肾透明细胞癌多层螺旋CT增强与肿瘤血管形成的相关性

Correlation between tumor angiogenesis and imaging features of multiphasic spiral computed tomography in clear renal cell carcinoma

目的探讨肾透明细胞癌MSCT增强征象与肿瘤血管形成的相关性。方法回顾性分析50例肾透明细胞癌MSCT增强征象与MVD、VEGF表达的关系。结果 (1)50例CRCC的MVD平均为(34±10.78)条/视野,VEGF阳性表达率94%(47/50)。MVD与VEGF的阳性表达无相关性(rs=0.0502,P>0.05)。(2)CT征像与MVD及VEGF的表达:肿瘤直径>3.0cm组,肿瘤内有出血坏死组,有静脉癌栓组的VEGF阳性表达、MVD均高于相对应组,各组间均有统计学意义(P<0.05);有淋巴结转移组及无假包膜组的MVD均高于相对应组,各组间均有统计学意义(P<0.05)。CMP期肿瘤强化CT值、强化程度、强化比值与MVD呈正相关(r分别为0.817、0.812及0.457,P均<0.05)。(3)本组CRCCⅠ期13例,Ⅱ期15例,Ⅲ期13例,Ⅳ期9例。MSCT对CRCC检出率、定性诊断正确率均为100%,分期正确率88%(44/50)。结论肾透明细胞癌的MSCT增强影像特征可客观反映CRCC中MVD及VEGF的阳性表达,可无创地判断RCC的发生、发展、侵袭和转移,能为临床选择抗肿瘤血管生成治疗提供影像依据。

Objective To evaluate the correlation between imaging features of multiple spiral computed tomography（MSCT） and tumor angiogenesis in clear renal cell carcinoma（CRCC）.Methods Fifty patients with CRCC diagnosed by pathology underwent MSCT examinations.MVD and the expression of VEGF were examined immunohistochemically using SABC techniques.Results The mean MVD in 50 CRCC cases was 34±10.78.The positive expression rate of VEGF were 94%（47/50）.There were no correlation between the MVD and the expression of VEGF in CRCC（rs=0.0502,P〉0.05）.The MVD and positive expression of VEGF in groups of CRCC with diameter larger than 3.0cm,central necrosis and intravenous tumor emboli were obviously higher than those in the contrast group（P〈0.05,〈0.05,〈0.05）.The MVD in groups of CRCC with lymph node metastasis and non-pseudocapsule were higher than the contrast group（P〈0.05,〈0.05）.In the CMP of CRCC,there were the positive correlation between the enhanced Hounsfield’s units and the MVD,the degree of enhancement correlated and MVD,reinforcement ratio and MVD（P〈0.05）.（3）The pathologic Robson staging of CRCC was as fllows：Ⅰin 15 cases,Ⅱ in 15 cases,Ⅲ in 13 cases,Ⅳ in 9 cases.The detection and characterization rate as well as accuracy of staging before operation about 50 CRCC of multiphasic MSCT scans were 100%,100% and 88%,respectively.Conclusion Some features of multiphasic enhanced scan by MSCT are closely correlated with MVD and expressions of VEGF in CRCC,wich could be a noninvasive method in predicting aggressiveness and metastasis.