摘要
目的 了解化疗对肾母细胞瘤细胞凋亡和坏死的影响。方法 对 44例肾母细胞瘤进行随机分组 ,A组 2 6例 ,给予VAC术前化疗 ,其中 8例尚加用了介入化疗 ,B组 18例 ,Ⅰ期手术治疗。用TUNEL技术和常规病理检查观察了全部标本的凋亡和坏死情况 ,并分组进行了比较。结果 术前化疗后A组瘤体凋亡指数 (AI)较B组明显增加 ;A组中化疗时间超过两周的病例AI较不足两周病例也有明显上升 ;但死亡和获两年以上生存病例 ,介入和非介入化疗、病理诊断FH和UH病例之间AI的比较没有统计学上的差异 ;术前化疗后瘤体坏死的机率较Ⅰ期手术有明显的升高 ;加介入化疗后瘤体坏死的机率则有更明显的增加。结论 化疗可以对肾母细胞瘤细胞同时产生凋亡和坏死双重作用 ,介入化疗产生坏死较为明显 ,AI有可能对化疗疗效进行评价 ,但尚无法作为预后指标。
Objective The aim of study is to investigate the influence of chemotherapy on apoptosis and necrosis in Wilms' tumor. Methods From 1990 to 1998, 44 children with Wilms' tumor were randomized into two groups. Group A ( n =26) underwent preoperative chemotherapy with Dacinomycine, Vincrinstine and Cyclophosphamide. Eight of them had additional chemo-embolization with iodized oil and Adramycin via renal artery. Group B ( n =18) underwent nephrectomy followed by chemotherapy. Utilizing the technique of TUNEL and routine pathological methods, the status of apoptosis and necrosis were determined in all specimens. Results The Apoptotic Index (AI) of group A was significantly higher than that of group B ( P < 0.05 ). Within group-A patients, AIs of those who had more than 14 days of chemotherapy were higher than the AI of those less than 14 days. The AIs between those who died and those who survived for two or more years, between those who had additional chemo-embolization and those who did not, between those diagnosed as FH and as UH, were not statistically significant. The difference in rates of complete tumor necrosis were statistically significant between group A and group B patients ( P < 0.05 ). The difference between those who had additional chemo-embolization and those who had not was also statistically significant ( P < 0.05 ). Conclusions Chemotherapy can produce significant apoptosis and necrosis in Wilms' tumors. Preoperative chemotherapy and additional chemo-embolization can lead to more necrosis. AI of Wilms' tumor may not be as a prognostic factor but can be used as an indicator of the efficacy of chemotherapy.
出处
《中华小儿外科杂志》
CSCD
2000年第3期159-161,共3页
Chinese Journal of Pediatric Surgery
