早期宫颈鳞癌患者微淋巴管的分布及其临床意义

Tumor lymphangiogenesis in cervical squamous cell carcinoma and its clinical significance

目的探讨早期宫颈鳞癌微淋巴管形成的临床意义。方法对35例Ⅰb、Ⅱa期的宫颈鳞癌患者的癌组织存档蜡块切片,用Podoplanin单抗免疫染色微淋巴管,图像分析系统定量分析癌内、癌周的淋巴管,并结合临床病理资料分析。结果(1)形态学观察示癌周淋巴管较癌内淋巴管粗大、密集。有淋巴结转移者,癌内淋巴管可见癌细胞。(2)宫颈鳞癌癌周淋巴管密度(LVD)为(31±10)条/mm2,癌内淋巴管密度为(20±10)条/mm2(P<0.01);癌周相对淋巴管面积(LVA)为(0.75±0.40)%,癌内LVA为(0.19±0.11)%(P<0.01)。(3)有盆腔淋巴结转移者的癌内及癌周的LVD、LVA分别为(29±7)条/mm2,(40±5)条/mm2,(0.27±0.10)%,(1.23±0.36)%,无淋巴结转移者为(16±8)条/mm2,(28±9)条/mm2,(0.16±0.09)%,(0.56±0.20)%,(P<0.01,0.01,<0.05及P<0.01)。(4)组织学分级Ⅰ、Ⅱ、Ⅲ级者的癌周LVA及癌内LVD、LVA分别为(0.42±0.10)%,(9±3)条/mm2,(0.06±0.04)%;(0.77±0.37)%,(21±8)条/mm2,(0.21±0.09)%;(0.83±0.46)%,(22±11)条/mm2,(0.21±0.12)%。Ⅱ、Ⅲ级与Ⅰ级比较的P均<0.05,而Ⅱ、Ⅲ者间比较的P>0.05。结论早期宫颈鳞癌高淋巴管分布与淋巴结转移有关。

Objective To investigate the clinical significance of lymphangiogenesis in cervical cancer.Methods Monoclonal podoplanin was used to immunostain the lymphatic microvessels in the paraffin sections of cervical squamous cancer tissues at the Ⅰ_b and Ⅱ_a stages from 35 cases kept in the archives. Computer-assisted morphometric analysis was used to quantitatively analyze the lymphatic vessels in intratumor and peritumor areas. The association with clinicopathologic data was analyzed.Results (1) The lymphatic microvessels were larger and denser in the peritumor areas than the intratumor areas. Cancer cells were found in the intratumoral lymphatic vessels of the lymph metastatic patients.(2) The lymphatic vessel density(LVD) of the peritumor areas was (31±10) vessels/mm^2, significantly greater than that in the intratumor areas [ (20±10)vessels/ mm^2, P<0.01]. The relative lymphatic vessel area(LVA) in the peritumor areas was (0.75±0.40)%,significantly larger than that of the intratumor areas [( 0.19±0.11)%, P<0.01].(3) The intra- and peri-tumoural LVD and LVA in the patients with lymph node metastasis were (29±7) vessels/ mm^2 and (40±5)vessels/mm^2 , and 0.27%±0.10% and 1.23%±0.36% respectively, all greater than those of the patients without lymph node metastasis [(16±8)vessels/ mm^2 and (28±9) vessels/ mm^2, and (0.16±0.09)%,(0.56±0.20)% respectively, P<0.01, <0.01, <0.05, and <0.01].(4) The peri-tumoral LVA and intra-tumoral LVD and LVA in the patients with histological grade Ⅰ, Ⅱ, and Ⅲ were (0.42±0.10)%,(9±3)vessels/mm^2,and( 0.06±0.04)%;( 0.77±0.37)%,(21±8) vessels/ mm^2,and (0.21±0.09)%; and (0.83±0.46)%,(22±11) vessels/ mm^2, and (0.21±0.12)% respectively. There were significant differences among the values of the grade Ⅱ patients and grade Ⅰ patients (all P<0.05) and the grade Ⅲ patients and grade Ⅰ patients (all P<0.05) and there were not significant differences between the values of the grade Ⅱ patients and the grade Ⅲ patients (all P>0.05), Ⅲ and grade Ⅰ,no statistic significances between grade Ⅱ and Ⅲ.Conclusion Higher lymphangiogenesis in early cervical squamous cell cancer may be associated with the risk of lymph node metastasis.