淋巴管癌栓和血管癌栓对非小细胞肺癌预后的影响

Prognostic impact of blood vessel invasion and lymphatic invasion on non-small cell lung cancer

关键词:  非小细胞肺癌  脉管癌栓  血管癌栓  淋巴管癌栓  预后

Key words:  [Key words]　non-small cell lung cancer  lymphovascular invasion  blood vessel invasion  lymphatic vessel invasion  prognostic

摘要:

[摘要]　脉管癌栓是指镜下发现肿瘤的小静脉、小动脉或小淋巴管的管壁受侵、破坏或管腔内有瘤栓，由此又可分为血管癌栓和淋巴管癌栓。目前研究表明，脉管癌栓是非小细胞肺癌的预后不良因子，其易导致肺癌发生早期复发及转移，据统计发现具有脉管癌栓的患者其无复发生存期（RFS）和总生存期（OS）均低于不具有脉管癌栓的患者，但此结果是由于血管癌栓作用还是淋巴管癌栓作用仍存在争议。据目前国内外文献报道，术前高分辨率CT和CEA水平可预示脉管癌栓发生的几率，其促进早期肺癌发生复发及转移的机制可能与血管内皮生长因子（VEGF）表达上调、集群孤立肿瘤细胞（ITCs）的存在等有关，在行免疫组化时，建议用CD34抗体标记血管癌栓，用D2-40抗体标记淋巴管癌栓。同时建议行病理诊断时对血管癌栓和淋巴管癌栓进行鉴别，建议脉管癌栓纳入NSCLC的TNM分期中，重新评估ⅠA期具有脉管癌栓的患者是否需行术后辅助化疗。

Abstract:

[Abstract]　Lymphovascular invasion is defined as tumor growth around the vessel, destruction of vascular wall or intravascular tumor thrombi formation. It can be divided into blood vessel invasion (BVI) and lymphatic vessel invasion (LVI). Recent studies have demonstrated that lymphovascular invasion is a poor prognostic factor of non-small cell lung cancer (NSCLC). It increases the risk of early recurrence and metastasis. Patients with lymphovascular invasion have lower relapse-free survival (RFS) and overall survival (OS) than patients without lymphovascular invasion. However, it remains controversial if this result is due to the role of BVI or LVI. According to domestic and international literatures, preoperative high resolution computed tomography (CT) and CEA levels can predict the possibility of lymphovascular invasion, which promotes early recurrence and metastasis of NSCLC by such mechanisms as VEGF up-regulation, the existence of ITCs and so on. It is recommended to use anti-CD34 to mark BVI and anti-D2-40 to mark LVI by immunohistochemistry. It is also suggested to separate BVI from LVI upon and incorporate lymphovascular invasion into the new edition of the TNM classification. Furthermore, the need for postoperative adjuvant chemotherapy in patients with stage IA NSCLC should be re-evaluated.