作者：陈松耀1，缪娜波2，李展宇1，陈创奇1，王天宝3

单位：1.中山大学附属第一医院 胃肠外科中心，广东 广州 510080； 2.中山大学附属第一医院 病理科，广东 广州 510080； 3.中国医学科学院肿瘤医院深圳医院 胃肠外科，广东 深圳 518116

Authors:  CHEN Songyao1, MIU Nabo2, LI Zhanyu1, CHEN Chuangqi1, WANG Tianbao3

Unit:  1.Department of Gastrointestinal Surgery, First Affiliated Hospital of Sun Yat -sen University, Guangzhou 510080, Guangdong, China； 2.Department of Pathology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, Guangdong, China； 3.Department of Gastrointestinal Surgery, Cancer Hospital Chinese Academy of Medical Sciences, Shenzhen Center, Shenzhen 518116, Guangdong, China

摘要：

目的 辅助化疗的取舍是Ⅱ期结直肠癌全程管理中的一个重要组成部分,目前对辅助化疗的生存获益仍存在较多争议。本研究旨于探讨肿瘤组织中CD105标记的微血管密度(Microvessel density, MVD)对Ⅱ期结直肠癌预后的影响。材料与方法 回顾性分析中山大学附属第一医院2004年9月至2012年7月胃肠外科中心术后病理确诊为Ⅱ期结直肠癌的病例160例,另选取10例正常大肠黏膜组织,免疫组化检测CD105-MVD,比较两者MVD的差异。用Kruskal-Wallis检验CD105-MVD与临床病理因素之间的关系。通过ROC曲线将病例划分为CD105-MVD高低组。采用Kaplan-Meier法分析两组之间预后的差异。使用单因素和多因素Cox比例风险回归分析影响患者生存的独立风险因素。结果 结直肠癌组织中CD105-MVD明显高于正常大肠黏膜组织(P<0.01)。通过ROC曲线发现,CD105-MVD预测Ⅱ期结直肠癌术后复发转移的界值为19.9。CD105-MVD低组较高组更容易出现复发转移。CD105-MVD与Ⅱ期结直肠癌T分期、检获淋巴结数目有显著统计学差异(P<0.05)。Ⅱ期结直肠癌CD105-MVD高低组间的肿瘤相关生存时间比较无显著性统计学差异(P=0.132),无病生存时间之间比较虽无显著性差异(P=0.074),但提示可能存在较大的差别。对Ⅱ期结直肠癌患者DFS行多因素Cox分析显示,CD105-MVD≥19.9 (HR=0.492, 95%CI:0.268-0.904, P=0.022)。结论 本研究发现肿瘤组织中CD105-MVD可能是Ⅱ期结直肠癌患者DFS的独立预后因素,未来需要多中心更大样本研究来证实本研究结果。

关键词：  CD105; 微血管密度; 预后; Ⅱ期结直肠癌

Abstract：

Objective  The choice of adjuvant chemotherapy is an important part of the overall management of stage II colorectal cancer. The survival benefits of adjuvant chemotherapy still controversial. The purpose of this study was to investigate the prognostic value of CD105-labled tumor microvessel density (MVD)in stage II colorectal cancer. Materials and Methods 160 patients undergoing radical resection surgery for pathological TNM stage II colorectal cancer, between September 2004 to July 2012 in the First Affiliated Hospital of Sun Yat-sen University, were included. CD105-MVD was detected in 10 normal colorectal mucosa tissues. Kruskal-Wallis test was used to compare the difference of CD105-MVD between normal colorectal mucosa and tumor tissue. Kruskal-Wallis was used to examine the relationship made to divide the cases into CD105-MVD high and low groups. We used Kaplan-Meier method to show the differences of prognosis between the two groups. Univariate and multivariate Cox proportional hazards models to analyze independent risk factors affecting patient survival. Results CD105-MVD in colorectal cancer tissues was significantly different from that in normal colorectal mucosa tissues (P<0.01). There were no significant differences in gender, size of tumors, T stage, general type of tumors, histological type, differentiation degree, intestinal obstruction between two groups(P>0.05). By making ROC curve, it was found that the threshold value of CD105-MVD for predicting recurrence of stage II colorectal cancer was 19.9. Recurrence were more likely in the lower CD105-MVD group than higher CD105-MVD group. CD105-MVD was significantly correlated with T stage and lymph nodes detected in stage II colorectal cancer (P<0.05). There was no significant difference in CSS (P=0.132) between low CD105-MVD group and high CD105-MVD group in stage II colorectal cancer. Although there was also no significant difference in DFS (P=0.074), it may refer a big difference. Multivariate Cox analysis identified CD105-MVD (≥19.9) (HR 0.492, 95%CI: 0.268-0.904, P=0.022) as independent prognostic factors for DFS in patients with stage II colorectal cancer. Conclusions This study found that CD105-MVD may be an independent prognostic factor for DFS in patients with stage II colorectal cancer. In the future, a larger multicenter sample study is needed to confirm the results of this study.

Key Words:  CD105; Microvessel density; Stage II colorectal cancer; Prognosis