局部晚期鼻咽癌原发灶ADC值与病理指标的相关性

发布时间：2018-11-15 13:23

【摘要】：摘要背景与目的肿瘤表观扩散系数(Apparent Dffusion Coefficient,ADC)值与多个部位肿瘤的放疗疗效具有一定的相关性。我们的前期研究也证实鼻咽癌原发灶ADC值的早期变化程度与近期疗效有明显相关，但其具体机制不明。为进一步探讨鼻咽癌原发灶ADC值变化的病理机制，我们分析鼻咽癌原发灶ADC值与肿瘤组织细胞密度、微血管密度及核增殖指数的相关性。材料与方法对2010年4月至2011年11月间接受调强放疗的局部晚期鼻咽癌患者，，分别于治疗前及放疗两周时行常规MRI及DWI检查，b值为0、800s/mm~2，测量鼻咽癌原发灶的ADC值。对鼻咽癌治疗前活检组织的病理切片进行HE染色及免疫组化染色，计算肿瘤细胞密度、微血管密度及核增殖指数。分析鼻咽癌治疗前的ADC值、放疗2周与治疗前ADC的差值与肿瘤细胞密度、微血管密度及核增殖指数的相关性。结果共79例鼻咽癌最终入组，T3期33例，T4期46例。鼻咽癌原发灶放疗前ADC值为(8.15±1.28)x10~(-4)mm~2/s (最小值5.24x10~(-4)mm~2/s--最大值12.1x10~(-4)mm~2/s)；放疗两周后ADC值为(13.32±2.44) x10~(-4)mm~2/s (最小值9.1x10~(-4)mm~2/s---最大值19.4x10~(-4)mm~2/s)；两个时间点ADC值的差值（5.16±2.33) x10~(-4)mm~2/s (最小值1.68x10~(-4)mm~2/s---最大值10.95x10~(-4)mm~2/s)）。鼻咽癌活检组织的肿瘤细胞密度为（54±19）%(最小值4%---最大值88%)，微血管密度为每高倍视野66.46±23.94个(最小值18个---最大值116个)，核增殖指数为6.89±3.18分(最小值0分---最大值12分)。鼻咽癌原发灶放疗前的ADC值与肿瘤细胞密度、微血管密度及核增殖指数的无明显相关性(P值分别为0.896、0.517和0.201。两个时间点的ADC值变化与肿瘤细胞密度呈负相关(r=-0.426，P＜0.001)；与微血管密度成正相关(r=0.429, P＜0.001)；与核增殖指数无明显相关(P=0.820)。放疗前ADC值与年龄、T分期呈线性相关，与细胞密度、微血管密度、核增殖指数、是否化疗、病理类型无线性相关；两个时间点的ADC值变化与细胞密度、CD34及年龄呈线性相关。结论鼻咽癌放疗早期的ADC值变化程度可能与肿瘤细胞密度和微血管密度有关，这可能是其预测放疗疗效的病理学基础。
[Abstract]:Background and objective the apparent diffusion coefficient (Apparent Dffusion Coefficient,ADC) of tumor was correlated with the radiotherapy effect of multiple tumors. Our previous study also confirmed that the early change of ADC in primary nasopharyngeal carcinoma was significantly correlated with the recent curative effect, but the specific mechanism was unclear. In order to further investigate the pathological mechanism of ADC changes in primary nasopharyngeal carcinoma (NPC), we analyzed the correlation between ADC value and tumor cell density, microvessel density and nuclear proliferation index in primary nasopharyngeal carcinoma (NPC). Materials and methods patients with locally advanced nasopharyngeal carcinoma receiving indirect intensity modulated radiotherapy from April 2010 to November 2011 were examined by routine MRI and DWI before treatment and two weeks after radiotherapy. The b value was 0.800s / mm2. The ADC values of primary nasopharyngeal carcinoma (NPC) were measured. HE staining and immunohistochemical staining were used to calculate tumor cell density, microvessel density and nuclear proliferation index. The ADC value before treatment and the correlation between the difference of ADC and tumor cell density, microvessel density and nuclear proliferation index in 2 weeks after radiotherapy and before treatment were analyzed. Results there were 79 cases of nasopharyngeal carcinoma, 33 cases in T3 stage and 46 cases in T 4 stage. The ADC value of primary nasopharyngeal carcinoma before radiotherapy was (8.15 卤1.28) x 10 ~ (-4) mm~2/s (the minimum value was 5.24 x 10 ~ (-4) mm~2/s-- 12.1x10 ~ (-4) mm~2/s). The ADC value was (13.32 卤2.44) x 10 ~ (-4) mm~2/s (minimum value 9.1 x 10 ~ (-4) mm~2/s- 19.4 x 10 ~ (-4) mm~2/s) after two weeks of radiotherapy. The difference of ADC value between two time points (5.16 卤2.33) x 10 ~ (-4) mm~2/s (minimum value 1.68 x 10 ~ (-4) mm~2/s- maximum 10.95 x 10 ~ (-4) mm~2/s).) The cell density of nasopharyngeal carcinoma biopsy tissue was (54 卤19)% (the minimum value was 4-88%), and the microvessel density was 66.46 卤23.94 (minimum 18-maximum 116) per high power field. The nuclear proliferation index was 6.89 卤3.18 (minimum 0-maximum 12). There was no significant correlation between ADC value and tumor cell density, microvessel density and nuclear proliferation index (P = 0.896, 0.517 and 0.201, respectively) before radiotherapy in primary nasopharyngeal carcinoma. The changes of ADC were negatively correlated with tumor cell density (r = -0.426, P < 0.001), positively correlated with microvessel density (r = 0.429, P < 0.001), and not correlated with nuclear proliferation index (P < 0. 820). There was no linear correlation between ADC value and age, T stage, cell density, microvessel density, nuclear proliferation index, chemotherapy or not, and pathological type. The changes of ADC value at two time points were linearly correlated with cell density, CD34 and age. Conclusion the changes of ADC in early stage of radiotherapy may be related to tumor cell density and microvessel density, which may be the pathological basis for predicting the therapeutic effect of radiotherapy for nasopharyngeal carcinoma.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R739.63

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