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KMID : 0350519930460020599
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Journal of Catholic Medical College
1993 Volume.46 No. 2 p.599 ~ p.614
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Multivariate Analysis of the Response to Induction Chemotherapy in Carcinoma of the Uterine Cervix-Histologic Scoring System, Flow Cytometry and Immunohistochemical Stain
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Abstract
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Iuduction chemotherapy before definitive surgery or radiotherapy may be effective in reducing tumor volume or clinical stage, enhance regionl control of disease and survival in patients with advanced uterine cervical cancer. However, there are
potential
disadvantages to the use of induction chemotherapy in resistant cases, which may delay the local treatment, produce drug resistant cell lines and increase toxicity of local treatment. So, liduction chemotherapy needs a precise evaluation of
clinical and
cytokinetic observations. Based on the understanding of various characteristics of tumor cells, the search for biologic fators that may predict for the response to chemotherapy or survival must continue, and cytokinetic studies of tumor biopsies
obtained before and after induction chemotherapy may provide useful prognostic factors.
In this study, histopathologic scoring, flow cytometric DNA analysis and immunohistochemical staining features of cancer cells were investigated in biopsy specimens obtained before and 7 days after induction chemotherapy in 22 patients with
cervical
cancer. In immunohistochemical stains, the expression of c-myc cncogene and prohferation cell nuclear antigen(PCNA) were also examined. The tumor size was measured before and 1 month after first chemotherapy. And the relationships between
reduction
of
tumor size and various parameters were evaluated.
@ES The results were as follows ;
@EN 1. There weere significant decrease of tumor mass, DNA, index(DI), PCNA(+) cells and histologic score after chemotherapy, but decrease of S-fraction was not significant(P=0.096).
2. After chemotherapy score of amount of cancer cells(ACC), preservation of cancer cells(PCC) and number of mitosis (M) were significantly decreased, and te score of cancer cell necrosis(N) was significantly increased. The relationships between
reduced
tumor mass and histologic parameters were significant in increase of N score (P=0.038) and decrease of total histologic score (P=0.04).
3. In aneuploid tumors (n=12) , 7 cases were changed to diploid tumor in flow cytometric analysis after chemotherapy. More significant reduction of tumor mass (P=0.002) and decrease of PCNA(+) cells (P=0.011) were noticed in group changed to
diploid
tumor after chemotherapy.
4. Growth fraction assessed by PCNA was significantly correlated with S-fraction in flow cytometric analysis (P<0.001, r=0.767), and the decrease of PCNA(+) cells was shown strong positive correlation with reduction of tumor mass(P<0.001,
r=0.703).
5. c-myc gene ovrexpression was not related with DI, S-fraction and reduction of tumor mass, but high percent of PCNA( + ) cells was noticed in c-myc( + ) group (P<0.05).
In conclusion, this study showed that various histologic and cytokinetic parameters of tumor biopsies obtained before and 7 days after induction chemotherapy offered prognostic indicators that might be useful for treatment decision.
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KEYWORD
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