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目的探讨Ⅳ型胶原和基质金属蛋白酶-2(MMP2)、MMP9在胆囊癌血管生成拟态(VM)中的表达与意义。方法74例胆囊癌、胆囊腺瘤和慢性胆囊炎各10例病理标本及资料,应用免疫组织化学 Envision、SABC 法测定上述病变组织Ⅳ型胶原和 MMP2、MMP9表达,Kaplan-Meier生存曲线和 Cox 风险模型分析其与胆囊癌 VM 的相关性和临床意义。结果(1)在 VM(+)胆囊癌,Ⅳ型胶原表达明显低于、MMP2表达明显高于 VM(-)胆囊癌(P>0.01),MMP9则无差异。(2)Ⅳ型胶原与 VM(+)胆囊癌分化程度负相关;MMP2、MMP9与 VM(+)胆囊癌的 Nevin 晚期、侵犯浆膜、肝转移正相关,MMP2尚与 VM(+)胆囊癌的低分化和淋巴结转移正相关。(3)Ⅳ型胶原阳性和 MMP2、MMP9阴性 VM(+)胆囊癌患者术后5年生存期明显短于 VM(-)胆囊癌(P<0.01;P<0.05;P<0.01),MMP2阳性 VM(+)胆囊癌患者术后5年生存期亦明显短于 VM(-)胆囊癌。VM、Ⅳ型胶原是影响胆囊癌患者预后的独立因素。结论Ⅳ型胶原、MMP2分别与胆囊癌VM 呈负、正相关,MMP9与胆囊癌 VM 无关;Ⅳ型胶原和 MMP2可作为判断胆囊癌是否存在 VM 及VM 胆囊癌预后的重要指标。
Objective To investigate the expression and significance of type Ⅳ collagen and matrix metalloproteinase-2 (MMP2) and MMP9 in vasculogenic mimicry (VM) of gallbladder carcinomas. Methods Totally 74 cases of gallbladder carcinoma, gallbladder adenoma and chronic cholecystitis were collected from 10 cases of pathological specimens. The expressions of type Ⅳ collagen, MMP2, MMP9, Kaplan-Meier survival and Cox were determined by immunohistochemistry Envision and SABC Model analysis of its relevance and clinical significance of gallbladder cancer VM. Results (1) The expression of type Ⅳ collagen in VM (+) gallbladder carcinoma was significantly lower than that in VM (-) gallbladder carcinoma (P> 0.01), while the expression of MMP9 was no difference. (2) There was a negative correlation between type IV collagen and the degree of differentiation of VM (+) gallbladder carcinoma; MMP2, MMP9 was positively correlated with nevin in VM (+) gallbladder carcinoma, There was a positive correlation between poor differentiation and lymph node metastasis. (3) The survival of patients with type Ⅳ collagen and MMP2, MMP9 negative VM (+) gallbladder cancer after 5 years was significantly shorter than that of VM (-) gallbladder cancer (P <0.01; P <0.05; P <0.01) The 5-year survival of patients with VM (+) gallbladder cancer was also significantly shorter than that of VM (-) gallbladder cancer. VM, type Ⅳ collagen is an independent factor affecting the prognosis of patients with gallbladder cancer. Conclusion The expressions of type Ⅳ collagen and MMP2 are negatively and positively correlated with gallbladder carcinoma VM respectively. MMP9 is not associated with gallbladder carcinoma VM. Type Ⅳ collagen and MMP2 can be used as important markers to determine the prognosis of gallbladder carcinoma and VM gallbladder carcinoma.