新生淋巴管及其受侵对非小细胞肺癌的预后价值

Prognostic Value of Lymphangeogenesis and Lymphatic Vessel Invasionin Non-small Cell Lung Cancer

背景与目的已有的研究表明新生淋巴管与多种肿瘤的进展和淋巴转移相关,本研究拟探讨非小细胞肺癌病灶内(旁)新生淋巴管密度及其受肿瘤侵袭状况对非小细胞肺癌的预后价值。方法选择特异性单克隆抗体D2-40标记新生淋巴管内皮细胞,以免疫组化方法检测79例II期-III期非小细胞肺癌病灶内及其中部分病灶旁新生淋巴管表达及其受侵状况,结合患者临床、病理及随访资料,判断其对患者预后的影响和评估价值。结果①病灶内新生淋巴管密度:N2患者高于N0患者(P=0.015),新生淋巴管受侵患者明显高于未受侵患者(P=0.009),肺癌低分化明显高于高分化肺癌(P=0.007),腺癌高于鳞癌(P=0.025),患者生存率与之呈负性相关(P=0.007);②病灶旁新生淋巴管密度与预后无明显相关性;③N2肺癌病灶内新生淋巴管受侵多于N0肺癌;④病灶内和病灶旁新生淋巴管受侵患者的生存率低于未受侵患者。结论病灶内新生淋巴管密度是影响非小细胞肺癌患者预后的重要因素,可作为判断预后的指标。新生淋巴管受侵的预后意义值得关注。

Background and objective Studies have shown that tumor metastasis in a variety of tumors is associated with lymphangiogenesis and lymphatic vessel invasion （LVI）. Tumor metastasis is an important factor that affects the prognosis of patients. The aim of this study is to determine the prognostic value oflymphangiogenesis and LVI in nonsmall cell lung cancer （NSCLC）. Methods We marked the endothelial cells of lymph vessels in lymphangiogenesis with specific monoclonal antibody D2-40. Immunohistochemistry was used to detect the expression of lymphangiogenesis and LVI in 79 cases of stageⅠ-Ⅲ NSCLC. Results The intratumoral lymphatic vessel density （ITLVD） was significantly higher in patients with N2 disease than those with NO disease （P=0.01S）. The ITLVD was significantly higher in patients with LVI＋ than that in those with LVI- （P=0.009）. The ITLVD was also remarkably higher in poorly differentiated tumors than that in highly differen- tiated ones （P=0.007）. The ITLVD was remarkably higher in adenocarcinoma than that in squamous cell carcinomas （P=0.02S）. Kaplan-Meier revealed that the survival rates of patients with higher ITLVD were remarkably poorer than those with lower ITLVD （P=0.007）. Thus, the ITLVD is an important prognostic factor of NSCLC. The peritumoral lymphatic vessel density is not correlated with the prognosis. Conclusion The ITLVD level is an important prognostic factor of NSCLC.