食管鳞癌中细胞凋亡、MVD及PCNA、VEGF表达的临床意义

Clinical Significance of Apoptosis , MVD ,PCNA, VEGF in squamous cell carcinoma of esophagus

目的 研究食管鳞癌中细胞凋亡、PCNA、VEGF、MVD与传统组织病理学因素对食管鳞癌预后的影响。方法 该研究采用原位DNA末端标记 (TUNEL法 )、免疫组化 (S -P法 )及组织病理学等方法研究食管鳞癌组织中凋亡、PCNA、CD34、VEGF的表达 ,计算出凋亡指数 (AI)、增殖指数 (PI)及微血管密度 (MVD) ,并测出VEGF的平均吸光度。结果 AI、PI、VEGF、MVD与肿瘤的分化程度、TNM分期有密切关系。低分化程度组和高TNM分期组PI、MVD值、VEGF吸光度明显高于高分化程度组及低TNM分期组 (P <0 .0 1) ,而其AI值明显低于高分化程度组及低TNM分期组 (P <0 .0 1)。浸润深度超过肌层组及有淋巴结转移组VEGF、MVD明显高于浸润深度未超过肌层及无淋巴结转移组 (P <0 .0 1) ,而AI与浸润深度无关 (P >0 .0 5 ) ,PI与淋巴结转移无关 (P >0 .0 5 )。单因素分析结果显示患者生存率降低与AI、PI、MVD、VEGF、TNM分期、淋巴结转移、分化程度和浸润深度有关。结论 细胞凋亡、细胞增殖和血管形成参与了食管鳞癌的形成 ,并对其生长起促进作用。VEGF与食管鳞癌的血管形成有密切关系 ,VEGF和MVD表达增高有助于食管鳞癌的浸润转移 ;患者生存率降低与AI、PI、MVD、VEGF、TNM分期、淋巴结转移、分化程度和浸润深度有关。

Objective: To study the relationship between apoptosis, MVD, expressions of PCNA,VEGF and clinico-pathological characteristics in esophageal squamous cell carcinoma (ESCC),and prognosis in ESCC.Methods: 61 primary surgical specimens of esophageal squamous cell carcinomas were examined for PCNA, VEGF and MVD by immunohistochemical staining (S-P). Apoptosis was determined by TUNEL (TdT mediating dUTP-biotin nick end-labeling) method. Clinico-pathologic characterstics were examined by histopathology. Results: It was noted that AI, PI, VEGF, MVD were well correlated with differentiation, TNM stage. Lower tumor differentiation and higher TNM stage were related to drecreasing AI, increasing PI, MVD and VEGF(A). In addition, VEGF and MVD in the groups of invasion beyond muscularis and lymph node metastasis were significantly higher than them in the groups of invasion reaching muscularis and no lymph node metastasis (P<0.01). But there were not significant correlation existed between AI and invasion and PI and lymph node metastasis. The simple-factor analysis results showed that AI, PI, MVD, VEGF, TNM stages, lymph node metastases, and tumor differentiation, and invasion related to survival rates decrease.Conclusions:Apoptosis, cell proliferation and angiogenesis take part in ESCC and promote its growth.VEGF is highly related to angiogenesis of ESCC. The increase of VEGF and MVD may promote invasion and lymph node metastasis. AI, PI, VEGF, MVD, differentiation, depth of invasion, lymph node metastasis and TNM stage are related to lower survival rates in ESCC.