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目的探讨原发性胆囊癌患者是否存在血管生成拟态(VM)及其 VM 存在的临床意义。方法收集1994年1月至2000年12月期间同济大学附属同济医院收治的74例经手术切除和病理确诊的原发性胆囊癌患者病理标本及相关临床病理参数和预后指标;应用 HE 染色、CD_(31)和 PAS双重染色,观察胆囊癌患者是否存在 VM,并作上述相关参数的单因素分析、Kaplan-Meier 生存比较和Cox 风险模型分析。结果在74例胆囊癌患者中发现13.5%(10/74)存在 VM。胆囊癌 VM 与患者性别、年龄、肿瘤部位、瘤体大小、分化程度、Nevin 分期、浸润深度、局部淋巴转移无关;但与组织类型(x~2=10.241,P=0.017)、肝转移(x~2=11.904,P=0.001)和生存期(x~2=5.7221,P=0.0168)有关。Cox 分析表明,VM(F=24.0508,P=0.0001,相对危险度=11.868)和浸润深度、淋巴结转移、肝转移、手术方式(姑息手术)一样,是影响胆囊癌患者预后的独立的危险因素。结论人原发性胆囊癌存在VM,有 VM 存在的胆囊癌患者,易发生血行转移,预后差。
Objective To investigate the clinical significance of the presence of vasculogenic mimicry (VM) and its presence of VM in patients with primary gallbladder cancer. Methods 74 patients with primary gallbladder cancer who underwent resection and pathology were collected from Tongji Hospital affiliated to Tongji University from January 1994 to December 2000. The pathological specimens and related clinicopathological parameters and prognostic indicators were collected. HE staining, (31) and PAS double staining to observe the presence or absence of VM in patients with gallbladder cancer. Univariate analysis, Kaplan-Meier survival comparison and Cox risk model were used to analyze the above parameters. Results In 74 gallbladder cancer patients, 13.5% (10/74) of VMs were found. The gallbladder carcinoma VM had no correlation with the gender, age, tumor location, tumor size, differentiation degree, Nevin stage, depth of invasion, and local lymph node metastasis. However, ~ 2 = 11.904, P = 0.001) and survival (x ~ 2 = 5.7221, P = 0.0168). Cox analysis showed that VM (F = 24.0508, P = 0.0001, relative risk = 11.868) was an independent risk factor for the prognosis of patients with gallbladder cancer, as was the depth of invasion, lymph node metastasis, liver metastases and surgical procedures (palliative surgery). Conclusions The presence of VM in human primary gallbladder cancer and the presence of VM in gallbladder cancer patients are prone to metastasis of blood with poor prognosis.