胸腺上皮源性肿瘤诱导微血管生成的预后意义

The prognostic value of thymic epithelial tumors inducing neoplastic angiogenesis

目的:通过观察胸腺上皮源性肿瘤微血管生成与部分临床病理参数的关系和对患者生存期的影响,探讨微血管密度(microvessel density,MVD)作为评估患者预后指标的临床意义。方法:用免疫组织化学Envision法检测单克隆抗体CD34在66例胸腺上皮源性肿瘤手术切除标本中的表达,对其中62例患者随访16～178个月并进行生存分析。结果:MVD在不同性别和年龄组中的差别均无显著性差异(P>0.05),肿瘤体积增大(≥11.0 cm)时MVD有增高趋势,但与对照组(<11.0 cm)比较差别无统计学意义(P>0.05)。MVD在各组织学类型之间存在显著性差异(P<0.05),各Masaoka临床分期之间的差异也有统计学意义(P<0.01)。患者是否合并重症肌无力不影响MVD值(P>0.05)。Kaplan-Meier生存曲线显示不同组织学类型之间生存率存在显著性差异(P<0.01),Masaoka临床各分期之间生存率也存在显著性差异(P<0.01),高MVD值组(≥37.0)5年和10年生存率显著低于低MVD值组(<37.0),差别有统计学意义(P<0.05)。结论:促微血管生成可能是胸腺上皮源性肿瘤侵袭生长和临床演进的重要事件,MVD可以作为判断胸腺上皮源性肿瘤患者预后的有价值指标,将MVD、WHO组织学分型、Masaoka临床分期结合起来更有利于评估患者的预后。

Objective： To assess the correlation between neoplastic microvessel density（MVD） and a series of pathological characteristics and study the prognostic value in postoperative patients of thymic epithelial tumors.Methods：MVD in 66 cases of thymic epithelial tumor was evaluated by the expression of monoclonal CD34 antibody.Survival analysis of 62 patients with 16~178 months follow-up was calculated using the Kaplan-Meier method and differences in survival were analyzed using the log rank test.Results：There were no significant correlation between MVD and some pathological characteristics including the patients＇ age（P 0.05） and gender（P 0.05）.Although bigger tumor（≥11.0 cm） developed higher MVD value,no significant difference was found compared with smaller tumor（11.0 cm）.MVD values were significantly different among subtypes of WHO histological classifications（P 0.05）and clinical stages of Masaoka＇s staging system（P 0.01）.No positive correlation was found between MVD value and the status whether the patients had paraneoplastic myasthenial gravis or not（P 0.05）.The survival curves showed that the increased MVD,WHO histological classifications and Masaoka＇s staging system were valuable prognostic predictors of thymic epithelial tumors.Conclusion：Tumor angiogenic activity might play an important role in capsular and widely neighbouring invasion of thymic epithelial tumors.MVD together with WHO histological classifications and Masaoka＇s staging system seem to be more helpful for clinical prognostic estimation.