胃癌淋巴管的形态计量学研究

Morphological Quantitative Analysis of Lymph Vessel in Gastric Carcinoma

目的研究胃癌淋巴管的形态学特征及其与淋巴结转移的关系。方法采用D2-40免疫组化染色检测70例胃癌中心区、癌旁区、正常区内的淋巴管,分析淋巴管的形态学特征与淋巴结转移的关系。结果胃癌癌旁区淋巴管密度(41.32±15.62)个、总面积(33139.08±19352.37)μm2、平均面积(802.12±728.09)μm2、平均周径(132.35±65.76)μm;正常区淋巴管密度(30.06±11.86)个、总面积(45424.65±33824.64)μm2、平均面积(1511.28±1301.21)μm2、平均周径(196.19±103.72)μm,差异均有统计学意义(P分别为0.000、0.009、0.000、0.000)。淋巴结转移组胃癌癌旁区淋巴管密度(43.67±16.42)个、总面积(35866.71±19678.53)μm2、总周径(5851.28±1897.13)μm、平均面积(1050.31±765.47)μm2、平均周径(161.90±77.13)μm,无淋巴结转移组胃癌癌旁区的密度(33.38±9.02)个、总面积(23933.34±15405.2)μm2、总周径(4173.56±2028.18)μm、平均面积(723.76±534.75)μm2、平均周径(123.01±60.88)μm,差异均有统计学意义(P分别为0.019、0.029、0.003、0.000、0.000);以胃癌癌旁区淋巴管侵犯预测淋巴结转移与病理检查的检出率差异无统计学意义(P=0.125),且吻合度强(κ=0.822>0.7,P=0.000)。结论胃癌淋巴管新生存在于癌旁区,新生淋巴管管腔小;胃癌细胞可能是通过破坏癌旁区淋巴管进入淋巴循环而形成淋巴结转移;癌旁区淋巴管侵犯及淋巴管密度与淋巴结转移有关,有望成为预测淋巴结转移及决定手术方式的重要因子。

Objective To study the characteristics of lymph vessel in gastric cancer and its relationship with lymph node metastasis （LM）. Methods Lymph vessel in normal, peripheral, central region of 70 primary human gastric cancer were investigated by IHC staining for D2 411. The relation between lymph vessel density （LVD）, lymph vessel mean area （LVMA）, lymph vessel mean diameter （LVMD）, lymph vessel invasion（LVI） and LM were analysed. Results Compared with the normal region of gastric cancer, the LVD of peripheral region of gastric cancer is significantly high （41.32 ± 15. 62 vs 30. 06 ± 11.86, P = 0. 000 ） ,and there was a significant decrease in LVMA （8112. 12 ± 728.09μm^2 vs 1511. 28± 1301.21 μm^2 , P = 0. 000） and LVMD （ 132.35 ± 65. 76μm vs 196. 19 ± 1113. 72μm, P = 0. 1100）. The LVD （43. 67 ± 16. 42 ws 33. 38± 9. 02,P = 0. 019）, total area （35866. 71 ± 19678. 53μm^2 vs 23933. 34 ± 15405.2μm^2 , P= 0. 029 ）, total perimeter （5851.28± 1897. 13μm vs 4173. 56 ± 21128. 18μm,P = 1）. I）113）, mean area （1050. 31 ± 765.47 μm2 vs 723.76 ± 534. 75 μm^2 , P = 0. 000）, mean perimeter （ 161.90± 77.13μm vs 123. 01± 60. 88 μm,P = 0. 000） of lymphatics in peripheral region of gastric cancer with LM was significantly increased than that of gastric cancer without LM. The prediction of LM for gastric cancer by LVI is in common with routine pathology （P = 0. 125, k = 0. 822〉0. 7, P = 0. 000）. Conclusion Lymphangiogenesis exists in peripheral region of gastric cancer, and the lumina of newly formed lymphatics are much small, therefore the lymphocinesia of that region is inadequate. Malignent cells may penetrate the lymphatics and get into lymphocinesia via destroyed parts of endothelium in peripheral region of gastric carcinorna. Increased LVD and LVI were significantly associated with LM, and may play an important role in detecting LM in gastric cancer and the decision making process for additional surgery.