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直肠癌是我国消化道常见的癌症之一,30年来,直肠癌发病率年均上升3% ~4%[1-2]。因为其解剖位置深入盆腔,与周围组织关系复杂,所以手术难度高,肿瘤切除不易彻底,导致术后复发率及转移率都高。直肠癌的发生及发展是多因素相互协同作用的结果,过程中受到多种相关基因的调控[3-4]。而血管生成拟态(vasculogenic mimicry,VM)是各种肿瘤细胞依赖自身可塑性而形成的独立于内皮血管的供血系统。目前已有大量应用免疫组织化学(免疫组化)方法研究血管生成拟态在相关肿瘤中作用的文献,研究技术已经相当成熟。本研究通过相关免疫组化技术研究VM的存在与直肠腺癌病人相关临床病理指标之间的联系。现作报道。
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176例直肠腺癌中有35例VM表达为阳性,阳性率19.89%,典型结构见图 1。
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不同性别、年龄组及肿瘤的长径间VM的形成差异均无统计学意义(P>0.05);而在低分化组、伴有血管、神经侵犯组、伴有淋巴结转移组的VM阳性率显著较高(P<0.01) (见表 1)。
变量 n VM χ2 P + - 肿瘤长径/cm ≤5 143 25 118 2.77 >0.05 >5 33 10 23 年龄/岁 ≤60 81 17 64 0.11 >0.05 >60 95 18 77 性别 男 123 21 102 2.03 >0.05 女 53 14 39 分化程度 高分化 45 5 40 22.28 <0.01 中分化 89 11 78 低分化 42 19 23 血管、神经侵犯 无 121 16 105 10.79 <0.01 有 55 19 36 淋巴结转移 无 126 11 115 34.65 <0.01 有 50 24 26 表 1 直肠腺癌临床病理参数与VM的关系
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以总生存率为因变量(死亡=0,生存=1),以VM、淋巴结转移及血管、神经侵犯为自变量进行logistic回归分析,结果显示,VM的阳性率越高,病人的生存时间越短(P<0.01);有淋巴结转移的病人比无淋巴结转移的病人生存时间短(P<0.01);有血管、神经侵犯的病人比无血管、神经侵犯的病人生存时间短(P<0.05)(见表 2)。
变量 B SE Wald χ2 P OR(95%CI) VM 0.93 0.31 11.24 < 0.01 1.16~2.37 淋巴结转移 0.87 0.26 12.43 < 0.01 1.27~3.51 血管神经侵犯 0.53 0.40 5.79 < 0.05 1.24~3.71 表 2 176例直肠腺癌病人的多因素分析
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本组病例总的5年生存率为27.84%(49/176)。Log-rank分析结果显示VM阳性表达组与阴性表达组的平均生存时间分别为(11.3±7.7)月和(41.9±14.6)月,2组差异有统计学意义(t′=17.09,P<0.01)。
血管生成拟态在直肠腺癌中的临床病理意义
Clinical pathological significance of vasculogenic mimicry in rectal adenocarcinoma
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摘要:
目的通过搜集相关资料研究直肠腺癌中血管生成拟态(VM)是否存在及其相关临床病理意义。 方法收集176例直肠腺癌相关临床病理资料,利用免疫组织化学EliVisionTM plus的方法,观察其中是否存在VM,将其分成阳性和阴性2组,分析VM的存在是否与相关临床病理指标之间有关。 结果176例组织标本中35例VM为阳性,阳性率为19.89%,不同性别、年龄组及肿瘤的长径间VM的形成差异均无统计学意义(P>0.05);而在低分化组、伴有血管、神经侵犯组、伴有淋巴结转移组的VM阳性率显著较高(P<0.01)。多因素回归分析表明VM的阳性表达率越高,病人的生存时间越短(P<0.01);有淋巴结转移的病人比无淋巴结转移的病人生存时间短(P<0.01);有血管、神经侵犯的病人比无血管、神经侵犯的病人生存时间短(P<0.05)。 结论VM存在于直肠腺癌中,且VM的形成对直肠腺癌的发生、发展及其预后都具有重要的意义。 Abstract:Objective To study the presence or absence of vasculogenic mimicry(VM) in rectal adenocarcinoma by some relevant data, and explore its clinical and pathological significance. MethodsThe clinicopathological data of 176 patients with rectal adenocarcinoma were collected.The VM was detected using immunohistochemical EliVisionTM plus method, and the cases were divided into the positive and negative groups.The relationship between VM and clinicopathological parameters was analyzed. Results Among 176 tissue samples, the positive expression of VM in 35 cases was identified, and the positive rate of which was 19.89%.The differences of the formation of VM among different gender, age and length of tumor were not statistically significant(P>0.05).The positive rates of VM in poor differentiation group, vascular and nerve invasion group and lymph node metastasis group significantly increased(P < 0.01).The Results of multivariate regression analysis showed that the survival time of patients became short with the increasing of the positive rate of VM(P < 0.01), the survival time of patients with lymph node metastasis was shorter than that in patients without lymph node metastasis(P < 0.01), and the survival time of patients with vascular and nerve invasion was shorter than that in patients without vascular and nerve invasion(P < 0.05). Conclusions VM is present in rectal adenocarcinoma, and the formation of VM is of great significance to the occurrence, development and prognosis of rectal adenocarcinoma. -
Key words:
- rectal adenocarcinoma /
- vasculogenic mimicry /
- clinical pathology /
- immunohistochemistry
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表 1 直肠腺癌临床病理参数与VM的关系
变量 n VM χ2 P + - 肿瘤长径/cm ≤5 143 25 118 2.77 >0.05 >5 33 10 23 年龄/岁 ≤60 81 17 64 0.11 >0.05 >60 95 18 77 性别 男 123 21 102 2.03 >0.05 女 53 14 39 分化程度 高分化 45 5 40 22.28 <0.01 中分化 89 11 78 低分化 42 19 23 血管、神经侵犯 无 121 16 105 10.79 <0.01 有 55 19 36 淋巴结转移 无 126 11 115 34.65 <0.01 有 50 24 26 表 2 176例直肠腺癌病人的多因素分析
变量 B SE Wald χ2 P OR(95%CI) VM 0.93 0.31 11.24 < 0.01 1.16~2.37 淋巴结转移 0.87 0.26 12.43 < 0.01 1.27~3.51 血管神经侵犯 0.53 0.40 5.79 < 0.05 1.24~3.71 -
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