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目的 采用末端脱氧核苷酸转移酶介导的脱氧核苷酸切口末端标记 (TUNEL)法检测鼻咽癌患者不同剂量照射前后肿瘤细胞凋亡的变化 ,并初步探讨其潜在的临床意义。方法 将接受根治性放射治疗的病理证实为鼻咽低分化鳞状细胞癌的 2 5例患者分为 5个组 ,每组 5例。 5个组分别在分割剂量 1.9Gy/次照射 1～ 5次后 3～ 6h活检取鼻咽肿瘤组织。采用TUNEL免疫组织化学法检测鼻咽癌组织放射治疗前、后肿瘤细胞凋亡。结果 放射治疗前、后凋亡指数均数分别为 0 .44(0 .10～ 1.15 ) ,0 .5 1(0 .0 5～ 1.40 ) (P >0 .0 5 )。照射 9.5Gy后的凋亡指数较放射治疗前明显增加(0 .98对 0 .44 ,P =0 .0 0 9)。凋亡指数 <0 .35和≥ 0 .35病例的无瘤生存率曲线差异无显著意义 (P >0 .0 5 )。影响无瘤生存率的单因素和多因素分析未显示出凋亡指数是独立的预后因素。结论 鼻咽癌常规分割照射 9.5Gy后肿瘤细胞凋亡指数较放射治疗前显著增加。放射治疗前肿瘤细胞自发性凋亡水平未显示出独立的预后价值。
Objective To detect the changes of tumor cell apoptosis in patients with nasopharyngeal carcinoma (NPC) before and after irradiation with different dosages of terminal deoxynucleotidyl transferase mediated deoxynucleotidyl transferase nick end labeling (TUNEL), and to explore its potential clinical significance. Methods Twenty-five patients with poorly differentiated squamous cell carcinoma of the nasopharynx confirmed by radical radiotherapy were divided into five groups (n = 5). The nasopharyngeal tissues were biopsied in 5 groups 3 ~ 6h after the dose of 1.9Gy / time was irradiated 1 ~ 5 times respectively. TUNEL immunohistochemistry was used to detect the apoptosis of tumor cells before and after radiotherapy of nasopharyngeal carcinoma. Results The average number of apoptotic index before and after radiotherapy was 0.44 (0.10 ~ 1.15) and 0.51 (0. 05 ~ 1.40) respectively (P> 0.05). The apoptotic index after 9.5 Gy irradiation was significantly higher than that before radiotherapy (0.98 vs 0.44, P = 0.090). There was no significant difference in the tumor-free survival rate between the apoptotic index <0.35 and ≥ 0.35 (P> 0.05). Univariate and multivariate analyzes that affected disease-free survival did not show that apoptosis index was an independent prognostic factor. Conclusion The apoptotic index of NPC after 9.5Gy routine radiotherapy is significantly higher than that before radiotherapy. The level of spontaneous apoptosis of tumor cells before radiotherapy did not show an independent prognostic value.