鼻咽癌组织中淋巴管与微血管表达的相关性

The relationship between expression of lymph vessels and micro vessels in nasopharyngeal carinoma

背景与目的:鼻咽癌以淋巴道转移多见,极小的原发灶伴巨大颈淋巴结转移在临床并不少见。本研究拟分析鼻咽癌早发区域淋巴结转移的相关因素,为进一步临床靶向治疗提供参考。方法:对140例初治鼻咽癌的组织标本,用免疫组化的方法及计算机辅助的图像分析系统定量分析瘤周及瘤内肿瘤组织中淋巴管(D2-40)状况及微血管(CD34)状况的关系,同时分析与颈淋巴结转移的关系。结果:140例标本淋巴管和微血管染色均阳性。瘤周的微血管和淋巴管腔及数量均大于瘤内(P<0.001)。在颈淋巴结转移组,淋巴管密度(lymph vessel density,LVD)、淋巴管面积(lymph vessel area,LVA)、微血管密度(micro-vessel density,MVD)和微血管面积(micro-vessel ar-ea,MVA)均明显高于无颈淋巴结转移者(瘤内瘤周LVD:P=0.049,和P=0.012;LVA:P=0.04和P=0.005;MVD:P=0.004和P=0.012,MVA:P=0.038和P=0.0056)。D2-40的表达与N分期密切相关,而与年龄、T分期及临床分期无关。CD34的表达与年龄、T分期及临床分期相关。CD34的表达与D2-40的表达呈正相关。结论:鼻咽癌组织中淋巴管是肿瘤颈淋巴结转移的重要预期因素。肿瘤组织中淋巴管和微血管的表达倾向呈一致性。阻断淋巴管增生的靶向治疗是否具有同抑制肿瘤内血管增生一样的临床意义值得进一步研究。

Background and purpose： Lymph node metastases is very common in nasopharyngeal carcinoma （ NPC）, a small primary lesion in the nasopharyngeal cavity with a huge neck metastatic mass is not rare clinically. The purpose of this study was to evaluate the factors relative to early local metastases in NPC and afford reference for target treatment. Methods： 140 NPC patients who were pathologically proved and treated in our hospital were included. Immunostaining for the lymphatic marker D2-40 and for the vascular endothelial marker CD34 were used in same NPC specimen. Computer- assisted morphometric analysis was used. The lymph vessels and blood vessels were quantified within the tumor and in the peritumoral area in all patients in the same specimen. Results： Both lymph vessels and blood vessels within the tumor were found more numerous and larger than in the peritumoral area （P 〈 0. 001 ）. Lymph vessel number （lymph vessel density, LVD）, lymph vessel area （micro-vessel area, MVA）, blood vessel number （ micro-vessel density, MVD） and blood vessel area （micro-vessel area, MVA） were significantly higher in the group with neck lymph node metastasis than in the group with no neck metastasis （intra- and peritnmoral LVD： P = 0.049 and P = 0.012, respectively; LVA： P = 0.04 and P= 0.005, respectively; MVD： P =0.004 and P =0.012, respectively; MVA： P =0.038 and P =0.0056, respectively）. A significant correlation was found between the expression of lymph vessels and N stage, no significant correlation was found between the lymph vessel parameters and age, gender, T stage and clinical stage. There was a significant correlation between the blood vessel parameters and age, T stage and clinical stage, no significant correlation was found between the blood vessel parameters and gender. If tumors had a high peritumoral and intratumoral LVD, LVA, a high MVD, MVA could also be observed. Conclusions： The results indicated that the quantity of both lymph vessels and blood vessels in intratumoral and peritumoral had a positive correlation with neck lymph node metastasis in NPC. The same expression trend of lymph vessel and blood vessel existed in NPC. It may suggest that the blockage of lymphangiogenesis has the same significance as the blockage of angiogenesis.