胰腺癌的CT影像表现与临床病理因素及血管生成的关系

The Multislice CT Findings in Pancreatic Ductal Carcinoma:A Correlative Study with Clinicopathologic Parameters and Angiogenesis

目的研究胰腺癌多层螺旋CT(MSCT)影像表现与临床病理因素及肿瘤血管生成的关系。资料与方法搜集36例经手术病理证实为胰腺导管细胞癌患者的癌肿组织石蜡切片进行特殊免疫组织化学染色。36例患者术前均行MSCT多期动态增强扫描。采用Loyer的CT诊断标准,对受侵胰周血管进行CT分级,并以横断面图像结合多平面重组(MPR)图像,评价肿瘤对周围组织器官的侵犯情况。评价CT像上胰腺癌血管侵犯、胰周侵犯与肿瘤部位、淋巴转移、肝脏转移、UICC分期、病理分级、微血管密度(MVD)、血管内皮生成因子(VEGF)、VEGF-C、金属蛋白酶(MMP)MMP-2、MMP-9的关系。结果对于胰周血管侵犯,统计结果示UICC分期(P<0.001),病理分级(P=0.02),MVD(P<0.023),VEGF(P=0.01),VEGF-C(P=0.016),MMP-2(P=0.041)有统计学意义。对于胰外侵犯,统计学结果示淋巴转移(P=0.031),肝脏转移(P=0.025),UICC分期(P<0.001),MVD(P<0.001),VEGF(P=0.02),MMP-2(P=0.01),MMP-9(P=0.003)有统计学意义。进一步非参数统计显示胰外侵犯,血管侵犯与未侵犯组的平均UICC分期差异均有统计学意义(P<0.001),但对于平均病理分级,则差异均无统计学意义(P=0.275,P=1.00)。结论CT影像上胰外侵犯、血管侵犯的表现与肿瘤UICC分期、血管生成关系密切,与肿瘤病理分级无直接联系。血管侵犯和淋巴转移、肝转移并没有明显的相关性,但胰外侵犯和转移密切相关。

Objective To study the correlation of muhislice spiral CT findings, clinicopathologic parameters and angiogenesis. Materials and Methods 36 patients with pancreatic carcinoma proved by pathological results were performed CT manning before resection. Paraffin embedded specimens from these patients were immunostained for microvascular density （MVD）, vascular endothelial growth factor （VEGF）, VEGF C, Matrix metalloproteinases （MMP 2, MMP9）. The correlations among the CT findings and clinicopathologic features, the expression of individual angiogenic factors and MVD were analyzed statistically. Results The CT findings of peripancreatic vascular invasion correlated with UICC staging （ P 〈 0. 001 ）, pathological grade （ P = 0.02）, MVD （ P 〈 0.023）, VEGF （ P = 0.01 ）, VEGF C （ P = 0. 016）, MMP 2 （ P = 0.041 ） . The CT findings of peripancreatic tissue invasion correlated with lymphatic metastasis （ P = 0. 031 ）, hepatic metastasis （ P = 0. 025 ）, UICC staging （ P 〈 0. 001 ）, MVD （P〈0.001）, VEGF（P=0.02）, MMP2（P=0.01）, MMP9（P=0.003）. Conclusion The CT findings ofperipancreatic vascular and local invasion correlate with UICC staging and angiogenesis significantly, but not correlate with pathological grade. There are obvious correlation between tumor local invasion and lymphoid or liver metastasis, but not correlate between vascular invasion and lymphoid or liver metastasis.