肝细胞肝癌中血管生成拟态的研究

目的探讨肝细胞肝癌（HCC）中是否存在血管生成拟态（VM），并进一步闸述VM存在的临床意义。方法收集99例手术切除并死于HCC临床资料和随访资料完整的病例，进行过碘酸雪夫氏反应（PAS）与CD31双重染色以及CD105、CD31、Hepatocyte免疫组织化学染色检测HCC中是否存在VM。结果12．12％（12／99）的患者HCC具有VM。Edmondson分级Ⅰ～Ⅱ级HCC中VM阳性率（2．5％）低于Ⅲ～Ⅳ级HCC中VM阳性率（18．64％）（x^2=4．416，P〈0．05）；VM组的国际癌症病期分期与无VM组的相比差异无统计学意义，但VM组更易于发生远处转移（x^2=8．873，P〈0．01）。Kaplan-Meier生存分析显示VM阳性组的生存率低于VM阴性组（P〈0．01）。结论HCC中存在VM，恶性度越高HCC形成拟态的能力越强。具有VM的HCC易发生转移，预后差。

A study on vasculogenic mimicry in hepatocellular carcinoma

Objectives To explore if vasculogenic mimicry (VM) exists in hepatocellular carcinoma (HCC) and to explain the clinical significance of VM. Methods Ninety-nine HCC resection specimens with complete clinical and prognostic data were collected. Immunohistochemical staining of CD31 and CD105, hepatocyte and PAS staining of the histological preparations were conducted to explore if VM exists in those HCC. Results 12.12% (12 specimens) of the 99 specimens exhibited evidence of VM. One of 40 HCC specimens (2.5%) which belong to Edmondson pathologic grade I-II exhibited VM; 11 of 59 HCC specimens which belong to Edmondson pathologic grade III-VI (18.64%) exhibited VM, the low differentiated HCC (gradeIII-VI) exhibited more VM specimens than the high differentiated HCC (grade I-II) (X2 = 4.416, P < 0.05). The biological behavior of VM was assessed and the stages of the cancers, using the TNM (tumor, node, metastases) classification criteria, were analyzed. These parameters of the VM and non-VM groups were compared. The mean TNM stage of the VM group was not more advanced than that of the non-VM group. The hematogenous metastases ( lung, bone, peritoneum et al) between the 2 groups were compared, and in the VM group the hematogenous metastasis rate was higher (X2= 8.873, P < 0.01 ). Kaplan-Meier actuarial survival curves were used to compare the VM group (n = 12) with the non-VM group (n= 87). Median survival time of the VM group was 9 months and that of the non-VM group was 31 months. The VM group had a lower survival rate than the non-VM group (P< 0.01). Conclusion VM exists in HCC, and the higher invasive HCCs exhibit more VM than the less invasive HCCs. The HCC patients in the VM group had a higher rate of hematogenous metastases, a lower survival rate, and a poorer prognosis.