MSCT影像表现及肿瘤血管生成对胰腺癌预后价值的探讨

目的:研究MSCT影像表现及肿瘤血管生成对判断胰腺癌预后的价值。方法:回顾性分析36例经手术证实的胰腺癌患者的CT影像表现(肿瘤胰外侵犯,胰周血管侵犯)、临床病理因素,并采用免疫组化方法检测测量肿瘤微血管密度(MVD)、血管内皮生长因子(VEGF)和金属蛋白酶(MMP)表达水平,与患者的预后进行相关性分析。36例患者术前均行MSCT检查和CT血管成像、多平面重组(MPR)等图像后处理。结果:COX回归分析发现胰腺癌患者的临床分期、病理分级、CT影像表现(胰外侵犯,血管侵犯)、MMP-2表达水平与患者的预后有相关性(P<0.05),其中以CT图像上有胰外侵犯和血管侵犯的相对风险度最高(18.18,6.173)。结论:胰腺癌胰外侵犯、胰周血管侵犯的CT影像表现是预后的独立影响因素,而MVD、VEGF、MMP-9对胰腺癌预后评价无显著性意义。     

大肠癌肠外浸润螺旋CT征象与肿瘤血管生成的相关性

目的 探讨大肠癌肠外浸润的螺旋CT（SCT）征象与病理、肿瘤微血管密度（MVD）、血管内皮生长因子（VEGF）和基质金属蛋白酶-2（MMP-2）表达的关系。方法 40例大肠癌患者，术前均行SCT多期动态扫描，术后标本采用免疫组织化学方法染色，检测VEGF和MMP-2的表达和计数MVD。结果 螺旋CT判断大肠癌肠外、肠壁浸润的准确率为92．5％（37／40）。肠外、肠壁浸润组的转移率分别为75．0％（21／28）和33．3％（4／12），其差异有统计学意义（P〈0．05）。大肠癌肠壁、肠外浸润组间的CT强化程度、MVD、VEGF和MMP-2的表达比较差异有统计学意义（P〈0．05）。CT强化程度与MVD之间呈正相关（P〈0．05）。结论 SCT增强扫描能较准确地判断大肠癌的肠外浸润，且肠外浸润预示着更高的转移倾向；CT强化程度可作为定量分析指标初步判断肿瘤血管生成，MVD、VEGF、MMP-2表达与大肠癌浸润密切相关，肿瘤血管生成在大肠癌的浸润过程中起着促进作用。     

肝癌患者血清VEGF的表达及临床意义

目的：探讨肝癌患者血清血管内皮生长因子（vascular endothelial growth factor,VEGF)表达情况及临床意义。方法：选择70例肝癌、30例肝硬化和20例正常对照血清标本，采用定量ELISA法检测血清VEGF含量。记录肝癌组临床病理特征，与肝癌组血清VEGF水平做相关性分析。结果肝癌组血清VEGF显著高于肝硬化组和正常对照组（P＜0．05，P＜0．001）。肝癌患者血清VEGF与肿块大小成正相关（P＜0．05）；出现液化坏死病变、伴有远处转移，及肝癌切除术后复发患者血清VEGF水平明显增高（P＜0．05），TNMⅢ、Ⅳ期患者血清VEGF浓度也明显高于TNMⅠ、Ⅱ期患者（P＜0．05）。结论：血清VEGF水平可作为肝癌诊断和预后评价的重要指标。     

胰腺导管癌组织中VEGF表达和肿瘤微血管计数的临床意义

目的探讨胰腺癌组织中血管内皮生长因子(VEGF)的蛋白表达、肿瘤微血管(MVD))计数与肿瘤临床病理学特征,研究胰腺肿瘤的预后因素。方法选择病理证实为胰腺导管腺癌且资料完整的48例石蜡切块标本,应用免疫组织化学的方法进行VEGF蛋白检测及MVD计数,与正常胰腺组织及癌旁组织对照,并结合病人临床病理资料进行分析。结果胰腺癌组织中VEGF表达阳性率为64．58％(31／48)。MVD计数为10～34个,中位数为21。VEGF蛋白表达与MVD计数有明显相关性(P＜0．01)。VEGF蛋白表达与肿瘤大小、淋巴结转移和肿瘤TNM分期都有相关性,肿瘤≥2cm比＜2cm的VEGF表达阳性率高(P＜O．05)。有淋巴结转移者VEGF表达阳性率高(P＜0．01)。肿瘤TNM分期Ⅲ～Ⅳ期比Ⅰ～Ⅱ期VEGF表达阳性率高(P＜0．05)。COX分析显示,VEGF蛋白表达及MVD计数与病人生成时间有关。VEGF表达阳性,死亡危险度大;MVD个数多者,死亡危险度大。结论血管生存在胰腺癌的发生、发展和转移过程中起着重要的作用,VEGF和MVD可作为评价胰腺癌预后的指标之一,抗血管治疗可能成为胰腺癌的一种新的治疗手段。     

肾上腺腺瘤和非腺瘤动态增强CT表现与血管生成相关性的初步研究

目的探讨肾上腺腺瘤和非腺瘤血管生成[微血管密度（MVD），血管内皮生长因子（VEGF）]特点与动态增强CT表现的相关性，以阐述其动态增强机制。方法经手术病理证实的42例46个肾上腺肿块（腺瘤23个、非腺瘤18个、增生结节5个）均行动态增强CT检查和病理学检查。首先评价肾上腺腺瘤和非腺瘤动态增强CT表现，而后分析肾上腺肿块动态增强CT表现特征[时间-密度（T-D）曲线、廓清率（Wash）]与血管生成之间的相关关系。结果腺瘤与非腺瘤间T—D曲线类型和7min延时点相对廓清率（Washr）和绝对廓清率（Washa）差异均存在统计学意义（P=0．000）。肾上腺肿块T—D曲线廓清迅速组（A、C型）与廓清缓慢组（B、D、E型）间、7min延时点Washr≥34％组与〈34％组间、Washai≥43％组与〈43％组间MVD、VEGF表达水平差异均有统计学意义（P〈0．05）。肿块廓清曲线为A、C型，和（或）Washr≥34HU，和（或）Washai≥43％组均提示为腺瘤，反之提示为非腺瘤。T—D曲线廓清迅速组、7min延时点Washri≥34％组和Washa≥143％组MVD、VEGF表达水平分别高于廓清缓慢组、〈34％组和〈43％组；由此提示动态增强CT表现特征与MVD、VEGF表达存在相关性。另一方面，腺瘤和非腺瘤间MVD和VEGF表达存在显著不同。结论MVD和VEGF可能是导致腺瘤和非腺瘤具有不同的T—D曲线类型和廓清率的主要因素之一。     

乳腺病变动态增强MRI与血管生成的相关性

目的探讨乳腺良、恶性病变MR动态增强（DCE）参数与肿瘤血管生成的关系。方法对51例乳腺良、恶性病变患者行前瞻性DCE—MR检查，计算动态增强参数：最大增强线性斜率（Smax，增强峰值（PH）、峰值时间（Tpeak）。所有病例手术病理标本行免疫组织化学染色，测定微血管密度（MVD）计数和血管内皮生长因子（VEGF）表达，分析各动态增强参数与乳腺癌MVD和VEGF表达的相关性。并比较29例乳腺癌与12例乳腺纤维腺瘤、10例乳腺病、10例癌旁正常组织MVD计数和VEGF表达的差别。结果乳腺癌Smax（2．04±1．8；r=0．807，P〈0．01）、PH（678±260；r=0．697，P〈0．01）与MVD呈正相关，Tpeak（69±38）与MVD呈负相关（r=-0．425，P〈0．05）。乳腺癌组MVD计数[（65．09±15．81）个／200倍视野]明显高于纤维腺瘤组、乳腺腺病组及癌旁正常组织组（P值分别为0．043、0．018、0．002）。69％（20／29）乳腺癌VEGF表达阳性，也明显高于其余各组（P值分别为0．035、0．007、0．001）。乳腺癌边缘区域的MVD（60．38±24．14）个／200倍视野，高于中央区域（37．64±16．52）个／200倍视野；（t=2．635，P=0．016）。腋窝淋巴结转移组的MVD（73．23±23．02）个／200倍视野，高于无转移组（59．34±18．03）个／200倍视野，（t=2．303，P=0．031）。结论乳腺癌部分MR—DCE参数与MVD、VEGF相关，能较客观地反映乳腺癌血管生成状况，其MVD计数和VEGF表达明显高于乳腺良性病变及癌旁正常组织。     

乙酰肝素酶的表达与胰腺癌临床病理参数及肿瘤血管生成的关系

目的：检测胰腺癌标本中乙酰肝素酶及CD34表达，探讨乙酰肝素酶的表达与胰腺癌临床病理参数及与肿瘤血管生成之间的关系。方法：免疫组化SP法检测78例胰腺癌中乙酰肝素酶及CD34的表达，分析乙酰肝素酶表达与胰腺癌临床病理特征及与肿瘤微血管密度（MVD）的相关性。结果：乙酰肝素酶表达与胰腺癌转移相关，有淋巴结或远处转移者表达明显升高（P〈O．05）；同TNM分期相关，Ⅲ～Ⅳ期阳性率较Ⅱ期升高（P〈O．01）。胰腺癌中乙酰肝素酶表达阳性者MVD值明显高于乙酰肝素酶表达阴性者（P〈0．01）。结论：乙酰肝素酶在胰腺癌中高表达，同胰腺癌转移、分期及血管生成密切相关，乙酰肝素酶的表达促进了胰腺癌的转移及血管生成。     

宫颈癌介入治疗术前血清VEGF检测的临床价值

目的探讨宫颈癌介入治疗(动脉内灌注化疗)术前血清血管内皮生长因子(VEGF)检测的临床价值及对介入治疗疗效的影响。方法 35例ⅠB-ⅣA期宫颈癌介入治疗术前采用酶联免疫吸附试验(ELISA)测定血清VEGF,比较不同年龄、临床分期、肿瘤分级、病理类型、肿瘤大小、是否淋巴转移的血清VEGF水平差异,分析血清VEGF水平对介入治疗疗效及生存时间的影响;应用多因素Cox风险比例模型分析影响预后的因素。结果血清VEGF在不同肿瘤大小(P=0.001)、病理类型(P=0.026)患者中存在差异;并对介入治疗疗效(P=0.012)及生存时间存在显著影响(log rank P=0.001)。多因素分析显示,临床分期(P=0.019)、血清VEGF水平(P=0.009)、介入治疗疗效(P=0.007)是患者预后的独立影响因素。结论宫颈癌血清VEGF水平对介入治疗疗效及生存时间存在显著影响,具有重要的临床价值。     

胃癌螺旋CT增强扫描表现与肿瘤血管生成关系的初步研究

目的探讨胃癌CT强化特征与肿瘤血管生成的相关性,寻求1种无创、有效的判定胃癌恶性程度及预后的方法。方法经手术病理证实的胃癌27例,术前行水充盈螺旋CT低张平扫及三期增强扫描,并测定肿瘤区域的CT值。胃癌标本组织切片经抗Ⅷ因子相关抗原(factorⅧrelatedantigen,F8RA)单克隆抗体和抗血管内皮生长因子(VEGF)多克隆抗体2种试剂分别做免疫组织化学染色,测定肿瘤的微血管密度(microvesseldensities,MVD)和VEGF阳性表达率,将CT形态表现、强化程度及特征与组织学结果进行比较。结果螺旋CT术前对胃癌的T、N、M分期准确率分别为77·8%、74·1%和100%,原发灶、淋巴结和转移情况分期(TNM分期)符合率为81·5%。癌灶CT最大强化增加值为40~83HU,平均62·53HU;肿瘤MVD为4~27条/高倍镜视野,平均15·35条/高倍镜视野。胃癌的最大CT强化值与MVD之间存在显著的相关性(r=0·708,t=5·015,P<0·001);VEGF阳性组的MVD和强化峰值(PA)显著高于VEGF阴性组(秩和检验,0·025相似文献   

肝门部胆管癌MR表现与病理、肿瘤血管生成的相关性研究

目的 探讨肝门部胆管癌MRI表现与病理、肿瘤血管生成之间的相关性.方法 对28例肝门部胆管癌患者术前行MR扫描,分析MRI形态学特征、动态增强表现;术后标本行免疫组化染色测定病灶微血管密度（MVD）、血管内皮生长因子（VEGF）的表达情况,并分析其与MRI表现之间的相关性.结果 侵袭转移（16例）组、病灶内胆管扩张（8例）组的MVD、VEGF表达明显高于无侵袭转移组、无病灶内胆管扩张组,且均具有统计学意义（P＜0.05）.肿瘤生长方式的分型与MVD、VEGF表达无明显相关性（P＞0.05）.MRI动态增强扫描中,不同强化形式组间的MVD值存在统计学差异（P＜0.05）,ASI（早期信号强度增强率）与MVD呈明显正相关,与VEGF的表达亦有相关性.结论 肝门部胆管癌MRI表现与病理、肿瘤血管生成之间存在一定相关性,可根据其MRI表现对癌灶的生物学行为和预后进行评估.     

Bladder transitional cell carcinoma: correlation of contrast enhancement on computed tomography with histological grade and tumour angiogenesis

AIM: To investigate the correlation between the degree of contrast enhancement of bladder cancer in the early enhanced phase of helical computed tomography (CT) and microvessel density (MVD), vascular endothelial growth factor (VEGF) and histological grade. MATERIALS AND METHODS: Sixty-five patients with transitional cell carcinoma of the bladder were examined by incremental unenhanced CT and helical CT at 40-45 s after initiation of intravenous administration of contrast medium before surgery. The CT density in Hounsfield units of bladder carcinomas were measured in the middle of the maximum diameter section of the cancer lesions on unenhanced and enhanced CT. The degree of contrast enhancement of the tumour was determined as the absolute increase in Hounsfield units. Histological grade, VEGF and MVD were analysed for each cancer. The Pearson and Spearman correlation tests were used to determine the strength of the relationships between CT enhancement and histological grade, VEGF expression and MVD. RESULTS: Different degrees of enhancement were observed in 91 cancers during the early enhanced phase of helical CT. Mean MVDs and mean CT enhancing values of different histological grade groups were statistically different (p < 0.001). A positive correlation was found in the CT-enhancing value of bladder cancer and MVD (Pearson correlation test; r = 0.938, p < 0.001) and histological grade (Spearman rank correlation; r = 0.734, p < 0.001). VEGF of bladder cancer did not correlate with the change in CT attenuation (Spearman rank correlation; r = 0.087, p = 0.410) and MVD (Spearman rank correlation, r = 0.103, p = 0.330). CONCLUSION: In bladder cancer, the degree of contrast enhancement during the early enhanced helical CT is correlated with the MVD and histological grade of tumour. It is possible that MVD is the histopathological basis of early contrast enhancement of bladder cancer.     

非小细胞肺癌MR动态增强表现与肿瘤血管生成的相关性

目的　探讨非小细胞肺癌 (NSCLC)的微血管密度 (MVD)及其血管内皮生长因子 (VEGF)与MR动态增强指标间的关系。资料与方法　以 3 3例经手术证实为NSCLC的病例作为研究对象 ,分析肿块的最大强化斜率 (Smax)和峰值到达时间 (TTP)。组织切片经CD3 4和VEGF免疫组织化学染色 ,分析MVD和VEGF表达的阳性率。将Smax和TTP分别与肿瘤的病理类型以及免疫组织化学结果 (MVD、VEGF)进行各自的比较。结果　 ( 1 )肺癌的Smax与MVD和VEGF之间呈显著正相关 (r分别为 0 .6 1 5 ,0 .72 3 ,P <0 .0 0 1 ) ;( 2 )TTP与MVD和VEGF之间呈显著的负相关(r分别为 - 0 .4 78和 - 0 .5 3 8,P <0 .0 1和 0 .0 0 1 )。结论　MR动态增强指标Smax和TTP能够反映NSCLC的MVD和VEGF表达的高低 ,从而推测其血管生成状况。     

Functional computed tomography imaging of tumor-induced angiogenesis: preliminary results of new tracer kinetic modeling using a computer discretization approach

PURPOSE: The aim of this study was to establish functional computed tomography (CT) imaging as a method for assessing tumor-induced angiogenesis. MATERIALS AND METHODS: Functional CT imaging was mathematically analyzed for 14 renal cell carcinomas by means of two-compartment modeling using a computer-discretization approach. The model incorporated diffusible kinetics of contrast medium including leakage from the capillary to the extravascular compartment and back-flux to the capillary compartment. The correlations between functional CT parameters [relative blood volume (rbv), permeability 1 (Pm1), and permeability 2 (Pm2)] and histopathological markers of angiogenesis [microvessel density (MVD) and vascular endothelial growth factor (VEGF)] were statistically analyzed. RESULTS: The modeling was successfully performed, showing similarity between the mathematically simulated curve and the measured time-density curve. There were significant linear correlations between MVD grade and Pm1 (r = 0.841, P = 0.001) and between VEGF grade and Pm2 (r = 0.804, P = 0.005) by Pearson's correlation coefficient. CONCLUSION: This method may be a useful tool for the assessment of tumor-induced angiogenesis.     

胰腺癌CT表现与手术病理及D2-40表达的相关性研究

目的:探讨胰腺癌CT征象与手术病理及癌组织淋巴管生成之间的关系.方法:对33例胰腺癌患者(男24例,女9例,年龄38～79岁)行CT平扫及动脉期、门静脉期、延迟期增强扫描,分析胰腺癌的病灶大小、密度、强化程度、对胰周组织的侵犯、胰胆管扩张,胰周淋巴结等CT征象,所有病例均行手术切除,术后标本采用单克隆抗体D2-40免疫组化方法检测肿瘤组织中的瘤周和瘤内淋巴管密度(pLVD,iLVD).使用Kappa检验和t检验统计学方法将CT表现与病理结果、淋巴管密度进行对照.结果:CT诊断胰腺癌病灶的大小、胰周组织侵犯、胰周淋巴结转移与手术病理结果一致性良好(P＜0.05),CT对胰腺癌分期的准确性为78.79％(26/33).CT征象中胰周组织侵犯、胰周淋巴结肿大、分期与胰腺癌pLVD有关(P＜0.05).与iLVD无关(P＞0.05);CT征象中病灶大小、密度、胰胆管扩张、病灶强化程度则与pLVD、iLVD均无关(P＞0.05).结论:CT能较可靠地反映胰腺癌的病理学特征;胰周组织侵犯、胰周淋巴结肿大等CT征象与胰腺癌组织的淋巴管密度有关,可一定程度上揭示胰腺癌组织的淋巴管生成、淋巴结转移及判断预后.     

18F-FDG PET/CT 显像在直肠癌术前分期中的价值及与临床病理特征关系的研究

目的 探讨18F-氟脱氧葡萄糖（FDG）PET/CT显像在直肠癌术前肿瘤、结节、转移（TNM）分期中的价值及原发灶最大标准化摄取值（SUV_max）与临床及病理特征的相关性。 方法 回顾性分析2013年1月至2018年12月在福建省肿瘤医院术前行18F-FDG PET/CT检查且经术后病理证实为直肠癌的117例患者（男性66例、女性51例,年龄29~83岁,中位年龄57岁）的相关资料,评估18F-FDG PET/CT对直肠癌原发灶浸润深度、淋巴结转移、远处转移及临床分期的准确率。一致性检验采用Kappa检验。基于性别、年龄、病灶长径、病理类型、分化程度、淋巴血管侵犯（LVI）、周围神经侵犯（PNI）、TNM分期、临床分期进行分组,采用独立样本t检验和单因素方差分析比较组间原发灶SUV_max的差异;采用Pearson或Spearson相关分析法分析原发灶SUV_max与临床及病理特征之间的相关性。 结果 18F-FDG PET/CT对直肠癌原发灶浸润深度、淋巴结转移、远处转移、临床分期的诊断准确率分别为76.1%、81.2%、95.7%、76.9%,与病理结果的一致性为κ=0.601、0.535、0.867、0.667（均P<0.01）。不同病灶长径（t=4.982,P<0.01）、LVI（t=?2.581,P=0.011）、PNI（t=?2.873,P=0.005、N分期（t=2.792,P=0.006）、临床分期（F=3.072,P=0.031）的原发灶SUV_max的组间差异均有统计学意义;不同性别（t=0.688,P=0.493）、年龄（t=1.523,P=0.130）、病理类型（t=0.886,P=0.377）、分化程度（t=0.045,P=0.964）、T分期（F=2.323,P=0.103）、M分期（t=?1.502,P=0.136）的原发灶SUV_max的组间差异均无统计学意义。原发灶SUV_max与病灶长径、LVI、PNI、N分期、临床分期呈正相关（r=0.230~0.308,均P<0.05）。 结论 18F-FDG PET/CT对于直肠癌原发灶、淋巴结转移及远处转移均有较高的诊断准确率,是直肠癌分期的有效方法。原发灶SUV_max可部分反映肿瘤的增殖及侵袭能力。     

Grading of uterine cervical cancer by using the ADC difference value and its correlation with microvascular density and vascular endothelial growth factor

Objective

To investigate the application value of the ADC_difference value in evaluating the pathological grade of uterine cervical cancer and to analyse the correlations among microvascular density (MVD), vascular endothelial growth factor (VEGF) expression and maximum ADC_difference value.

Methods

Fifty-six patients with uterine cervical cancer were included in this prospective study. All underwent conventional MRI and DWI. MVD and VEGF were evaluated by immunohistochemical staining with anti-CD34 and anti-VEGF, respectively.

Results

Maximum ADC_difference value and MVD count showed statistical differences among different pathological grades (P?<?0.001, P?<?0.001). There was a significant positive linear correlation between the maximum ADC_difference value and pathological tumour grade (P?<?0.001), and also between MVD count and pathological tumour grade (P?<?0.001). No significant differences were found between the level of VEGF expression and pathological tumour grade (P?=?0.222). The maximum ADC_difference value correlated positively with both the MVD count and the level of VEGF expression (P?<?0.001, P?<?0.001).

Conclusions

Quantitative analysis of maximum ADC_difference value of uterine cervical cancer may represent the grade of tumour differentiation and provide valuable information on tumour microcirculation and perfusion, thus allowing a promising new method of non-invasively assessing the pathological grade, which could serve as a substitution for assessing tumour angiogenesis.

Key Points

? Diffusion-weighted magnetic resonance imaging offers numerous new parameters concerning cervical cancer. ? Relationships between ADC _difference values and grades of tumour differentiation are examined. ? Quantitative analysis may provide valuable information on tumour microcirculation and perfusion. ? The maximum ADC _difference value could serve as a substitute for assessing tumour angiogenesis.     

Quantification of angiogenesis by functional computed tomography in a Matrigel model in rats

RATIONALE AND OBJECTIVES: The aim was to evaluate functional computed tomography (fCT) in the quantification of angiogenesis by comparing the tissue perfusion parameters measured by CT perfusion (CTP) software with histologic vascular parameters in a Matrigel model in rats. It was hypothesized that tissue perfusion parameters and histologic vascular parameters are related. MATERIALS AND METHODS: In vivo angiogenesis assays were performed using Matrigel supplemented with escalating doses (0 ng [control group], 250 ng, and 1,000 ng) of recombinant rat vascular endothelial growth factor (VEGF164) subcutaneously injected into the backs of Sprague Dawley rats. On day 7, rats with Matrigel plug underwent fCT following a bolus injection of iodinated contrast medium. Using CTP software, fCT parameters were generated (blood flow [BF], blood volume [BV], mean transit time, and permeability-surface area product) and functional maps on the basis of a distributed parameter tracer kinetic model, the adiabatic approximation to the tissue homogeneity model. The animals were then sacrificed. Matrigel plug was sectioned into slices corresponding to the CT scan plane and stained with CD31 immunohistochemical stain. Histologic vascular parameters, including microvascular density (MVD), vessel number (VN), vascular area, and vascular perimeter, were measured. CTP and histologic parameters were correlated. RESULTS: The Matrigel plugs with the 1,000-ng VEGF group exhibited a higher MVD than the 250-ng VEGF and control groups (P < .05). VN differed significantly between the control versus the 250-ng VEGF groups and 250-ng versus 1,000-ng VEGF groups (P < .05), with the highest VN in the 250-ng VEGF group. BF, mean transit time, and permeability-surface area product each differed significantly to VEGF levels. Changes in BF and BV did not correspond with increases in MVD or VN; however, in the 250-ng VEGF group, there was a strong positive correlation (r = 0.9) between BV and VN, vascular area, and vascular perimeter, which was not seen in the control or 1,000-ng VEGF group. All fCT parameters significantly correlated with each other (P < .05), with strong correlations between BF and mean transit time (r = -0.7) and between BF and permeability-surface area product (r = 0.7) and a weak correlation between BF and BV (r = 0.3). CONCLUSION: These results validate the VEGF-induced endothelial cell in a rat Matrigel model. In addition, histologic vascular parameter MVD does not correlate with fCT parameters measured by CTP software.     

血管内皮生长因子及其受体在大肠癌中的表达及其意义

目的　探讨血管内皮生长因子 (VEGF)及其受体 (FLT ,FLK 1)在大肠癌组织中的表达及其对肿瘤新生血管生成及转移的影响。方法　应用免疫组化技术 ,检测 75例人大肠癌组织VEGF ,FLT ,FLK 1的表达和微血管密度 (MVD) ,并分析其与病理分型分级、浸润深度、淋巴结、淋巴管和血管转移相关性。结果　VEGF ,FLT ,FLK 1主要表达于癌浸润边缘和坏死组织周围。FLT表达于癌细胞膜和 (或 )细胞质 ,而FLK 1则只表达于细胞质。VEGF ,FLK 1强阳性组 ( )MVD计数增多 (P均 <0 .0 5 ) ;淋巴结转移组VEGF ,FLT ,FLK 1强阳性表达例数增多 (P <0 .0 5 )。结论　大肠癌VEGF ,FLT及FLK 1表达增强在肿瘤血管生成和侵袭转移中有重要作用。     

MRI与CT在鼻咽癌诊断中的应用价值及分期系统比较

目的 评价MRI与CT检查在鼻咽癌诊断中的应用价值,并对鼻咽癌2008年分期、1992年福州分期及2002年国际抗癌联盟(UICC)分期系统进行比较.方法 分析76例鼻咽癌初诊患者MRI和CT影像资料,依据2008年分期以MRI为标准,评价MRI与CT对鼻咽癌新分期的差异.并以MRI为标准,比较鼻咽癌不同分期系统间的差异.MRI与CT对肿瘤侵犯范围比较采用McNemar法检验.结果 MRI判断鼻咽癌翼内肌(22例)、翼外肌(15例)、颅底(35例)及颅内(11例)侵犯方面与CT(分别为24、11、32、6例)存在差异,但无统计学意义(P＞0.05);MRI在判断咽旁间隙侵犯(50例)、咽后组淋巴结转移(48例)、T1期(18例)、T2期(15例)、N0期(18例)、N1期(33例)上,与CT(分别为61、23、11、22、24、27例)不一致者分别为11例、25例、7例、7例、6例及6例,差异有统计学意义(P＜0.05).CT多显示的11例咽旁间隙侵犯,MRI证实5例为咽旁间隙受压,6例为咽后组淋巴结转移,而MRI较CT共多显示咽后组淋巴结转移25例,以上2点为引起T、N分期差异的主要原因.鼻咽癌2008年分期与1992年分期比较,T分期上升9例,下降1例,N分期上升16例,临床分期上升15例,下降1例;与2002年UICC分期比较,T分期上升7例,N分期上升10例,临床分期上升12例.结论 与鼻咽癌2008分期规定的MR检查比较,CT在显示病变咽旁间隙侵犯及咽后组淋巴结转移方面存在较大差异.相对于1992年分期及2002年UICC分期,鼻咽癌2008分期主要使肿瘤T、N分期上升、临床分期上升.