大肠癌患者肿瘤相关血管中胰岛素受体表达及其与肿瘤组织病理学特征的关系

目的: 研究肿瘤相关血管中胰岛素受体（IR）在伴或不伴代谢综合征（MS）大肠癌患者中的表达及其与大肠癌病理特征之间的关系。方法: 采用组织芯片结合免疫组织化学技术检测220例根治性切除大肠癌患者肿瘤相关血管中IR表达，分析在伴和不伴MS两类患者肿瘤相关血管中IR表达与大肠癌病理学特征（病理学亚型、组织学分级、浸润深度、淋巴结转移和TNM分期）之间的关系。结果: IR在正常大肠组织血管内皮细胞中呈阴性表达，而在大肠癌组织及其与正常交界区血管内皮细胞中呈阳性表达。伴MS患者肿瘤相关血管中IR高表达检出率低于不伴MS的患者（分别为21.6%和41.0%，P < 0.05）。肿瘤相关血管中IR高表达与肿瘤深部浸润、淋巴结转移、高TNM分期相关（P < 0.05或P < 0.01），肿瘤相关血管中IR高表达可增加肿瘤深部浸润风险（OR=2.21，95% CI：1.10~4.44，P < 0.05）、淋巴结转移风险（OR=2.21，95% CI：1.26~3.86，P < 0.01）和高TNM分期风险（OR=2.08，95% CI：1.19~3.63，P < 0.05）。上述相关性可存在于不伴MS患者中，在伴MS的患者中未体现。结论: 血管内皮细胞IR高表达与肿瘤浸润、转移等侵袭性特征相关，可作为大肠癌患者，特别是不伴MS大肠癌患者预后判断的潜在指标。

Expression of tumor-associated vascular insulin receptor in colorectal cancer and its relationship with tumor pathological features

Objective: To study the expression of tumor associated vascular insulin receptor (TVIR) in colorectal cancer with or without metabolic syndrome (MS) and its relationship with the pathological features of colorectal cancer. Methods: The expression of TVIR in 220 colorectal cancer specimens was detected by tissue microarray and immunohistochemistry. The relationships between the expression of TVIR and the pathological features (pathological subtypes, histological grade, invasion depth, lymph node metastasis and TNM stage) of colorectal cancer with/without MS were analyzed. Results: The insulin receptor expression was observed in colorectal cancer tissue or border area between cancer and normal tissue, but not in normal intestinal tissue. The high-expression rates of TVIR in MS group was remarkably lower than that of non-MS group (21.6%vs. 41.0%, P < 0.05). TVIR high expression was significantly associated with tumor deep invasion, lymph node metastasis and high TNM stage (P < 0.05 or P < 0.01). Univariate logistic regression analysis showed high-expression of TVIR to be significantly associated with risk of deep invasion (OR=2.21, 95% CI: 1.10-4.44, P < 0.05), lymph node metastasis (OR=2.21, 95% CI: 1.26-3.86, P < 0.01) and high TNM stage (OR=2.08, 95% CI: 1.19-3.63, P < 0.05). Such associations can be observed in patients without MS, but not in patients with MS. Conclusions: High-expression of TVIR is associated with aggressive pathological features such as invasion, lymph node metastasis and high TNM stage of colorectal cancer, especially for those patients without MS. TVIR could be a useful biological marker for prognosis of colorectal cancer.