调强放疗联合化疗对子宫内膜癌患者疗效和癌基因表达的影响

国际妇产科学杂志 ›› 2019, Vol. 46 ›› Issue (5): 591-594.

调强放疗联合化疗对子宫内膜癌患者疗效和癌基因表达的影响

张明川，王莉

450000 郑州大学附属肿瘤医院妇瘤科

收稿日期:2019-03-28 修回日期:2019-06-24 出版日期:2019-10-15 发布日期:2019-10-21
通讯作者: 王莉，E-mail：rurmy315@163.com E-mail:esmzb39@163.com
基金资助:
河南省科技攻关项目（102102310107）

Effect of Intensity-Modulated Radiotherapy Combined with Chemotherapy on Oncogene in Patients with Endometrial Carcinoma

ZHANG Ming-chuan, WANG Li

Department of Gynecology, Affiliated Tumor Hospital, Zhengzhou University, Zhengzhou 450000, China

Received:2019-03-28 Revised:2019-06-24 Published:2019-10-15 Online:2019-10-21
Contact: WANG Li, E-mail：rurmy315@163.com E-mail:esmzb39@163.com
Supported by:

摘要/Abstract

摘要： 目的：探究调强放疗联合化疗治疗子宫内膜癌的效果及对患者癌基因表达变化的影响。方法：选取2017年1月—2018年1月在郑州大学附属肿瘤医院进行治疗的子宫内膜癌患者100例，按照随机数字表法随机分为化疗组和联合组，各50例。化疗组使用紫杉醇+铂类（TC）化疗方案进行化疗，联合组在化疗组的方法基础上使用调强放疗。对2组患者治疗前后的生活质量进行评分；比较2组患者治疗效果；实时荧光定量聚合酶链反应（PCR）检测原癌基因c-erbB2、c-myc、K-ras和抑癌基因P53、P16、第10号染色体上磷酸酶和张力蛋白同源缺失的基因（PTEN）；统计2组患者治疗过程中不良反应发生率。结果：2组患者治疗前各生活功能评分比较差异无统计学意义（P＞0.05）；治疗后2组患者各生活功能评分均高于治疗前，且联合组高于化疗组，差异有统计学意义（P＜0.05）。联合组的治疗总有效率高于化疗组（P＜0.05）。治疗后2组患者原癌基因c-erbB2、c-myc、K-ras的表达量均低于治疗前，且联合组的表达量低于化疗组（P＜0.05）。治疗后2组患者抑癌基因P53、P16、PTEN的表达量均高于治疗前，且联合组患者抑癌基因的表达量高于化疗组（P＜0.05）。联合组治疗过程中不良反应发生率低于化疗组（P＜0.05）。结论：运用调强放疗联合化疗在子宫内膜癌患者术后进行干预，可以有效提高治疗效果，改善患者的生活质量及原癌基因、抑癌基因的表达情况，不良反应较少，值得临床推广应用。

关键词: 放射疗法, 调强适形, 抗肿瘤联合化疗方案, 子宫内膜肿瘤, 原癌基因, 基因, 肿瘤抑制

Abstract: Objective：To explore the effect of intensity modulated radiation therapy (IMRT) combined with chemotherapy on endometrial cancer and on the expression of oncogene in the patients. Methods: A total of 100 patients with endometrial cancer who were treated in the Tumor Hospital Affiliated to Zhengzhou University from January 2017 to January 2018 were randomly divided into chemotherapy group and combined group, 50 cases in each group. The chemotherapy group was treated with paclitaxel plus platinum (TC) chemotherapy regimen, and the combined group was treated with intensity modulated radiotherapy (IMRT) based on the chemotherapy group. The quality of life of the two groups was scored before and after treatment; the therapeutic effects of the two groups were compared, and the proto-oncogenes c-erbB2, c-myc, K-ras and tumor suppressor genes P53, P16 and PTEN were detected by real-time fluorescence quantitative RT-PCR. The incidence of adverse reactions in the two groups during treatment was counted. Results: There was no significant difference in the scores of life function between the two groups before treatment (P＞0.05); after treatment, the scores of life function of the two groups were higher than those before treatment, and those of the combined group was higher than those of the chemotherapy group, the difference was statistically significant (P＜0.05). The total effective rate of combined group was higher than that of chemotherapy group (P＜0.05). The expression levels of proto-oncogenes c-erbB2, c-myc and K-ras in the two groups after treatment were lower than those before treatment, and the expression levels in the combined group were lower than those in the chemotherapy group (P＜0.05). After treatment, the expression of tumor suppressor genes P53, P16 and PTEN in the two groups were higher than those before treatment, and the expression of tumor suppressor genes in the combined group was higher than that in the chemotherapy group (P＜0.05). The incidence of adverse reactions in combined group was lower than that in chemotherapy group (P＜0.05). Conclusions: IMRT combined with chemotherapy after endometrial cancer surgery can effectively improve the treatment effect, improve the quality of life of patients and the expression of proto-oncogene and anti-oncogene, with fewer adverse reactions, which is worthy of clinical application.

Key words: Radiotherapy, intensity-modulated, Antineoplastic combined chemotherapy protocols, Endometrial neoplasms, Proto-oncogenes, Genes, tumor suppressor

中图分类号:

张明川，王莉. 调强放疗联合化疗对子宫内膜癌患者疗效和癌基因表达的影响[J]. 国际妇产科学杂志, 2019, 46(5): 591-594.

ZHANG Ming-chuan, WANG Li. Effect of Intensity-Modulated Radiotherapy Combined with Chemotherapy on Oncogene in Patients with Endometrial Carcinoma[J]. Journal of International Obstetrics and Gynecology, 2019, 46(5): 591-594.

参考文献

[1]杨玉芳.子宫内膜癌的病理学研究进展[J].医学信息,2015,28(47):419-420. [2]杨玉敏,郑启忠.原癌基因c-myb与抑癌基因P27在子宫内膜癌中的表达及意义[J].国际免疫学杂志,2016,39(3):225-228. [3]公苓苓,郭杨,孙浩罡等.子宫内膜癌的治疗进展[J].中国妇幼保健,2015,30(11):1797-1799. [4]刘福安,于世英.癌症患者生活质量评估量表QLQ-52的设计及质量评价[J].临床肿瘤学杂志,2005,10(3):235-239. [5]王健,曹东,顾文静等.WHO标准与RECIST标准评价恶性肿瘤治疗效果的比较[J].中国基层医药,2013,20(5):652-654. [6] Zhang Q, Xu P, Lu Y,et al. Correlation of MACC1/c-Myc Expression in Endometrial Carcinoma with Clinical/Pathological Features or Prognosis. Med SciMonit. 2018 Jul 9;24:4738-4744. [7]徐玉云.TC化疗联合调强放疗治疗Ⅲ期子宫内膜癌术后的应用效果[J].中国实用医药,2017,12(33):52-53 [8]李国强,罗敬,郑志坚等.高危子宫内膜癌术后调强放疗联合TC化疗的疗效观察[J].中国医学创新,2017,14(14):21-24. [9] Ni J, Yin ZM, Yuan SH,et al. [A randomized study of intensity-modulated radiation therapy versus three dimensional conformal radiation therapy for pelvic radiation in patients of post-operative treatment with gynecologic malignant tumor]. Zhonghua Fu Chan Ke Za Zhi. 2017 Mar25;52(3):168-174. [10]张丽萍.子宫内膜癌淋巴结复发患者调强放疗同步化疗生存分析[J].中华全科医学,2016,14(11):1863-1866. [11]张佳.子宫内膜癌抑癌基因研究进展[J].国际妇产科学杂志,2011,38(5):428-431. [12]张雪.子宫内膜癌肿瘤相关基因的研究进展[J].山西医药杂志,2015,44(15):1767-1769. [13]冯文,房瑜,杨成喜等.ERCC1及C-erbB2在子宫内膜癌组织中的表达及其对中西医结合疗效的影响[J].山东大学学报（医学版）,2013,51(10):81-84. [14]莫秋荣,梁科庆,农勤高等.子宫内膜癌中c-Myc和cyclin E的表达及临床意义[J].临床肿瘤学杂志,2013,18(11):986-989. [15]赵春梅.RSAAF6、K-Ras在子宫内膜癌的表达及其临床意义的研究[D].河北医科大学,2014. [16]Xiong J, He M, Hansen K,et al. The clinical significance of K-ras mutation in endometrial "surface epithelial changes" and their associated endometrial adenocarcinoma. Gynecol Oncol. 2016 Jul;142(1):163-168. [17]丁堪铄,卢丽娜,余莉萍等.C-erbB-2、p53、Ki-67、ER、PR在子宫内膜癌中的表达及临床相关性[J].实用医学杂志,2015,31(24):4069-4071. [18]王冬,崔俊琪,马爱国等.P16、P63、PAX-2在子宫内膜癌中的作用及临床意义[J].中国生育健康杂志,2015,26(Z1):35-37. [19]曹晓智,王小捷,李凤山等.宫内膜细胞p16基因表达检测筛查子宫内膜癌的研究[J].中国计划生育和妇产科,2013,5(6):47-49. [20]张彤,沈丹华,陈云新等.PTEN、PAX-2和β-catenin在Ⅰ型子宫内膜癌及其癌前病变中的表达及意义[J].现代妇产科进展,2014,23(2):85-88.