细胞凋亡、血管内皮生长因子与食管鳞癌淋巴结转移及预后的关系

目的探讨食管鳞癌组织中细胞凋亡、血管内皮生长因子（VEGF）的表达与临床病理及预后的关系。方法采用原位DNA末端标记（TUNEL法）、免疫组化（S-P法）及组织病理学等方法，检测61例原发性食管鳞癌组织中细胞凋亡、VEGF的表达。计算出凋亡指数（AI）并测出VEGF的平均吸光度，进行单因素和多因素COX分析。结果AI和VEGF吸光度（A）与肿瘤的分化程度、TNM分期有关。低分化程度组和高TNM分期组VEGF吸光度明显高于高分化程度组及低TNM分期组（P〈0．01），而其AI值明显低于高分化程度组及低TNM分期组（P〈0．01）。浸润深度超过肌层组及有淋巴结转移组VEGF明显高于浸润深度未超过肌层及无淋巴结转移组（P〈0．01），而AI与浸润深度无关（P〉0．05）。单因素分析结果显示患者生存率降低与AI、VEGF、TNM分期、淋巴结转移、分化程度和浸润深度有关。将上述指标进行多因素COX分析，结果显示AI、VEGF是独立的预后因素。结论细胞凋亡和血管形成参与了食管鳞癌的形成；VEGF与食管鳞癌的血管形成密切相关，其表达增高与食管鳞癌的浸润及淋巴结转移有关；AI、VEGF是食管鳞癌独立的预后因素。

The relationship between apoptosis, VEGF, lymph node metastasis and prognosis of squamous cell carcinoma of esophagus

Objective To investigate the relationship between apoptcsis, expressions of VEGF and clinicopathological characteris- tics, and prognosis in esophageal squamous cell carcinoma (ESCC). Methods Sixty-one surgical specimens of primary esophageal squa- mous cell carcinomas were examined for VEGF by immunohistochemical staining (S-P). Apoptcsis was determined by TUNEL (TdT media- ting dUTP-biotin nick end-labeling) method. Clinicopathologic features were examined by histopathology. The prognostic impacts of these pa- rameters were analyzed by univariate and survival analysis. Results AI and VEGF were well correlated with differentiation, TNM stage. Lower tumor differentiation and higher TNM stage were related to decreasing AI and VEGF. In addition, VEGF in the groups of invasion be- yond muscularis and lymph node metastasis is significant higher than that in invasion reaching muacularis and no lymph node metastasis (P <0.01). But there were no significant correlation between AI and invasion( P>0.05). The simple-factor analysis results showed that the decrease of AI, VEGF, lymph node metastases, lower tumor differentiation, and invasion reaching muscularis were related to decrease of sur- vival rate. However, multivariate Cox analysis demonstrated that only AI and VEGF were the significant prognostic factors. Conclusions Apoptosis and angiagenesis participate in ESCC and promote its growth. VEGF is related to angiogenesis of ESCC. The increase of VEGF may promote invasion and lymph node metastasis. AI and VEGF are significant prognostic factors in ESCC.