结直肠癌组织淋巴管分布特点与淋巴结转移及预后的关系

Detection of lymphatic microvessel distribution in colorectal carcinoma and its clinicopathological significance

目的探讨结直肠癌中淋巴管分布特点与结直肠癌转移和预后的关系。方法采用免疫组织化学方法,以D2-40为淋巴管特异性标志物,对102例结直肠癌及其相应癌旁组织、正常组织进行淋巴管染色,进行微淋巴管密度分析,并检测相应组织的VEGF-D,结合结直肠癌临床病理参数和预后进行分析。结果结直肠癌中心及浅表部位淋巴管多为闭锁的条索状,边缘区淋巴管多呈管样扩张状。结直肠癌边缘区淋巴管密度(21.6±5.6)较正常结直肠组织(5.4±2.8)和癌旁组织(6.7±3.4)显著增高(P<0.01)。结直肠癌边缘区微淋巴管密度与组织学分级、淋巴管受累、淋巴结转移及远处器官转移密切相关(P<0.01或<0.05)。结论结直肠癌组织中存在新生淋巴管,且主要分布于肿瘤边缘区,癌周围淋巴管密度增加与癌细胞转移相关,结直肠癌边缘区微淋巴管密度测定可能有助于评估其淋巴结转移和判断预后。VEGF-D阳性表达在DukesC、D期与A、B期之间差异存在显著性,表明VEGF-D在结直肠癌向浆膜层浸润或转移过程中表达升高。

Objective To investigate the relationship of the lymphatic microvessel distribution and density with lymphatic metastasis and prognosis of primary colorectal cancer（CRC） . Methods 102 patients with colorectal cancer were studied. Monoclonal antibody D2-40 was used immunohistochemically to detect the lymphatic microvessel density（ LMVD） of the primary colorectal cancer,peritumoral area of colorectal cancer and normal colorectal tissue,and analysis the relationship among the lymphatic microvessel density（LMVD） ,lymphatic invasion,lymph node metastasis and other clinicopathological parameters of the primary colorectal cancer. Results The shape of lymphatic microvessel in the intra-tumoral area and superfic lymphatic vessel were strip-like,while those in the peritumoral area were tubular distented. LMVD in the peri-tumoral area （ 21. 6 ± 5. 6） of colorectal cancer was significantly higher than that in near tumoral area（ 6. 7 ± 3. 4） and in nomal colorectal tissue（ 5. 4 ± 2. 8） （ P 0. 01） . LMVD in the peri-tumoral area of colorectal cancer was significantly associated with lymphatic invasion,lymph node metastasis and its clinical prognosis （ P 0. 05） . Conclusion Lymphangiogenesis occurred in human colorectal carcinomas. LMVD in the peri-tumoral area was significantly associated with lymphatic invasion and lymph node metastasis,and detection of LMVD in peri-tumoral area can be used for the prediction of lymph node metastasis and serves as a prognostic indicator for the progression of colorectal cancer. The expression of VEGF-D in CRC of Dukes C and D stages significantly different from that of Dukes A and B stages,indicating that VEGF-D increased during the serosal invasion and metastasis of CRC.