血管内皮生长因子D的表达与乳腺癌淋巴管生成及淋巴结转移的相关性

Association of expression of vascular endothelial growth factor D,lymphangiogenesis and lymph node metastasis in human breast cancer

目的探讨乳腺癌患者不同区域淋巴管生成、淋巴管浸润特点以及与血管内皮生长因子D（VEGF-D）的表达关系，并结合腋淋巴结转移状态进行分析。方法选取乳腺癌根治术石蜡标本79例，分4个区域（肿瘤区、癌周区、近癌区、远癌区）取材。切片行免疫组织化学染色，采用D2—40对淋巴管进行标记，检测各区域淋巴管密度（LVD）、淋巴管浸润（LV1）及VEGF-D表达情况。结果癌周区LVD最高（20．25±2．03），肿瘤区VEGF—D和LVI阳性率最高，分别为87．34％和63．29％。肿瘤区VEGF-D表达与LVD之间、LVD与LVI之间、VEGF．D表达与LVI之间差异无统计学意义（P〉0．05），但在其他各区域它们之间差异有统计学意义（P〈0．05），且呈正相关。癌周区LVD与腋淋巴结转移状态有关（P〈0．05）；癌周区和近癌区的VEGF-D表达及LV1与腋淋巴结转移之间差异有统计学意义（P〈0．05），但在其他区域差异无统计学意义（P〉0．05）。结论VEGF—D可能促进乳腺癌淋巴管生成，增加淋巴管浸润机会。LVD的增高易致淋巴管浸润，促进腋淋巴结转移。癌周区和近癌区在乳腺癌淋巴道转移以及评估腋淋巴结转移状态的研究中可能更具有意义。

Objective To investigate lymphangiogenesis, lymphovascular invasion （LVI） and the expression of vascular endothelial growth factor D （VEGF-D） and their correlations in different regions of human breast cancer, and to evaluate their associations with axillary lymph node metastasis. Methods Tissue samples of primary tumors from 79 patients undergoing curative surgical resections for breast cancer were divided into four regions： tumor region, peritumoral region, nearer-tumor region and farther-tumor region. Samples from the different regious were immunohistochemically examined for D2-40 and VEGF-D to evaluate lymphatic vessel density （LVD）, LVI and VEGF-D expression in different regions. Results LVD in the peritumoral region was highest 20.25 ± 2.03, and the positive rates of VEGF-D expression and LVI in tumor region were also highest （87.34% and 63.29%, respectively）. In the tumor region, there was no significant correlation （P 〉 0.05） between LVD and VEGF-D expression, between LVD and LVI, and between VEGF-D expression and LVI; however, there were significantly positive linear correlations （ P 〈 0.05 ） in other regions. Axillary lymph node metastasis significantly correlated with LVD in the peritumoral region, and significantly correlated with VEGF-D expression and LVI in the peritumoral and nearer-tumor regions （P 〈 0.05 ）. Conclusion The expression of VEGF-D might promote lymphangiogenesis and increase the chance of lymphovascular invasion in human breast cancer. The increase of LVD easily promotes LVI and axillary lymph node metastasis. The peritumoral and nearer- tumor regions may play more important roles in the study of lymphangiogenesis, lymphatic spread of breast cancer and in the evaluation of axillary lymph node metastasis.