肝细胞癌血管生成及其成熟度的临床意义

目的 探讨肝细胞癌 (HCC)血管生成及其成熟度对其生物学行为的影响。方法 选取行手术切除并经病理证实的HCC病例31例，手术后分别在边缘和中心进行标本取材并综合分析。利用免疫组化技术检测VEGF、Flk-1、PCNA的表达情况，并对微血管和成熟血管的数目、平均面积、总面积、周长、直径、异型指数、血管间距、表达部位，以及动脉数、静脉数、动脉比、静脉比、血管成熟指数和平均灌注分数等进行计数。分析以上血管生成相关参数与病灶大小、Edmondson病理分级、包膜情况、肝硬化及侵袭转移的关系。结果 在小、中、大病灶之间，微血管总面积和成熟血管总面积均具有统计学差异(P<0.05)；在EdmondsonⅠ～Ⅳ级之间，灌注分数逐渐增加，也存在统计学差异(F=3.452, P=0.049)。有包膜病灶的成熟血管平均面积、成熟血管周长、成熟血管平均直径及成熟血管管距明显大于无包膜的病灶(P<0.05)；侵袭转移组的成熟血管异型指数也大于阴性组(t=2.260, P=0.039)。在有、无肝硬化组之间，所有血管相关参数未见统计学差异(P>0.05)。结论 HCC的一些生物学行为更多依赖肿瘤的成熟血管。

Angiogenesis and maturation of hepatocellular carcinoma

Objective:To explore the effect of angiogenesis and its maturation of hepatocellular carcinoma (HCC) on biological behavior. Methods In thirty-one cases of HCC proved by surgery and pathology two sections from the tumor periphery and center area were removed. Continuous slices were stained with immunohistochemistry of five antibodies against VEGF, Flk-1, PCNA, CD34 and α-smooth muscle actin (SMA). Expressions of VEGF, Flk-1, and PCNA, vessel numbers, mean area, overall area, circumference, diameter, distance between adjacent vessels (DAV), and variety index of microvessels and mature vessels were counted. The arterioles and veinlets, mature vessel index and mean perfused fraction (mPF) were also calculated. The relationships between the above vascular parameters and diameter, Edmondson′s grade, capsule of HCC and cirrhosis were analyzed. Results There were differences in the overall area of micro-vessels and mature vessels among different diameters of the lesions (P<0.05). The mPF gradually became higher with the increase of Edmondson′s grade, and a statistical difference was found (F=3.452, P=0.049). The mean area, circumference, diameter and DAV of mature vessels were more in tunicary lesions than in non-encapsulated ones (P<0.05). Also, the variety index of mature vessels was higher in the invasive group than in the non-invasive one (t=2.260, P=0.039). No differences in any vascular parameters were shown between the cirrhotic and non-cirrhotic groups (P>0.05). Conclusion Some behavior of HCC may depend more on the mature vessels than on the micro-vessels.