.Results Apoptosis was found in 44 of 48 patients(91.67%).The apoptosis index(AI) in early stage tumors(T1,T2) was higher than that of advanced ones(T3,T4)(P<0.05).Patients with higher AI had much better prognosis than those with lower AI(P<0.05).Conclusion Apoptosis may take part in the etiology and development of NCSMT.AI before treatment may provide novel prediction for disease-free survival after surgical resection and postoperative radiochemotherapy in NPSMT.