头颈部癌诱导化疗后细胞凋亡与DNA含量的研究

目的：了解头颈部癌手术前诱导化疗后肿瘤细胞的凋亡情况及NDA含量的变化,为诱导化疗及手术切缘的设计提供理论基础。材料与方法;对30例未经治疗的头颈部鳞状细胞癌应用顺铂、平阳霉素、甲氨喋呤的联合化疗方案,化疗一周后手术,取肿瘤组织及肿瘤退缩区组织进行常规病理及流式细胞仪检查。结果：化疗后肿瘤组织及退缩区组织细胞凋亡较化疗前明显增高（分别为11．47％、14．92％及0．69％,P＜0．05）,化疗后S期比率下降（分别为13．22％、3．66％及18．37％,P＜0．05）,化疗前后肿瘤组织与退缩区组织的DNA倍体无明显的差异（1／30,1／30,2／30,P＞0．05）。结论：头颈部癌诱导化疗后可引起肿瘤细胞的凋亡,凋亡发生于细胞的有丝分裂前期,这种细胞凋亡持续到化疗结束后一周仍然存在;化疗后虽然肿瘤缩小,光镜下组织形态正常,但DNA仍未完全恢复正常,对化疗后肿瘤退缩区组织,如欲于手术中保留,应持慎重态度。

Study of apoptosis and DNA statues in head and neck carcinoma with preoperative chemotherapy

Purpose: In order to provide theoretical basis for clinical design ofpreoperative chemotherapy and determination of operative margin, the changes ofapopeosis and DNA statues in head and neck carcinoma with preoperative chemotherapy were studied. Material and methods: 30 cases of patients suffered from head andneck squamous cell carcinoma who did not receive any treatment previously weretreated with combined chemotherapy with cisplatin,bleomycins and methotrexat before surgery. Flowing cytometry and pathology were carried out to analyze apoptosisand DNA statues in specimens with tumor and retreated tumor. Results: Apoptosiswere higher in specimens with tumor and retreated tumor than that of prechemotherapy (11. 47%, 14' 92% and 0. 69% respectively, P < 0. 05 ). S phase rates afterchemotherapy were lower than that of prechemotherapy (13. 22%, 3. 66%, 18. 37%respectively, P<0.05). There was no difference in DNA ploidy statues before and after chemotherapy (1/30, 1/30, 2/30, p > 0.05 ). Conclusion: Induced by combinedchemotherapy in head and neck carcinoma,apoptosis happened in premitotic phase anddid't disappear until a week after chemotherapy. Though tumors shrank and its morphology looked normal under microscope, DNA statues in it were abnormal. It suggested that it is wise to be cautious when making a decision of remaining retreated tumor during surgery.[Chinese Arch Otolaryngol Head Neck Surg, 1999; 6 (2 ): 95~98From the Department of Head and Neck Surgery,Shandong Cancer Hospital and Institute,Jinan 250117 (Dr. Fang Jugao) ]