肝细胞癌螺旋CT征象与MVD及VEGF表达间关系的研究

Comparison of SCT Features With MVD and Expressions of VEGF in Hepatocellular Carcinoma

目的探讨肝细胞癌(HCC)的螺旋CT征象与瘤内微血管密度(MVD)及血管内皮生长因子(VEGF)表达之间的关系。资料与方法运用免疫组织化学SP法,检测45例经手术切除并病理证实的HCC瘤内MVD及VEGF的表达,所有病例术前均行CT平扫及增强扫描。结果CT征象与MVD、VEGF表达之间的关系:(1)瘤体边缘模糊组和清晰组的HCCMVD分别为50.3±16.2和38.7±13.4,VEGF阳性表达率分别为90.0%(19/21)和54.1%(13/24),组间MVD及VEGF阳性表达率均有显著性差异(P<0.01)。(2)瘤内有坏死不强化组和无坏死组的HCCMVD分别为65.3±17.6和38.2±13.0,VEGF阳性表达率分别为77.8%(7/9)和69.4%(25/36),组间MVD及VEGF阳性表达率均有显著性差异(P<0.01)。(3)有扩散转移组和无扩散转移组的HCCMVD分别为73.9±20.4和40.6±17.1,VEGF阳性表达率分别为100.0%(18/18)和51.8%(14/27),组间MVD及VEGF阳性表达率均有显著性差异(P<0.01)。(4)瘤体直径>5cm和直径≤5cm的HCCMVD分别为54.6±18.4和46.1±16.5,VEGF阳性表达率分别为75.0%(15/20)和68.0%(17/25),组间MVD及VEGF阳性表达率均无显著性差异(P>0.05)。(5)动脉供血型、双重供血型及少供血型HCC的MVD分别为70.6±22.9、65.7±21.6和25.1±13.5,VEGF阳性表达率分别为85.1%(23/27)、63.6%(7/11)和28.6%(2/7)。动脉供血型和双重供血型、双重供血型和少供血型之间VEGF阳性表达率差异均无显著性(P>0.05),动脉供血型或动脉供血型和双重供血型合并组与少供血型之间VEGF阳性表达率差异有显著性(P<0.05);动脉供血型和双重供血型的HCC,其MVD计数均高于少血供型,组间有显著性差异(P<0.01),动脉供血型与双重供血型MVD计数无显著性差异(P>0.1)。结论MVD及VEGF表达与HCC的边缘是否清晰、瘤内有无液化坏死、有无浸润转移及增强类型等CT征象密切相关,反映了新生血管是其生长、发展的形态学基础,在HCC的浸润转移中起重要作用。

Objective We analyse the correlation of SCT features with MVD and expressions of VEGF in order to evaluate the pathology basis of hepatocellular carcinoma（HCC）. Materials and Methods 45 cases of HCC proved by pathology were collected in our study. The MVD and expression of VEGF were examined by means of SP immunohistochemical technique. All patients were examined by plain and contrast enhanced CT scanning. Results （1）The MVD and VEGF positive rates in group of HCC with blurred margin were 50.3±16.2,90.0%（19/21）,and in those tumors with clear margin were 38.7±17.6,54.1%（13/24）. There was significant difference between two groups （P0.05）;（2）The MVD and VEGF positive rates were 65.3±17.6,77.8%（7/9） in group of tumor with central necrosis and 38.2±13.0,69.4%（25/36） in tumors without central necrosis,and the difference was statistically significant between two groups（P0.05）;（3）The MVD and VEGF positive rates were 73.9±20.4,100.0%（18） in tumors with high infiltration severity and 40.6±17.1,51.8%（14/27） in tumors without infiltration,and the difference was statistically significant（P0.05）;（4）The MVD and VEGF positive rates were 54.6±18.4,75.0%（15/20） in tumors with diameter larger than 5.0 cm and 46.1±16.5,68.0%（17/25） in those with diameter less than 5.0 cm,and there was no statistically significant correlation （P0.05）;（5）The MVD and VEGF positive rates were 70.6±22.9,85.1%（23/27） in tumors with blood supplied by hepatic arterial,65.7±21.6,63.6%（7/11） in those with blood supplied by both hepatic artery and portal vein,and 25.1±13.5,28.6%（2/7） in those with poor blood supplied. There was statistic difference of VEGF between arterial blood supplied and double blood supplied,and also statistic difference between double blood supplied and poorly blood supplied（P0.05）. In HCC with arterial and double blood supply,MVD expression level was higher than that with poor blood supplied （P0.01）. Conclusion The CT features of HCC,included border,central necrosis,metastasis and the enhancement patterns,are significantly related to MVD and expression of VEGF. It is indicated that the CT features play an important role in tumor growth and aggressiveness.