小儿肾母细胞瘤组织中VEGF—C的表达对微血管和淋巴管生成的影响及预后意义

The relationship between vascular endothelial growth factor-C and microvessel and lymphatic vessel devel- opment of nephroblastoma

目的探讨小儿肾母细胞瘤组织中VEGF-C的表达对微血管、淋巴管生成的影响及其预后意义。方法采用免疫组织化学PV9000法检测46例小儿肾母细胞瘤组织、19例瘤旁组织及8例正常肾组织中VEGF-C、CD34和LYVE-1的表达，并进行微血管密度（MVD）和淋巴管密度（LVD）计数。采用单因素分析VEGF-C、MVD和LVD与小儿,肾母细胞瘤临床病理特征的关系；采用Kap—lan-Meier法和Log-rank检验评价VEGF-C、MVD和LVD与患者预后的关系，并用Cox比例风险模型进行多因素分析。结果在正常。肾组织、瘤旁组织和肾母细胞瘤三种组织中，VEGF-C蛋白高表达率（12．50％、68．42％和73．91％）、MVD（8．25±2．82、13．32±3．94和16．98±3．74）和LVD（2．75±1．58、5．26±2．26和4．72±1．88）三者的表达差异均有统计学意义（P〈0．05）；VEGF-C高表达、MVD和LVD与肿瘤临床分期、血管浸润、淋巴结转移有关（P〈0．05），MVD还与肿瘤的大小有关（P=0．029）；VEGF-C表达、LVD和MVD三者间相互均有正相关关系（P〈0．05）；Cox多因素分析显示，血管浸润、MVD和LVD是影响患儿生存的独立危险因素，化疗程数是影响患儿生存的独立保护因素。结论VEGF-C高表达促进肾母细胞瘤微血管和淋巴管的生成，并可促进肿瘤转移而影响患儿预后。

Objective To investigate the relationship of vascular endothelial growth faetor-C and microvessel and lymphatic vessel development of nephroblastoma. Methods The expression of vascular endothelial growth factor-C was detected by immunohistochemistry （PV9000） method in nephroblastoma （46 cases）, tissue adjacent to the tumor （19 cases） and normal kidney tissue （8 cases）. The microvessel density （MVD） and lymphatic vessel density （LVD） were assessed after irnmunohistochemistry with CD34 and LYVE-1. The correlation between the expressions of VEGF-C, MVD, LVD and clinicopatholngieal parameters were analyzed by univariate method. The overall survival was evaluated by Kaplan-Meier method and log-rank test. Multivariate analysis was carried out using Cox proportion hazard model. Results The high expressions of VEGF-C （12. 50%, 68. 42%, 73. 91% ）, MVD （8. 25±2. 82, 13.32±3.94, 16.98±3.74） and LVD （2.75± 1.58, 5.26±2.26, 4.72±1.88） had statistical differences in the above-mentioned 3 kinds of tissues （P〈0. 05）, three of them also had associated with tumor staging, vascular invasion and lymph node metastasis. Moreover, MVD was associated with tumor size （P = 0. 029）. Any two of the high expressions of VEGF-C, MVD and LVD had positive correlation （P〈0. 05）. Cox regression analysis showed vascular invasion, MVD and LVD were the independent risk factors, and course of chemotherapy was an independent protected factor. Conclusions High expression of VEGF-C implies high potential of angiogenesis and lymphangiogenesis, metastasis and poorer survival in nephroblastoma.