肝内与肝门部胆管癌临床病理学的差异性研究

摘要

目的 探讨肝内(ICC)与肝门部胆管癌(HCCA)临床病理学特征及肿瘤相关蛋白表达的差异.方法 回顾性分析86例ICC和75例HCCA患者临床病理资料；免疫组织化学SP法观察肿瘤相关蛋白Her-1、Her-2、P170、VEGF、突变型P53、Ki-67、Top-Ⅱα的表达情况；Kappa法检验Ki-67、Top-Ⅱα对肿瘤细胞增殖程度的检验效果.结果 两组肿瘤的分化程度、淋巴结转移率、神经浸润发生率及VEGF阳性表达率之间的差异有统计学意义(各P值均＜0.05)；肿瘤相关蛋白Her-1、Her-2、P170、突变型P53蛋白阳性表达率之间的差异无统计学意义(各P值均＞0.05)；Ki-67、Top -Ⅱα对HCCA细胞增殖程度的检验效果一致性较好(K =0.468),但对ICC的检验效果一致性差(K=0.291).结论 肝内胆管细胞癌VEGF阳性表达率高,肿瘤恶性程度更高；肝门部胆管癌更易发生局部淋巴结转移和神经浸润；肿瘤相关蛋白的表达与病理特征密切相关,可作为评价胆管癌生物学特性的指标.%Objective To investigate the difference in expression of tumor associated proteins and pathological characteristics between hilar cholangiocarcinoma (HCCA) and intrahepatic cholangiocarcinoma (ICC). Methods 75 patients with HCCA and 86 patients with ICC were reviewed, and the expression of protein Her-1, Her-2, PI70, VEGF, mutant P53, Ki-67, and Top- H α were detected by immunohistochemical method. Concordance of protein Ki-67 and Top- II α in detecting tumor proliferation was analyzed by Kappa method. Results There was statistic significance in differentiated grade and lymph node metastasis and perineural invasion and positive expression of VEGF in the two groups ( P <0. 05). While no significant difference was detected in expression of protein Her-1, Her-2, PI70 and mutant P53 ( P > 0. 05). There was a good concordance between Ki-67 and Top- II α in detecting proliferation of tumor cells in HCCA through Kappa analysis (K = 0.468) , while a poor concordance was present in ICC (K = 0.291). Conclusions ICC has higher level of expression of VEGF, while HCCA has higher probability of lymph node metastasis and perineural invasion. The expression of tumor associated proteins is closely related with pathological characteristics and they can be used to evaluate the characteristics of oncobiology in cholangiocarcinoma.