新生血管生成与肝细胞癌侵袭、转移和预后的关系

目的　探讨原发性肝细胞癌 (HCC)新生血管生成与临床病理指标的关系及其可否用于预测HCC侵袭、转移和预后。方法　采用免疫组织化学方法 ,检测了 2 0例正常肝组织、2 0例肝硬化组织、85例HCC及癌旁组织中CD34的表达 ,以及HCC的微血管密度 (MVD)。结果　CD34的染色定位在血管内皮细胞上 ,HCC窦样血管CD34表达为强阳性 ;除门管区小血管分支及中央静脉外 ,癌旁肝组织、肝硬化组织、正常肝组织基本不表达CD34 ;HCC的MVD范围 (18～ 36 0 ) / 0 74mm2 、(15 6 5±6 2 4) / 0 74mm2 。HCC的MVD与肿瘤大小、病灶数目、分化程度、门静脉瘤栓形成、包膜状况均有显著关系 (P <0 0 5或 0 0 1) ;与HBsAg是否阳性、术前AFP水平无关 (P >0 0 5 ) ;与预后亦有关 ,少血管组(MVD <15 6 )预后显著优于多血管组 (MVD≥ 15 6 ) ,术后平均无瘤生存期少血管组为 5 3个月 ,多血管组为 14个月 ,(P <0 0 0 1)。结论　CD34的表达反映了HCC的新生血管化 ,与HCC的发展有关。MVD可作为判断HCC侵袭、转移和预后的指标。

Relationship between tumor angiogenesis and invasion, metastasis and prognosis of hepatocellular carcinoma

Objective　To investigate the relationship between the tumor angiogenesis and the clinicopathological variables of hepatocellular carcinoma (HCC) and determine whether tumor angiogenesis can be used as an indicator for predicting invasion, metastasis and prognosis of HCC. Methods　Using the immunohistochemical S-P method, CD34 expression was detected in liver tissue from 20 normal individuals, 20 patients with liver cirrhosis and 85 patients with HCC and juxtacancerous tissues and the microvascular density (MVD) determined in those from 85 patients with HCC. Results　CD34 was mainly located in the cell cytoplasm of endothelial cells. The CD34 staining was confined to vessels in the portal triad in the above-mentioned various tissues. In HCC tissues, however, sinusoid-like vessels reacted intensively with anti-CD34 and the MVD was 156.5±62.4 (per 0.74 mm2). MVD was correlated to tumor size, number, differentiation, emboli in the portal vein and capsule (P<0.05 or 0.01) but not to HBsAg and AFP (P>0.05). It was also correlated with prognosis of HCC. The mean tumor-free survival of MVD ≥156 was 14 months while that of MVD <156 was 53 months (P<0.01). Conclusion　The expression of CD34 in sinusoid-like vessels in HCC tissues represents the neovascularization. Angiogenesis in HCC is associated with the progression of HCC. MVD can be used as an indicator to judge the invasion, metastasis and prognosis of HCC.