肾母细胞瘤经动脉化疗栓塞术疗效机制探讨

目的： 探讨肾母细胞瘤术前经动脉化疗栓塞的疗效机制。方法: 17例肾母细胞瘤患儿介入治疗后再行肿瘤切除，另 22例行单纯手术切除。对照分析2组肾母细胞瘤样本中细胞和间质的变化，采用原位细胞凋亡(TUNEL 法) 检测瘤细胞凋亡，并通过免疫组化法检测瘤细胞P53、Bcl-2 和Bax蛋白的表达。术后随访2年以上。结果: 介入组与单纯手术组的肿瘤坏死区域平均面积分别为60%、15 %（Uc = 2.84）；肿瘤组织呈X₃、X₄退变者分别为58.8%（10/17）和4.55%（1/22）（2c= 11.4）、间质纤维组织增生程度中、重度变化者分别为64.7%（11/17）和18.2%（4/22）（Uc = 2.72）、淋巴细胞侵润者分别为70.6%（12/17）和18.2%（4/22）（2c=10.9），2组有显著差异（P<0.01）；介入组肿瘤细胞分裂指数的中位数为0.2/10高倍视野，明显低于单纯手术组的1.4/10高倍视野（Uc = 54.50 ，P<0.01）；94.9(37/39)的病例中均有不同数量的阳性凋亡细胞出现。介入组肿瘤细胞凋亡指数的中位数为25.9/10高倍视野，明显高于单纯手术组的12.8/10高倍视野（Uc = 117.00，P<0.05）。P53和Bcl-2蛋白表达与瘤细胞凋亡及分化程度均无相关性（P>0.05），但Bax 蛋白在介入组瘤细胞表达率（80.0%）明显高于单纯手术组（40.0%），差异显著（P<0.05）。介入组2年无瘤生存率为73.3%（11/15），单纯手术组为42.9%（6/14）。结论: 经动脉化疗栓塞治疗能够有效杀伤肿瘤细胞、抑制肿瘤生长，诱导由Bax蛋白介导的肿瘤细胞凋亡。

Effect of preoperative transarterial chemoembolization on nephroblastoma

AIM: To explore the effect and mechanism of preoperative transarterial chemoembolization on nephroblastoma.METHODS: Comparative analysis of clinical and pathological features in 39 children with Wilms’ tumor was conducted.TUNEL assay was used to detect the apoptosis of tumor in two groups with or without preoperative interventional treatment.The expressions of P53,Bcl-2 and Bax proteins were detected by immunochemical methods.The patients were followed-up for more than 2 years.RESULTS: The extent of neoplastic cell necrosis and degeneration,interstital fiber tissue hyperplasia of tumor and the number of infiltrating lymphocytes were observed,which were higher in interventional group than those in simple excision group (P<0.01).The median of mitotic index in tumor cells was 0.2 in interventional group,and 1.4 in simple excision group.The median of apoptotic index (AI) of the tumor cells was 25.9 in study group and 12.8 in control group (Uc=54.50,P<0.01),(Uc=117.00,P<0.05).The comparison between the means obtained in two groups revealed statistical difference (P<0.05).The expressions of P53 and Bcl-2 proteins were not correlated with apoptotic index,but the rate of expression of Bax protein (80.0%) in interventional group was higher than that (40.0%) in simple excision group.The two year event-free rate was 73.3％ (11/15) in study group and 42.9％ (6/14) in control group.CONCLUSION: Transarterial chemoembolization on nephroblastoma is effectively used to kill and inhibit tumor cell growth,as well as induce tumor cell apoptosis by Bax protein.