CAJ | 학술논문

目的探讨化疗对临床难以切除小儿实体肿瘤微血管密度(MVD)及血管内皮生长因子(VEGF)的影响.方法 2002年1月至2012年1月河北医科大学第二医院小儿外科收治的80例Ⅲb～Ⅳb期实体肿瘤患儿,经影像学及术前查体显示均为难以一期切除的恶性肿瘤,经肿瘤病理活检后分为神经母细胞瘤组25例,肝母细胞瘤组25例,肾母细胞瘤组30例.3种肿瘤患儿均按病理结果实施化疗后行手术切除.统计每组患儿的手术切除率,分别应用免疫组织化学法检测对比各组术前活检标本、手术后大体标本中MVD及VEGF的表达情况.结果化疗后各组手术切除率分别为神经母细胞瘤80.00％(20/25例),肝母细胞瘤92.00％ (23/25例),肾母细胞瘤96.67％(29/30例),各组间比较差异无统计学意义(x2=4.286,P=0.117).神经母细胞瘤、肝母细胞瘤、肾母细胞瘤化疗前VEGF阳性率分别为80.00％(20/25例)、90.00％(18/20例)和83.33％ (25/30例),MVD值分别为48.39±15.87、52.16±16.12和46.82±19.07.化疗后神经母细胞瘤、肝母细胞瘤、肾母细胞瘤各组VEGF阳性率分别为52.00％(13/25例)、45.00％(9/20例)和30.00％(9/30例),MVD值分别为31.31±14.21、25.19±15.31和29.06±13.05,与化疗前比较均有显著下降,差异均有统计学意义(P均＜0.05).结论术前化疗可有效提高临床上切除困难小儿实体恶性肿瘤的手术切除率,MVD值和VEGF可作为判断化疗疗效和能否提高手术切除率的评价指标.
목적 탐토화료대림상난이절제소인실체종류미혈관밀도(MVD)급혈관내피생장인자(VEGF)적영향.방법 2002년1월지2012년1월하북의과대학제이의원소인외과수치적80례Ⅲb～Ⅳb기실체종류환인,경영상학급술전사체현시균위난이일기절제적악성종류,경종류병리활검후분위신경모세포류조25례,간모세포류조25례,신모세포류조30례.3충종류환인균안병리결과실시화료후행수술절제.통계매조환인적수술절제솔,분별응용면역조직화학법검측대비각조술전활검표본、수술후대체표본중MVD급VEGF적표체정황.결과 화료후각조수술절제솔분별위신경모세포류80.00％(20/25례),간모세포류92.00％ (23/25례),신모세포류96.67％(29/30례),각조간비교차이무통계학의의(x2=4.286,P=0.117).신경모세포류、간모세포류、신모세포류화료전VEGF양성솔분별위80.00％(20/25례)、90.00％(18/20례)화83.33％ (25/30례),MVD치분별위48.39±15.87、52.16±16.12화46.82±19.07.화료후신경모세포류、간모세포류、신모세포류각조VEGF양성솔분별위52.00％(13/25례)、45.00％(9/20례)화30.00％(9/30례),MVD치분별위31.31±14.21、25.19±15.31화29.06±13.05,여화료전비교균유현저하강,차이균유통계학의의(P균＜0.05).결론 술전화료가유효제고림상상절제곤난소인실체악성종류적수술절제솔,MVD치화VEGF가작위판단화료료효화능부제고수술절제솔적평개지표.
Objective To explore the influence and clinical significance of chemotherapy on the expressions of micro-vessel density (MVD) and vascular endothelial growth factor (VEGF) in pediatric difficult removal solid tumor.Methods From Jan.2002 to Jan.2012,totally 80 cases of the hospitalized pediatric patients with solid tumor (Ⅲ b-Ⅳb stage) were enrolled in this study in Department of Pediatric Surgery of the Second Hospital of Hebei Medical University.All of the tumors were identified as difficult removal malignant tumor by imageology and physical examinations.After biopsy of the tumors,these patients were divided into neuroblastoma group (25 cases),hepatoblastoma group (25cases) and Wilms' tumor group (30 cases).All patients in these 3 groups underwent chemotherapy respectively according to their different pathologic findings,thereafter,the tumor resections were performed.The resection rates of tumor in each groups were recorded and the expressions of MVD and VEGF between preoperative biopsy and postoperative specimens were detected and compared by immunohistochemistry in different groups.Results With chemotherapy,the resection rate of neuroblastoma was 80.00％ (20/25 cases),hepatoblastoma was 92.00％ (23/25 cases) and Wilms' tumor was 96.67％ (29/30 cases).There was no significant difference among them (x2 =4.286,P =0.117).Before chemotherapy,the positive expressions of VEGF in neuroblastoma,hepatoblastoma and Wilms' tumor were 80.00％ (20/25 cases),90.00％ (18/20 cases) and 83.33％ (25/30 cases) respectively,at the same time,the values of MVD were 48.39 ± 15.87,52.16 ± 16.12 and 46.82 ± 19.07.After chemotherapy,the expressions of VEGF and MVD in neuroblastoma,hepatoblastoma and Wilms' tumor were 52.00％ (13/25 cases),45.00％ (9/20 cases),30.00％ (9/30 cases) and 31.31 ± 14.21,25.19 ± 15.31 and 29.06 ± 13.05.Compared with the expressions of them in each group before chemotherapy,significant differences were found (all P ＜ 0.05).Conclusions Chemotherapy can efficiently promote the resection rate for pediatric difficult removal solid tumor.MVD and VEGF can be considered as the markers in evaluating the outcomes of chemotherapy and promoting the resection rate of tumors.