Anemia in cervical cancers: Impact on survival, patterns of relapse, and association with hypoxia and angiogenesis
Anemia in cervical cancers: Impact on survival, patterns of relapse, and association with hypoxia and angiogenesis
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DOI：
10.1016/s0360-3016(03)00123-8
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发表时间：
2003-07-01
影响因子：
7
通讯作者：
Haensgen, G
中科院分区：
文献类型：
--
作者：
Dunst, J;Kuhnt, T;Haensgen, G
目的：贫血对宫颈癌预后的影响已得到公认。我们研究了贫血对宫颈癌预后和复发模式的影响。此外，我们分析了贫血，肿瘤缺氧，血管生成之间的关系。方法和材料：87例（平均年龄58岁）与宫颈鳞状细胞癌（IIB期：n = 19; IIIB期：n = 59; IVA期：n = 9）前瞻性地参加了1995年至1999年的研究。患者接受了明确的放射治疗，联合外照射放射治疗（45-50.4戈伊）和高剂量率近距离放射治疗（5 X 7戈伊）。在放疗前和19.8戈伊后用Eppendorf pO（2）-组织图测量肿瘤氧合。通过测量46例患者治疗前活检组织中的微血管密度来确定血管生成。肿瘤氧合的影响（0戈伊和19.8戈伊），血红蛋白（hb）水平（在0戈伊和19.8戈伊），血管生成和临床参数对生存和复发的影响进行了研究。3年总生存率（中位随访42个月后），整个患者组为57%，IIB期为72%，IIIB期为60%，IVA期为22%。治疗前贫血的存在对复发率有显著影响。然而，治疗中期hb水平（19.8戈伊）对局部失败率和生存率的影响最大：在19.8戈伊时，20例hb > 13 g/dL的患者的3年局部失败率为6%，47例hb在11和13 g/dL之间的患者的3年局部失败率为15%，20例hb> 13 g/dL的患者的3年局部失败率为67
Purpose: The prognostic impact of anemia in cervical cancers is well established. We have investigated the impact of anemia on prognosis and patterns of relapse in cervical cancers. Furthermore, we analyzed the relationship between anemia, tumor hypoxia, and angiogenesis.Methods and Materials: Eighty-seven patients (mean age 58 years) with squamous cell cancer of the cervix (Stage IIB: n = 19; Stage IIIB: n = 59; Stage IVA: n = 9) were prospectively enrolled in the study from 1995 through 1999. Patients underwent definitive radiotherapy with a combination of external beam radiotherapy (45-50.4 Gy) and high-dose-rate brachytherapy (5 X 7 Gy). Tumor oxygenation was measured with the Eppendorf pO(2)-histograph before radiotherapy and after 19.8 Gy. Angiogenesis was determined by measuring the microvessel density in pretreatment biopsies in 46 patients. The impact of tumor oxygenation (at 0 Gy and 19.8 Gy), hemoglobin (hb) level (at 0 Gy and 19.8 Gy), angiogenesis and clinical parameters on survival and relapse was investigated.Results: The 3-year overall survival rate (after a median follow-up of 42 months) was 57% for the whole group of patients, 72% for Stage IIB, 60% for Stage IIIB, and 22% for Stage IVA. The presence of pretreatment anemia had a significant impact on the relapse rate. However, the midtherapy hb level (at 19.8 Gy) had the strongest impact on local failure rate and survival: 3-year local failure rate was 6% in 20 patients with a hb > 13 g/dL at 19.8 Gy, 15% in 47 patients with an hb between 11 and 13 g/dL, and 67% in 20 patients with an hb