자궁경부암에서 선행항암화학요법시 유세포분석에 의한 DNA 양상과 임상적 특성과의 관계 에 관한 연구 = Flowcytometric DAN Patterns of the Cervix Cancer patients Treated with Neoadjuvant Chemohterapy in Relation to Clinical Characteristics

다국어 초록 (Multilingual Abstract)

DNA analysis by flow cytometry(FACS) has been reported to be useful prognostic technique for cervix cancer. But study on the cervix cancer patients treated with neoadjuvant chemotherapy using flow cytometry has not been well known. The goal of this study was to examine DNA patterns by flow cytometry as a potential prognostic factor for a cervix cancer treated with cisplatin based neoadjuvant chemotherapy. At least two cycles of the neoadjuvant chemotherapy was done at stage Ib or IIa bullky tumors (tumor diameter >3cm), and stage IIb or III tumors, After then surgery including pelvic lymph-adenectomy was done at 27 patients who had complete or partial response on the chemotherapy. Flow cytometric analysis was performed on paraffin-embedded tissue before chemotherapy and after surgery for the ploidy and cell cycle distribution. The DNA ploidy of the cell, cell cycle distribution, FIGO stage, pelvic lymph node involvement, histologic type, age (40 years), tumor diameter(5cm), depth of the cervical invasion (1/2) after neoadjuvant chemotherapy were analysed in all patients . There were nine aneuploid tumors and eighteen diploid tumors before neoadjuvant chemotherapy on the flow cytometric analysis. The eight aneuploid tumor changed to diploid tumor after neoadjuvant chemotherapy, and the eithteen diploid tumor did not change their diploidy status. The S-phase fraction of the cells was higher in aneuploid tumor than diploid tumors, and decreased after neoadjuvnat chemotherapy. There was no pelvic lymph node metastasis at the aneuploid tumor (pre-chemotherapy), and the eight pelvic lymph-node metastasis occured at the diploid tumor(pre-chemotherapy). This may suggetst that the aneuploid tumor respond to chemotherapy more than the diploid tumor in terms of pelvic lymph-node metastasis. Multivariate analysis using the pre-chemotherapy S-phase fraction of the cells, histologic type, depth of the cervical invasion, FIGO stage pelvic lymph node involvement and tumor size (5cm) identify that the pre-chemotherapy S-phase fraction of the cells was the predictor of recurrence after two years follow up. In Conclusion, pre-chemotherapy DNA ploid sppears to be clinically useful predictor of pelvic lymph node involvement after neoadjuvant chemotherapy, and the pre-chemotherapy S-phase fraction of the cells appear to be clinically useful predictor of recurrence after two years follow up at cervical cancer patients treated with neoadjuvant chemotherapy and surgery. From the above results, it is considred that the aneuploid tumor may respond more to neoadjuvant chemotherapy than diploid tumor and have less pelvic lymph-node metastasis after neoadjuvant chemotherapy.