Express Of Survivin And Effect Of Apoptotic And Clinical Significance In Uterine Cervix Cancer After Pre-operational Intra-arterial Continuous-infusion Chemotherapy

Objective: The morbility of uterine cervix cancer is second only to breast cancer inmaliganant tumor of female. The therapy onⅠ～Ⅱa stage of uterine cervix cancer isprimary operation and assist radiotherapy;Ⅱb stage and aboveⅡb stage is primaryradiotherapy and assist chemotherapy; radiotherapy refer to all stage uterine cervix cancer.Accompaning the morbility of uterine cervix cancer tendenced to young and request ofbetter quality of life, preoperation radiotherapy is being replaced by preoperationneoadjuvant chemotherapy. Our study investigated the expression of survivin protein andcell apoptosis in uterine cervix cancer and prognosis factor, such as gross tumor volume,latero-uterine infiltrate,LNM in pelvic. We also contrastly evaluated effect of preoperationintra-arterial infusion chemotherapy on uterine cervix cancer.Methods: Sixty patients in uterine cervix cancer from January 2005 to March 2007 wereenrolled in the study, those patients were comfirmed with pathology and clinical stage forⅠb～Ⅱb, and were divided into three groups(20 cases every group): intra-arterial infusionchemotherapy (A group) and operation, radiotherapy (B group) and operation,systemic-chemotherapy combining with radiotherapy (C group) and operation. The therapyprotocol of A group: DDP80mg,E-ADM60mg and 5-FU1g(volume dose), intra-arterialinfusion-continue 30 minutes chemotherapy pass minipump according to angiographysuper-selectively arterial, respectively. The therapy protocol of B group: intracavitaryaferloading A spot irradiation and dose was 14～20Gy; external irradiation and dose was16Gy. The therapy protocol of C group: DDP80mg+5-FU1.0g systemic-chemotherapycombining with intracavitary aferloading A spot irradiation and dose was 14～20Gy.Operation therapy were maded in 10～14d post-treatment. Apoptotic cells of pretherapyand posttherapy were detected by TUNEL. Immunohistochemical stains and imageanalytical system were performed to examine the expression level and quantity of survivinof pretherapy and posttherapy. To evaluate effect of intra-arterial infusion chemotherapy through self comparsion and groups comparsion; groups comparative study in LNM, vesselinfiltration, interstitial tissue infiltration, latero-uterine infiltration and vagina infiltration inall groups. All the data were analysed by SPSS11.0 software.Quantitative data wereshowed by (?)±s, P＜0.05 was defined as threshold for statistical significance.Results: (1) The effective rate of macro-mass uterine cervix cancers (diameter＞4cm) were83.34％, 53.85％and 58.33％, respectively; The effective rate of all uterine cervix cancerswere 70.00％, 55.00％and 55.00％, respectively; there was significant difference inmacro-mass uterine cervix cancers(P＜0.01) and all uterine cervix cancers(P＜0.05)between group A and groupB,C. (2) The expression of survivin on three groups wereobviously decreased(group A P＜0.01, group B and C P＜0.05); the expression level andquantity of survivin of group A were lower than that of groupB and C (P＜0.05).(3) Thecell apoptotic index(AI) were obviously raised (group A P＜0.01, group B and C P＜0.05);AI of group A were higher than that of group B and C (P＜0.05). (4) There wassignificant difference in LNM, vessel infiltration, interstitial tissue infiltration,latero-uterine infiltration and vagina infiltration between group A and groupB,C (P＜0.05).(5) The proportion of young uterine cervix cancers were 25％(15/60) in our study.Conclusions: (1) The total effective rate of uterine cervix cancers were elevated in groupA, especially macro-mass uterine cervix cancers and tumor volume diminutive. (2) Theexpression level and quantity of survivin were obviously decreased and the AI wereobviously elevated in group A. (3) The expression level and quantity of survivin wereobviously decreased and the AI elevated on three groups. (4) the proportion of LNM,vessel infiltration, interstitial tissue infiltration, latero-uterine infiltration and vaginainfiltration were decreased in group A. The intra-arterial infusion chemotherapy increasedcompletely remission rate in clinical and pathological, elevated resection rate and 5 yearssurvival rate, and prolong life time.