喉癌颈淋巴结抗肿瘤免疫状态的研究

目的　通过对肿瘤引流淋巴结中增生性滤泡反应和树突状细胞 (dendriticcell,DC)浸润密度进行定量分析 ,探讨其在喉癌患者抗肿瘤免疫反应中的作用。方法　重新制备 4 7例行选择性颈淋巴结清扫术的喉癌患者的 15 7枚颈淋巴结石蜡切片 ,用抗S 10 0、CD4 5RO和CD2 0单克隆抗体免疫组化抗生物素 生物素过氧化物酶复合物 (avidin biotinperoxidase,ABC)法显示DC和增生性滤泡的分布并检测其密度。根据增生性滤泡反应的特点进行分型研究。结果　增生型滤泡反应的程度与类型和DC浸润密度有明显的相关性。术后生存 5年以上的患者淋巴结中滤泡计数和DC浸润密度明显多于生存期少于 5年者 (P <0 0 0 1)。无淋巴结转移组患者淋巴结中的滤泡计数和DC浸润密度较有转移组亦有明显增加 (P <0 0 0 1)。具有T细胞增生型滤泡反应的患者比T细胞非增生型患者有较高的 5年生存率 (P <0 0 1)和较低的淋巴结转移率 (P <0 0 5 )。结论　颈淋巴结中增生性滤泡反应和树突状细胞的浸润反映了机体免疫系统的抗肿瘤潜能。树突状细胞的浸润密度和增生性滤泡反应的程度及分型反映了该患者的抗肿瘤免疫状态 ,可以共同作为预后判定的重要指标。     

Infiltration of dendritic cells into cervical lymph nodes in laryngeal carcinoma]

OBJECTIVE: Dendritic cells(DC) form a system of highly efficient antigen-presenting cells. An immunohistochemical study was performed to prove their role in immune responses against cancer. METHODS: Paraffin blocks were prepared for staining with antibody against S-100 proteins in 157 lymph nodes obtained from elective cervical lymphadenectomy in 47 cases of laryngeal squamous cell carcinomas. RESULTS: The extent of infiltration by DC into the regional lymph nodes was evaluated in two groups according to negative and positive lymph node metastasis. Densities of DC ranged from 23.0 to 111.9, with an average of 57.2 +/- 16.0, in the negative metastasis nodes; and from 17.5 to 63.6, with an average of 38.3 +/- 14.9, in the positive metastasis nodes. The test revealed that the differences in population density between the two groups were significant (P < 0.001). Quantitative analysis showed that patients who survived longer than 5 years had significant higher numbers of DC in the lymph nodes than those who lived less than 5 years (P < 0.001). Densities of DC ranged from 32.0 to 111.9, with an average of 61.6 +/- 19.6, in the nodes of 20 cases of patients who survived longer than 5 years and from 17.5 to 65.8, with an average of 37.9 +/- 13.7, in the nodes of 27 cases of patients who survived less than 5 years. CONCLUSION: DC may be more directly involved in the host immune reaction against tumor by means of the most important antigen-presenting cells. DC in the cervical lymph nodes are important for establishing immunologic defense mechanisms in cases of laryngeal carcinomas, and the densities of DC can serve as a useful indicator in assessing prognosis of laryngeal carcinomas.     

Relationship among lymphatic metastasis, pericancerous lymphocytic reaction and dendritic cell infiltration in laryngeal carcinoma cells]

OBJECTIVE: To study the role and the clinical significance of dendritic cell infiltration against tumor cells in patients with laryngeal squamous cell carcinoma. METHODS: Immunohistochemical method using S-100 protein antibody was employed to detect dendritic cells (DC) on paraffin-embedded tissue sections from 23 patients with laryngeal squamous cell carcinomas. The relationships among the density of dendritic cell infiltration in laryngeal carcinomas and cervical lymphatic metastasis, pericancerous lymphocytic reaction and other clinicopathologic parameters were observed. RESULTS: The numbers of dendritic cells infiltrating among laryngeal carcinoma cells in patients with no cervical lymph metastasis was significantly larger than those with cervical lymphatic metastasis (t = 4.889, P < 0.01). Significant increase DC infiltration among laryngeal carcinoma cells was found in the group with intensively positive reaction of pericancerous lymphocyte than in the medium and weakly positive groups. The number of infiltrating dendritic cells in patients who had survived more than 5 years was significantly larger than those survived less than 5 years (t = 4.423, P < 0.01). The numbers of the infiltrating dendritic cells in patients with well-differentiated squamous cell carcinoma and poorly differentiated squamous cells carcinoma were 2.2 +/- 1.07 and 14.6 +/- 7.14 respectively, which were significantly different (q = 4.532, P < 0.05). CONCLUSION: The study showed that DC infiltration among laryngeal squamous carcinoma cells played an important role in the host immune reaction against tumor. It indicated that when the density of infiltrating DC is higher, the patients had less chance of cervical lymph metastasis and may have a longer survival time. There was a coordinative effect between DC infiltration in tumor cells and pericancerous lymphocyte reaction. Thus, the DC infiltration among laryngeal squamous cells could be used as an index of prognosis.     

喉癌喉咽癌哨位淋巴结的临床初步研究

目的 探讨喉癌喉咽癌哨位淋巴结的检测及其对颈淋巴结转移的预测价值。方法 用手术中注射蓝染料的方法,对29例颈淋巴结NO的喉癌喉咽癌患者进行了哨位淋巴结的临床研究。手术中取蓝染的哨位淋巴结作快速冰冻病理检查,并与HE染色病理检查结果及颈清扫切除的淋巴结病理检查对照,观察哨位淋巴结转移对颈淋巴结转移癌的预测值。结果 29例中28例成功地显示了哨位淋巴结,成功率达96．6％。每例发现蓝染的哨位淋巴结1－4个,平均每例则检出2．5个。有3例患者的哨位淋巴结检测有肿瘤转移,HE染色病理检查及颈清扫切除的淋巴结病理检查均证实颈淋巴结转移。25例哨位淋巴结冰冻病理检查阴性患者,颈淋巴结清扫标本亦未查见淋巴结转移。哨位淋巴结对颈淋巴结转移的阳性正确率和阴性预测率为100％。结论 哨痊淋巴结检测对喉咽癌的淋巴结转移有重要的预测价值。     

喉鳞状细胞癌及转移淋巴组织中Cyclin E的表达

目的：定量检测细胞周期素E（Cyclin E）在喉鳞状细胞癌及颈部淋巴组织中的表达,探讨其在喉癌转移中的可能作用。方法：采用激光共聚焦显微镜、多参数流式细胞技术对手术切除的21例喉鳞状细胞癌（7例伴颈淋巴结转移,14例不伴颈淋巴结转移）组织标本中Cyclin E的表达含量进行检测分析。结果：Cyclin E在喉鳞状细胞癌、阳性淋巴结、阴性淋巴结中均有不同程度的表达,喉鳞状细胞癌伴颈淋巴结转移平均荧光强度为78.12士6.54,略高于不伴颈淋巴结转移者（74.93士8．82）（P〉0．05）;阳性淋巴结平均荧光强度为93．65士7．48,明显高于阴性淋巴结（30．65士7．48）（P〈0．01）,且高于喉鳞状细胞癌伴颈淋巴结转移和不伴颈淋巴结转移者（P〈0．05）。结论：Cyclin E的异常表达是喉癌发生、发展过程中一个重要的分子事件;Cyclin E的检测可望成为临床评估喉癌淋巴结转移的指标之一。     

喉鳞癌微血管密度与颈淋巴结转移及病理临床分期的相关性研究

目的研究喉鳞癌微血管密度与颈淋巴结转移及病理临床分期的相关性。方法采用抗Ⅷ因子相关抗原的抗体标记肿瘤血管内皮细胞并测定喉鳞癌组织微血管密度。结果①颈淋巴结转移组喉鳞癌的微血管密度显著高于非转移组(32.1518±6.489∶18.0672±4.983,P<0.01);②喉鳞癌微血管密度大于均数组则颈淋巴结转移率显著增高(P<0.01);③病理临床分期晚期组喉鳞癌的微血管密度明显高于早期组(P<0.01)。结论喉鳞癌微血管密度可作为预测其颈淋巴结转移的一项指标。     

喉癌喉前淋巴结转移

回顾性调查1865例行全喉切除的喉癌病例．发现120例喉癌有喉前淋巴结，其中24例发生喉前淋巴结转移。非转移性喉前淋巴结最大直径从0．2cm大小到1cm左右不等，转移性喉前淋巴结从0．2cm到最大直径1．9cm。喉前淋巴结转移率为1．3％．其中声门上癌、声门癌、声门下癌和跨声门癌的喉前淋巴结转移率分别为0．39％、0．73％、5．02％和2．55％。喉前淋巴结转移与细胞分化无关，与喉癌原发部位及肿瘤分期有关，声门下癌或侵犯声门下区的喉癌较声门上癌和声门癌易发生喉前淋巴结转移，跨声门侵犯的喉癌较声门上癌易发生喉前淋巴结转移；T3、T4期喉癌，较T1、T2期喉癌易发生喉前淋巴结转移；有喉前淋巴结转移的喉癌．易发生颈侧淋巴结转移。     

喉癌端粒酶活性检测及其与颈淋巴结转移的相关性

目的 :探讨喉鳞状细胞癌端粒酶活性表达及其与颈淋巴结转移的相关性。方法 :采用多聚酶链反应 -酶联免疫吸附法 (PCR- EL ISA) ,对 47例喉鳞状细胞癌组织及 10例声带炎性息肉组织的端粒酶活性进行定量检测。结果 :47例喉鳞癌组织中 39例端粒酶呈阳性 (83% ) ,而 10例声带炎性息肉组织均为阴性 ,两组差异有极显著性意义 (P <0 .0 1) ;端粒酶活性在伴有颈淋巴结转移的喉癌中显著高于无淋巴结转移者 (P <0 .0 5 )。结论 :端粒酶在喉癌组织中有较高的表达 ,可作为喉癌的肿瘤标志物。喉癌组织端粒酶活性有可能作为预测喉癌转移和预后的指标 ,并可望指导临床有针对性地应用选择性颈廓清术。