恶性浆膜腔积液TOPO-I表达与顺铂/羟基喜树碱灌注化疗疗效及预后关系

摘要

Objective: To study the effect of pour into cDDP( cis - Diaminedichloroplatinum ) or HCPT( Hydroxy-camptothecin ) and the relation with the expression of topoisomerase - I in malignant effusions and its relationship with prognosis. Methods: We modified the current cell block preparation method for effusion samples by adding a " cylinder" to obtain more cell pellets. Immunocytochemistry was used for topoisomerase -I with the tumor cells in the malignant serous cavity effusions. The over all survival ( OS ) was analyzed by Kaplan - Meier method, and the relationship with prognosis was analyzed by multi - variate of Cox regression. Results: We collected 35 samples of cavity ef-fusions , including 17 with low expression and 18 high expression. There were no significant correlation to the expression of topoisomerase - I with the serum CEA ( P = 0. 368 ) and LDH ( P = 0. 754 ). The median survival time of the low expression group was 13 months, and the high expression group was 35 months ( P = 0. 057 ). They were not independent prognostic factors of the gender,age,pleural fluid or peritoneal fluid,the serum CEA and LDH which were analyzed by multi - variate of Cox regression. Conclusion: TOPO - I protein examination for the advanced tumor patients "with malignant serous cavity effusions, could guide the individualized treatment , which may reduces the side effect, increases the curative effect. It's need further study to confirm the result of our research, because of the limited amount samples.%目的:研究恶性浆膜腔积液肿瘤细胞拓扑异构酶-I(TOPO-I)表达情况与给予顺铂(cis-Diaminedichloroplatinum,cDDP)或羟基喜树碱(Hydroxycamptothecin,HCPT)胸腹腔灌注化疗疗效及与患者预后之间的关系.方法:应用改进后的细胞块石蜡包埋法进行包埋,检测恶性浆膜腔积液患者肿瘤细胞TOPO-I蛋白的表达情况.Kaplan-Meier法绘制生存曲线,Cox模型多因素分析相关预后因素.结果:共收集了35例恶性浆膜腔积液样本,TOPO-I蛋白低表达17例,高表达18例.TOPO-I蛋白表达与患者血清癌胚抗原(P=0.368)及乳酸脱氢酶(P=0.754)之间无明显相关性.低表达组中位生存时间为13个月,高表达组中位生存时间为35个月(P=0.057).Cox多因素分析显示,年龄、性别、是否胸腹水为首发症状、胸水还是腹水,血清CEA及血清LDH指标不是患者预后的独立因素.结论:对于晚期肿瘤并发恶性浆膜腔积液的患者,肿瘤细胞中TOPO-I蛋白高表达的患者可能会从顺铂或羟基喜树碱胸腹腔灌注化疗中获益,但由于本研究中样本量较少,其结果有待进一步扩大样本研究证实.