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背景与目的TNM分期系统广泛应用于非小细胞肺癌(non-smallcelllungcancer,NSCLC)患者的预后预测,但是由于同一分期内患者的生存期大不相同,应寻找更好的生物学预后指标。肿瘤新生血管的形成与肿瘤的进展及复发转移密切相关,但目前血管内皮生长因子(vascularendothelialgrowthfactor,VEGF)和肿瘤微血管密度(microvesseldensity,MVD)两种生物学指标与Ⅰ～Ⅱ期NSCLC预后的关系尚有较大争议。本研究检测了214例Ⅰ～Ⅱ期NSCLC组织中VEGF的表达和CD34标记的MVD的状况,探讨它们与Ⅰ～Ⅱ期NSCLC预后的关系。方法应用组织芯片技术和免疫组化法检测214例根治术后且术前未接受过放化疗等抗癌治疗的早期NSCLC患者(ⅠA期20例,ⅠB期137例,ⅡB期57例)组织中VEGF的表达和CD34标记的MVD的状况。结果VEGF的表达与性别、年龄、血型、病理类型、TNM分期无相关性(P>0.05)。MVD与年龄、病理类型相关(P<0.05);与性别、血型、TNM分期无关(P>0.05)。VEGF低表达组中和高表达组中CD34标记的MVD平均值分别为65.8±5.2和67.5±2.5;VEGF的表达与MVD无相关性(P>0.05)。MVD低值组与高值组总的5年生存率分别为60.0%和34.5%。单因素分析发现MVD值高的患者生存期较短(P=0.013)。进一步的Cox比例风险模型多因素分析也证明MVD(P=0.000)是影响预后的独立因素。结论早期非小细胞肺癌患者中CD34标记的MVD值高者的预后可能不良。
BACKGROUND & OBJECTIVE: The TNM staging system is widely used in predicting the prognosis of patients with non-small cell lung cancer (NSCLC). However, due to the large differences in the survival of patients in the same staging, better prognostic indicators should be sought. The formation of tumor neovascularization is closely related to tumor progression and recurrence and metastasis. However, the relationship between the two biological indexes of vascularendothelial growth factor (VEGF) and microvessel density (MVD) and the prognosis of stage Ⅰ ~ Ⅱ NSCLC There is much controversy. This study examined the expression of VEGF and CD34-labeled MVD in 214 cases of stage Ⅰ-Ⅱ NSCLC and their relationship with the prognosis of stage Ⅰ-Ⅱ NSCLC. Methods Tissue microarray technique and immunohistochemical method were used to detect the expression of 214 patients with early stage NSCLC after radical resection and without preoperative chemoradiotherapy (20 cases in stage IA, 137 cases in stage IB and 57 cases in stage IIB) VEGF expression and CD34-labeled MVD status. Results The expression of VEGF had no correlation with gender, age, blood type, pathological type and TNM stage (P> 0.05). MVD was related to age and pathological type (P <0.05), but not to sex, blood type and TNM stage (P> 0.05). The mean MVD of CD34 labeled in the low expression of VEGF group and high expression group were 65.8 ± 5.2 and 67.5 ± 2.5, respectively. There was no correlation between the expression of VEGF and MVD (P> 0.05). The overall 5-year survival rates for the MVD low and high groups were 60.0% and 34.5%, respectively. Univariate analysis found that patients with high MVD had shorter survival (P = 0.013). Multivariate analysis of further Cox proportional hazards models also demonstrated that MVD (P = 0.000) was an independent predictor of prognosis. Conclusion The prognosis of CD34-labeled MVD in patients with early-stage non-small cell lung cancer may be poor.