局部晚期宫颈鳞癌流式细胞术分析与放射治疗预后的关系

 目的 研究局部晚期宫颈鳞癌流式细胞术分析结果（DNA倍体、SPF和PI）与放疗预后的关系，探讨它们在预测宫颈癌放疗效果中的价值。方法 68例ⅢB期宫颈鳞癌病人在放疗前钳取宫颈癌组织，制备成单细胞悬液，采用流式细胞术检测癌细胞DNA倍体、S期比例（SPF）及增殖指数（PI），分析他们及其他临床参数与患者根治性放疗后疾病复发和生存的关系。结果 在68例标本中，异倍体检出率为47．1％（32／68），SPF和PI值为分别为（7．49±2．91）和（12．89±3．75）；在随访期间，全组宫颈癌患者复发率为44．1％（30／68）；二倍体组和异倍体组的5年无复发生存率分别为52．7％和35．2％（P〈0．（15），高SPF组和低SPF组5年无复发生存率分别为25．3％和56．6％（P〈0．05），高PI组和低PI组5年无复发生存率分别为37．5％和49．3％（P〈0．05）；经多因素分析显示，肿瘤大小和SPF是影响宫颈癌患者无复发生存的独立预后因素。结论 通过流式细胞术检测宫颈癌组织SPF可以预测局部晚期宫颈鳞癌放射治疗后的预后。

Prognostic Significance of Flow-cytometric DNA Anaysis in Locally Advanced Cervical Squamous Carcinoma

Objective 　To determine the utility of DNA flow cytometry as a prognostic indicator for risk of recurrence and survival in patients with locally advanced squamous cervical carcinoma. Methods 　DNA flow cytomet ry was performed to determine ploidy ,S phase fraction (SPF) ,and proliferative index ( PI) in 68 women with stage ⅢB squamous carcinomas of the cervix treated by radiotherapy (RT) . Sixty-eight tissue samples were obtained by punch biopsy from cervical primary tumor before RT. Flow-cytometric results ,along with other known prognostic variables for risk for recurrent disease and survival ,were analyzed using COX regression proportional hazards model ,and survival curves were generated by the Kaplan Meier method. Results 　Of 68 samples ,DNA ploidy patterns were 36 (52. 9 %) diploid and 32 (47. 1 %) aneuploid. The mean values of SPF and PI were 7. 49 ±2. 91 and 12. 89 ±3. 75 respectively. Thirty of 68 patients (44. 1 %) experienced recurrence during the follow-up . Aneuploid patients had lower 5-year recurrent free survival than those with diploid pattern (35. 2 % vs. 52. 7 %; P < 0. 05) and high SPF group had lower 5-year recurrent f ree survival than low SPF group as well (25. 3 % vs. 56. 6 %; P < 0. 05) . Multivariate analysis confirmed that only SPF and tumor size were the significant factor for 5-year recurrent free surval ( P < 0. 05) . Conclusion 　DNA ploidy and PI are not independent prognostic factors for tumor recurrence ; however ,a high SPF warrants further investigation as a potential prognostic indicator for risk of recurrent disease in patient s with squamous carcinoma of the uterine cervix.