| Background and purposeCervical cancer is one of the common malignant tumors in gynecology.With the widespread application of cervical exfoliative cytology screening and HPV detection,cervical cancer and its precancerous lesions can be found early,diagnosed and treated early,but some patients still have advanced metastasis or recurrence.At present,the main principles of cervical cancer treatment are surgery and radiotherapy.For locally advanced cervical cancer,In addition to the relative complications,there may still exist residual lesions in surgical treatment.Conventional radical radiotherapy and preoperative radiotherapy were effective for squamous cell carcinoma,but the survival rate of adenocarcinoma was not significantly improved,especially in the treatment of massive tumor(tumor diameter?4cm)and locally advanced cervical cancer.Neoadjuvant chemotherapy can reduce tumor volume,increase tumor resection rate,reduce postoperative complications and reduce local metastasis,so neoadjuvant chemotherapy is a good preoperative adjuvant therapy.At present,the efficacy of neoadjuvant chemotherapy is evaluated and monitored mainly by gynecological examination,ultrasound and imaging diagnosis,but few studies have been done to evaluate neoadjuvant chemotherapy by tumor markers in blood or tissue.Trapping receptor 3(decoy receptor3,DcR3)is a member of the tumor necrosis factor receptor(tumor necrosis factor receptor,TNF superfamily.It can competitively bind tumor necrosis factor(TNF),to block the ligand-mediated apoptosis pathway of tumor cells.Inhibition of cell apoptosis and reduction of immune surveillance and killing effects lead to the occurrence and development of tumor.Survivin is a kind of apoptosis suppressor gene,which is highly expressed in many kinds of tumor tissues.It can inhibit cell apoptosis and promote cell division,and accelerate the formation of tumor blood vessels.The aim of this study was to evaluate the clinical efficacy of paclitaxel combined with cisplatin chemotherapy in the treatment of iia2 cervical cancer.The expression of trapping receptor 3(DcR3),survival protein in serum and tissues of cervical cancer were detected,and the changes before and after chemotherapy were monitored.To evaluate the efficacy of neoadjuvant chemotherapy for cervical cancer by using tumor markers in blood or tissue.MethodsFrom February 2014 to January 2017,100 patients with IIA2 cervical cancer were randomly selected from gynecology and obstetrics department of Luoyang Central Hospital affiliated to Zhengzhou University.According to their histological types,they were divided into squamous cell carcinoma group(n = 70)and adenocarcinoma group(n = 30).Another 30 patients with benign uterine diseases(such as multiple uterine leiomyoma,adenomyosis,etc.)who were treated at the same time were selected as the control group.There was no difference in age and body mass index between squamous cell carcinoma group,adenocarcinoma group and control group.Patients with squamous cell carcinoma and adenocarcinoma were treated with intravenous chemotherapy for 2 courses.The expression of serum DcR3,Survivin was detected by elisa method before chemotherapy and 3 weeks after chemotherapy.The positive expression rate of DcR3,Survivin was detected by immunohistochemical method before chemotherapy and 3 weeks after chemotherapy.The expression of serum DcR3,Survivin in control group was detected by ELISA method,and the expression of DcR3,Survivin in postoperative tissues was detected by immunohistochemical method.Results1.The levels of DcR3 and Survivin in the patients with squamous cell carcinoma and adenocarcinoma were higher than those in the control group and decreased after chemotherapy.Before chemotherapy,there was no difference in serum DcR3 and Survivin levels between squamous cell carcinoma group and adenocarcinoma group(P>0.05).After two neoadjuvant chemotherapy for 3 weeks,the serum DcR3 and Survivin levels in patients with squamous cell carcinoma and adenocarcinoma were significantly lower than those before treatment(P<0.01).However,the levels of DcR3 and Survivin in squamous cell carcinoma group and adenocarcinoma group were still higher than those in control group [DcR3(35.78 ±5.23)pg/ml,Survivin(3.50 ±1.24)ng/ml].2.DcR3 was expressed in cytoplasm,survivin in nucleus,DcR3,Survivin expression in squamous cell carcinoma and adenocarcinoma was significantly higher than that in control group.DcR3 expression in squamous cell carcinoma group was(65.24 ±7.28)%,and that in squamous cell carcinoma group was(65.24 ±7.28)%.The expression of).Survivin in adenocarcinoma group(63.17 ±6.55)% was significantly higher than that in control tissue(9.25 ±3.98)%,the difference was statistically significant(P<0.01)in squamous cell carcinoma group(72.12 ±9.24)%.The positive expression rate in adenocarcinoma group(70.83 ±7.64)% was significantly higher than that in control group(6.45 ±2.61)%,(P<0.01).After chemotherapy,the expression of DcR3,survivin in cervical tissues of squamous cell carcinoma group and adenocarcinoma group was significantly decreased(P<0.01),but still significantly higher than that of control group.3.Neoadjuvant chemotherapy of TP regimen was effective for cervical cancer and the effective rate of squamous cell carcinoma was higher than that of adenocarcinoma.The total effective rate of short-term treatment was 77.14% in squamous cell carcinoma group and 56.67% in adenocarcinoma group.The total short-term effective rate in squamous cell carcinoma group was higher than that in adenocarcinoma group(P=0.04).4.Serum DcR3,Surivivin levels are positively correlated with tumor size and reflect tumor load in patients with cervical cancer.At 3 weeks after chemotherapy,the decrease rate of serum DcR3 was positively correlated with the rate of tumor reduction(r=0.43,P<0.01),and the decrease rate of serum Surivivin was positively correlated with the rate of tumor reduction(r=0.28,P=0.02).There was a positive correlation between the decrease rate of serum dcr3 and the rate of tumor reduction in adenocarcinoma group(r=0.43,P=0.02),and the decrease rate of serum Surivivin was positively correlated with the rate of tumor reduction(r=0.48,P=0.01).Conclusion1.Neoadjuvant chemotherapy of TP regimen has a good effect on locally advanced cervical cancer,and squamous cell carcinoma patients are more sensitive.2.Neoadjuvant chemotherapy with TP regimen can reduce the levels of DcR3 and Survivin in serum and cervical tissues.3.Serum DcR3,Surivivin levels are positively correlated with tumor size and reflect tumor load in patients with cervical cancer. |
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