Murray J D, Carlson G W, McLaughlin K, Pennington M, Lynn M, DeRose P B, Williams J K, Cohen C
Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA.
Am J Surg. 1997 Nov;174(5):523-6. doi: 10.1016/s0002-9610(97)00168-2.
Lymph node metastasis is the single greatest predictor of recurrence in laryngeal cancer. Prognostic factors are needed to target patients who may benefit from adjuvant therapy. Tumor angiogenesis correlates with metastasis in breast, bladder, and oral cavity cancer and may have prognostic value in other tumors.
In order to examine the relationship of tumor angiogenesis to recurrence, 51 patients with squamous cell carcinoma of the larynx were reviewed. In a blinded design, previously sectioned slides were chosen for advanced tumor and highest vessel concentration. Samples were cut and immunocytochemically stained for CD-31 (an endothelial marker). A computer image analyzer quantitated the percent area of staining. Variables were statistically examined against recurrence.
Patients were stratified by percent tumor staining. Nodal involvement was seen in 9 (36%) patients with tumor staining < or = 20% and in 20 (77%) with tumor staining > 20% (P = 0.003). Patients with < or = 20% staining and without metastasis had a 13% rate of recurrence whereas patients with > 20% staining and without metastasis had a 67% rate of recurrence (P = 0.025).
Though nodal status was suggestive of predictability, only angiogenesis is a statistically significant predictor of recurrence in node negative patients (P = 0.025). Angiogenesis shows strong correlation with regional recurrence and may be used as an independent prognostic indicator to determine clinically node negative patients who may be at higher risk for metastasis and require adjuvant therapy.
淋巴结转移是喉癌复发的唯一最重要预测因素。需要有预后因素来确定可能从辅助治疗中获益的患者。肿瘤血管生成与乳腺癌、膀胱癌和口腔癌的转移相关，并且可能在其他肿瘤中具有预后价值。
为了研究肿瘤血管生成与复发之间的关系，对51例喉鳞状细胞癌患者进行了回顾性分析。采用盲法设计，选择先前切片的载玻片用于观察晚期肿瘤和最高血管密度区域。将样本切片并进行免疫细胞化学染色以检测CD-31（一种内皮标志物）。使用计算机图像分析仪对染色面积百分比进行定量分析。对各变量与复发情况进行统计学检验。
根据肿瘤染色百分比对患者进行分层。肿瘤染色≤20%的患者中有9例（36%）出现淋巴结受累，而肿瘤染色>20%的患者中有20例（77%）出现淋巴结受累（P = 0.003）。染色≤20%且无转移的患者复发率为13%，而染色>20%且无转移的患者复发率为67%（P = 0.025）。
虽然淋巴结状态提示具有一定的预测性，但只有血管生成是淋巴结阴性患者复发的统计学显著预测因素（P = 0.025）。血管生成与区域复发密切相关，可作为独立的预后指标，以确定临床上淋巴结阴性但可能有较高转移风险且需要辅助治疗的患者。
