血管内皮因子、缺氧诱导因子1α及CD34在早期胃癌中的表达

目的：血管发生是实体瘤生长和转移过程中的关键步骤之一。本实验旨在研究血管内皮因子、缺氧诱导因子1α和CD34作为胃癌血管发生的标志物对预后的影响。方法：回顾性分析1990～2004年在Marmara大学附属医院接受胃全切除术或胃次全切除术的51例胃癌患者,通过免疫组织化学对其肿瘤组织中VEGF、HIF-1α和CD34的表达进行评估,并分析其生存效果。结果：51例患者中30例为男性,年龄34～81岁,平均63岁。平均随访时间为17个月。36例患者有淋巴结转移。43例患者TNM分级为T2级或T3级。分别有57%和71%的患者肿瘤有血液和淋巴结转移。65%和71%的患者肿瘤中VEGF和HIF-1α为阳性。CD34染色法评分为3￣68分,平均19分。VEGF、HIF-1α和CD34在未侵犯浆膜的肿瘤中的表达较在侵犯浆膜的肿瘤中表达更为频繁（P=0.018,P=0.012和P=0.003）;CD34在表达有VEGF和HIF-1α的肿瘤中的表达较未表达者尤其频繁（P=0.000,P=0.000）;HIF-1α在表达有VEGF的肿瘤中表达更频繁（P=0.000）,五年生存率为45%。未发现VEGF、HIF-1α和CD34的表达及其他病理特性对存活率有影响。结论：VEGF、HIF-1α和CD34的表达在未侵犯浆膜的肿瘤中更常见。长远看来,针对VEGF和HIF-1α的生物制剂对早期胃癌可能更有效。

Vascular endothelial growth factor, hypoxia-inducible factor 1 alpha and CD34 expressions in early-stage gastric tumors

Objective： Angiogenesis is one of the key steps in solid tumor growth and metastasis. This experiment plans to investigate the prognostic significance of vascular endothelial growth factor （VEGF）, hypoxia-inducible factor 1 α（HIF-1 α） and CD34 expressions as markers of angiogenesis in gastric cancer. Methods： We retrospectively reviewed the medical records of 51 gastric cancer patients who were operated on total or subtotal gastrectomy at Marmara University Hospital from 1990 to 2004 and evaluatedthe expressions of VEGF, HIF-1α and CD34 by immunohistochemistry in their archival tumor tissues. We recorded the clinical and pathological characteristics of these patients and analyzed their survival outcome. Results： 30 out of 51 patients were male. The average age was 63 years （34-81 years）. The average follow-up was 17 months. 36 patients had node-positive disease. The majority of patients（n=43） had T2 or T3 disease. Vascular and lymphatic invasions were present in 57% and 77% of tumors respectively. VEGF and HIF-1α were positive in 65% and 71% of tumors. The average CD34 staining score was 19 （3-68）. VEGF, HIF-1α and CD34 expressions were more frequent in tumors without serosal invasion （P= 0.018, P=0.012 and P=0.003 respectively）. CD34 expression was significantly more frequent in tumors with VEGF and HIF-1α expression （P=0.000, P=0.000）. HIF-1α expression was more frequent in tumors with VEGF expression （P=0.000）. The 5-year overall survival was 45%. VEGF, HIF-1α, CD34 expressions and other pathological characteristics were found to have no impact on survival. Conclusion： VEGF, HIF-1α and CD34 expressions are more common in tumors without serosal invasion. As a future perspective, biological agents targeting at VEGF and HIF-1α might be more effective at the early stage of gastric cancer.