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標題: | 舌鱗狀細胞癌的神經侵犯與神經生長因子表現 Perineural invasion and expression of nerve growth factor in oral tongue squamous cell carcinoma |
作者: | Wei-Ren Shen 沈威任 |
指導教授: | 江俊斌 |
關鍵字: | 口腔,舌,鱗狀細胞癌,神經侵犯,神經生長因子, oral,tongue,squmamous cell carcinoma,perineural invasion,nerve growth factor, |
出版年 : | 2013 |
學位: | 碩士 |
摘要: | 背景:
神經侵犯常見於舌鱗狀細胞癌。過去研究顯示神經侵犯不論在神經親合性高或低的腫瘤,都可以預測癌症患者的預後。神經生長因子(NGF)是促進神經侵犯的可能因子之一,並且它與癌細胞的增生、血管生成和基質破壞有關。 方法: 研究對象為116例T1-T4舌鱗狀細胞癌。重新覆閱hematoxylin & eosin染色切片並先進行S-100免疫染色,偵測顯微鏡下潛在的神經侵犯病灶、數目,舌鱗狀細胞癌切片同時進行NGF免疫染色。 結果: 重新觀察hematoxylin & eosin染色切片尋找潛在的神經侵犯病灶,神經侵犯陽性病例的比率由21%有效提升至38%;之後在S-100免疫染色切片輔助下,陽性比率再提至51%。藉由多變數分析,腫瘤厚度高於5 mm (p = 0.003) 和腫瘤最高侵犯端形式(WPOI)等級4以上(p = 0.001) 與神經侵犯的存在相關。Kaplan-Meier存活曲線分析,神經侵犯陽性病例比起神經侵犯陰性病例,有較差的整體存活率 (log-rank test, p = 0.0352)。高神經親合性的腫瘤(神經內侵犯、高於三個神經侵犯病灶、神經侵犯病灶直徑大於0.2 mm),其NGF標定分數會比低神經親合性腫瘤(無神經內侵犯、一至三個神經侵犯病灶、神經侵犯病灶直徑0.2 mm以下)來得高。此外,在單變數分析,較高的T 分期或N 分級、較高的腫瘤厚度、鄰近或是陽性的腫瘤切除邊緣和神經侵犯陽性都與NGF高度表現相關,然而多變數分析之後,只剩下T 分期能夠預測NGF表現強度。Kaplan-Meier存活曲線分析,NGF高度表現的病例比起NGF低度表現病例,有較差的整體存活率(log-rank test, p = 0.0292)。 結論: 謹慎地重新觀察hematoxylin & eosin或是進行S-100免疫染色切片,能有效偵測腫瘤組織內潛在的神經侵犯病灶。腫瘤厚度超過5 mm以及腫瘤侵犯端過於分散表示舌鱗狀細胞癌很有可能有神經侵犯存在。NGF標定分數與舌鱗狀細胞癌的神經親合性有正向關係。腫瘤水平長度是NGF於舌鱗狀細胞癌細胞表現的獨立預測因子。神經侵犯和NGF表現強度,可以預測舌鱗狀細胞癌患者的預後。 Background: Perineural invasion (PNI) is commonly seen in oral tongue squamous cell carcinoma (OTSCC). PNI can predict the prognosis in malignancies of low or high neurotropism. Nerve growth factor (NGF), a potential neurotropic factor promoting the PNI, is associated with tumor cell proliferation, angiogenesis, and stromal destruction. Methods: PNI was detected by reevaluation of H&E-stained and anti-S-100 immunostained tissue sections in 116 T1 to T4 OTSCC specimens. Immunohistochemical staining for nerve growth factor (NGF) was also performed in these 116 OTSCC cases. Results: The PNI rate increased from 22% of the original report, through 38% after reevaluation of H&E-stained tissue sections, to 51% with the help of anti-S-100 immunostaining. Univariate analyses showed a significant association of the presence of PNI with higher T status or N status, greater tumor thickness, close and positive tumor section margin, and higher grade of worst pattern of invasion (WPOI). Tumor thickness (p = 0.003) and WPOI (p = 0.001) were identified as independent predictors for the PNI by multivariate analyses. OTSCC patients with PNI had a poorer overall survival than those without PNI (log-rank test, p = 0.0352). OTSCCs with higher neurotrposim (intraneural spread, >3 PNI foci in each tissue section, and PNI focus diameter > 0.2 mm) demonstrated higher NGF labeling score than those with lower neurotropism (non-intraneural spread, 1-3 PNI foci in each tissue section, and PNI focus diameter ≤ 0.2 mm). Moreover, higher NGF expression level in OTSCCs had a significant and positive relation to higher T status or N status, greater tumor thickness, close and positive tumor section margin, and the presence of PNI by univariate analyses. However, only higher T status (p = 0.047) was identified as an independent factor for prediction of NGF expression level by multivariate analyses. In addition, OTSCC patients with high NGF expression level exhibited poorer overall survival than those with low NGF expression level (log-rank test, p = 0.0292). Conclusion: Cautious reevaluation of H&E-stained and anti-S-100 immunostained tissue sections is an effective method to detect occult PNI. Tumor thickness greater than 5 mm and markedly discrete invasion front pattern are two important factors to predict the presence of PNI. NGF expression level has a positive relation to neurotropism of OTSCCs. Horizontal tumor dimension is an independent predictor for NGF expression level in OTSCCs. Both PNI and NGF expression level can predict the prognosis of OTSCC patients. |
URI: | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/62668 |
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顯示於系所單位: | 臨床牙醫學研究所 |
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