【作者】 史璐；

【导师】 汪说之； 陈新明；

【作者基本信息】 武汉大学 ， 口腔基础医学， 2004， 硕士

【摘要】 目的 研究小涎腺粘液表皮样癌（MEC）组织学分级、检测血管内皮生长因子（VEGF）的表达，计数CD₃₄标记的肿瘤内微血管密度（MVD）并分析它们间的关系及其与肿瘤临床分期和复发的关系。 材料与方法 收集1970—2002年武汉大学口腔医院经治并经病理确诊的小涎腺粘液表皮样癌121例，其中77例符合本次实验病例选择标准。复习临床资料，重新读片，采用Auclair提出的量化分级标准对本组病例行组织学分级。对其中47例有完整随访资料的病例行免疫组织化学S-P法，检测VEGF的表达、计数CD₃₄标记的肿瘤内微血管密度，并行统计分析。 结果 77例中Ⅰ级32例占41.6％，Ⅱ级24例占31.2％，Ⅲ级21例占27.2％。经x²检验临床分期与组织学分级有关（x²=12.065，P＜0.05）。临床分期、组织学分级与肿瘤复发均显著相关（P＜0.05，log-rank检验）。47例小涎腺MEC中MVD为27.73±8.72（15～56）／×200，MVD与组织学分级、临床分期及复发均显著相关（P＜0.05）。47例中37例VEGF染色阳性（78.7％）。不同组织学分级、临床分期间VEGF阳性表达率差异无显著性（P＞0.05），VEGF表达与肿瘤复发无明显相关（P＞0.05，log-rank检验）。VEGF阳性组MVD（30.85±8.42）明显高于阴性组（20.71±3.73），差异有显著性（t=5.655，P＜0.05），VEGF表达与MVD呈正相关（r_s=0.6，P＜0.05，Spearman）。 结论 应用Auclair提出的量化分级标准对小涎腺粘液表皮样癌行组织学分级有助于判断肿瘤的生物学行为。小涎腺粘液表皮样癌中肿瘤细胞能产生VEGF促进血管生成，计数以CD₃₄标记的肿瘤内微血管密度在小涎腺MEC病理学分级诊断中及对判断肿瘤的生物学行为有一定应用价值。更多还原

【Abstract】 Objective This study evaluated the prognostic importance of a quantitative grading system, the expression of vascular endothelial growth factor(VEGF) and intratumoral microvessel density (MVD , labeled by anti-human CD34 monoclonal antibody) in mucoepidermoid carcinoma(MEC) of intraoral salivary glands.Materials & Methods We have clinicopathologically reviewed 77 cases of MEC originating in intraoral salivary glands that were treated at Hospital of Stomatology of Wuhan University between 1970 and 2002. Following the methods of Auclair, a quantitative grading system was used. The expression of VEGF, intratumoral microvessel density (MVD, labeled by anti-human CD34 monoclonal antibody) in 47 cases with complete follow-up materials were examined immunohistochemically.Results The percentages were 41.6% for low-grade, 31.2% for intermediate-grade and 27.2% for high-grade tumors. The correlation between the TNM classification and the histologic grading was significant ( x 2=12.065, P<0.05). Both the TNM classification and the histologic grading were associated with an increased incidence of recurrence (P<0.05,log-rank test). MVD in 47 cases varied from 15~56 (27.73?.72) /x200. MVD was correlated with the histologic grading, the TNM classification and tumor recurrence(P<0.05). Positive staining for VEGF was obtained in 37 of the 47 cases (78.7%). No significant difference in VEGF expression was found among the groups. No correlation was noted between VEGF expression and recurrence(P>0.05, log-rank test). MVD was significantly higher in VGEF positive than in VGEF negative cases (30.85?.42, 20.71?.73, respectively; t=5.655, P<0.05). The correlation between the expression of VEGF and MVD was significant(rs=0.6, P<0.05, Spearman).Conclusions Our study confirms that in MEC of intraoral salivary glands, tumor grade subdividing cases into low , intermediate and high grade by using the criteria delineated by Auclair, correlates well with prognosis. In MEC of intraoral salivary glands, tumor cells can produce VEGF to stimulate angiogenesis. MVD, labeled by anti-human CD34 monoclonal antibody, might be useful in evaluating the histopathologic grading and prognosis of patients with MEC of intraoral salivary glands.更多还原