Hashizume Satoshi, Nagayasu Takeshi, Hayashi Tomayoshi, Hidaka Shigekazu, Tsuchiya Tomoshi, Tagawa Tsutomu, Yamasaki Naoya, Furukawa Katsuro, Matsumoto Keitaro, Miyazaki Takuro
Division of Surgical Oncology, Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
Lung Cancer. 2009 Sep;65(3):363-70. doi: 10.1016/j.lungcan.2008.12.014. Epub 2009 Jan 21.
Despite the recognition that lymphatic and blood vessel invasion is an important prognostic factor in lung cancer, there is no common definition for pathological evaluation of vessel invasion. The aim of the present study was to determine whether D2-40 immunostaining can increase the accuracy of detection of lymphatic vessel invasion and whether our new grading system of vessel invasion by "degree" could be used instead of conventional evaluation by "presence" for pathological stage IA non-small cell lung cancer (NSCLC).
The vessel invasion classification was re-evaluated in 221 recent paraffin-embedded sections of p-stage IA NSCLC stained by Hematoxylin-Eosin (HE), Elastica-Van-Gieson (EVG), and D2-40.
After re-assessment using D2-40 immunostaining, 41.2% (31 of 75) of ly1 cases by HE/EVG changed to ly0, and 14.9% (17 of 114) of ly0 cases by HE/EVG changed to ly1. Overall, 4 of 28 ly2 cases on conventional staining were changed to ly1, and 2 were changed to ly0 using D2-40 immunostaining. When the patients were divided into two groups by the presence of vessel invasion (v/ly0 vs. 1, 2, 3), there was no significant difference in cancer-specific survival (p=0.1107, 0.0875, respectively), while when they were divided according to degree of vessel invasion (v/ly0, 1 vs. 2, 3), there was a statistically significant difference (p=0.0038, p=0.0002, respectively). On multivariate analysis, lymphatic vessel invasion had a significant impact on cancer-specific survival (p=0.0061).
Our results suggest that D2-40 immunostaining provides a precise diagnosis of lymphatic vessel invasion, and our new grading system of vessel invasion by "degree" is accurate and has prognostic value in early lung cancer.
尽管人们认识到淋巴管和血管侵犯是肺癌的一个重要预后因素，但对于血管侵犯的病理评估尚无统一的定义。本研究的目的是确定D2-40免疫染色是否能提高淋巴管侵犯检测的准确性，以及我们新的按“程度”对血管侵犯进行分级的系统是否可用于替代对病理IA期非小细胞肺癌（NSCLC）采用“存在与否”的传统评估方法。
对221例近期石蜡包埋的p-IA期NSCLC切片进行苏木精-伊红（HE）、弹性纤维-范吉森（EVG）和D2-40染色，重新评估血管侵犯分类。
使用D2-40免疫染色重新评估后，HE/EVG判定为ly1的病例中有41.2%（75例中的31例）变为ly0，HE/EVG判定为ly0的病例中有14.9%（114例中的17例）变为ly1。总体而言，传统染色判定为ly2的28例病例中，4例使用D2-40免疫染色变为ly1，2例变为ly0。当根据血管侵犯的存在情况（v/ly0与1、2、3）将患者分为两组时，癌症特异性生存率无显著差异（p分别为0.1107、0.0875），而根据血管侵犯程度（v/ly0、1与2、3）分组时，存在统计学显著差异（p分别为0.0038、0.0002）。多因素分析显示，淋巴管侵犯对癌症特异性生存率有显著影响（p=0.0061）。
我们的结果表明，D2-40免疫染色可对淋巴管侵犯进行精确诊断，我们新的按“程度”对血管侵犯进行分级的系统准确且对早期肺癌具有预后价值。
