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目的:观察直肠癌组织及其远侧端黏膜中p53蛋白表达及微血管分布的情况并从分子病理学水平上探讨直肠癌的安全远侧切缘。方法:对45例中低位直肠腺癌下缘进行标记;PET/CT检查并结合半定量免疫组织化学方法对直肠癌的远侧端黏膜p53表达及CD34表达的微血管密度(MVD)进行了研究。结果:直肠癌及远侧端直肠黏膜均可见p53蛋白表达及微血管分布,直肠癌肿瘤组织中p53蛋白表达及MVD明显高于直肠癌远侧端的直肠黏膜组织。直肠癌远侧端黏膜p53蛋白表达及MVD随着距离增大而减少,但有显著性异常改变只在有限的长度内(直肠远侧端1.5cm),阴性对照中仍有p53蛋白表达和微血管分布。直肠癌远侧端黏膜中p53蛋白表达及MVD基本上与肿瘤大小、分期以及病理类型无关。结论:从分子病理学角度来界定,2cm的直肠远侧端长度是安全的远侧切缘。
OBJECTIVE: To observe the expression of p53 protein and the distribution of microvessels in rectal cancer tissue and distal mucosa and to explore the safe distal margin of rectal cancer from the molecular pathological level. Methods: 45 cases of low rectal adenocarcinoma were labeled with the lower margin. PET / CT and semi-quantitative immunohistochemistry were used to study the expression of p53 in distal mucosa and the expression of CD34 on MVD in rectal cancer. Results: The expression of p53 protein and the distribution of microvessels were observed in rectal cancer and distal rectal mucosa. The expression of p53 protein and MVD in rectal cancer tissues were significantly higher than those in rectal mucosa. The expression of p53 protein and MVD in the distal mucosa of rectal cancer decreased with increasing distance, but there was significant abnormal change only within a limited length (1.5 cm distal to the rectum) and p53 protein and microvessel in the negative control distributed. The expression of p53 protein and MVD in distal mucosa of rectal cancer were not related to tumor size, stage and pathological type. CONCLUSIONS: As defined by molecular pathology, the distal rectal length of 2 cm is a safe distal margin.