Evaluation Of Metastasis And Recurrence Of Nonsmall-cell Lung Cancer By MSCT Perfusion Imaging And The Related Mechanism Research

Objective:To discuss the relationship between CT perfusion(CTP) parameters and metastasis,recurrence of NSCLC.The findings of CTP were compared with of that of tumor angiogenesis and lymphagiogenesis in order to explain the mechanism of the results that CTP can evaluatie and predict the metastasis and recurrence of NSCLC.Materials and Methods:44 patients were bring into our research who were examined and got surgical treatment in the Thoracic Surgery department of xiangya hospital CSU between 2005 March and 2008 January,they were underwent CT perfusion scan by 16-slice spiral CT a week ago before surgical treatment.The correlation analysis were made between CTP parameters and clinicopathological features.The corresponding layers of tumor tissue specimens to the layer of CT perfusion scan of 22 cases were selected to perform pathological examination.Immunohistochemistry,special staining,electron microscop were performed to build a technology platform of tumor microvascular architecture phenotype(TMAP),including the morphology of microvessel and lymphatic microvessel,maturity and basement membrane's integrity of microvessel,density of microvessel and lymphatic microvessel (MVD,LMVD),expression of VEGF and PCNA in tumor tissues.The interrelations between CTP parameters,clinicopathological features and TMAP were analysised.Resluts:1.The relationship between CTP parameters and clinicopathological features.(1)The results of multivariate correlation analysis showed that there were significant correlation between BF and differentiation,P-TNM stage, lymph node metastasis,metastasis and recurrence of post-operation(p＜0.01).(2)The BF and PEI decreased with decreasing differentiation of NSCLC,comparison between groups showed that BF of well differentiated was more than that of moderate or poor differentiation,PEI of well or moderate differentiated was more than that of poor differentiation(p＜0.05).The BF and PEI of lymph node metastasis positive group was greater than that of negative group(p＜0.01).The BF of P-TNMⅠ+Ⅱgroup was greater than that of P-TNMⅢ+Ⅳgroup(p＜0.01).The BF of metastasis and recurrence of post-operation positive group was greater than that of negative group(p＜0.01)(3)The results of logistic regression analysis showed that BF was the predominant influencing factor of metastasis and recurrence of NSCLC post-operation(p＜0.01),the total right rate of this logistic regression equation was 86.4%.2.The relationship between TMAP and clinicopathological features. (1)The surrounding area MVD,the central area MVD and the total MVD significantly more than area at the junction of MVD(p＜0.05),the difference between the surrounding,central area or total MVD were not significant(p＞0.05).There were more uncomplete lumen MVD in the surrounding area than the central area(p＜0.05).The surrounding area LMVD＞the total LMVD and peritumoral lung tissues LMVD＞central area LMVD(p＜0.05).The multivariate correlation analysis of TMAP and the clinicopathological features showed that:there were significantly positive correlations between the uncomplete lumen of MVD,the surrounding area LMVD and degree of differentiation,lymph node metastasis(p＜0.01),no correlations between the uncomplete lumen of MVD,the surrounding area LMVD and pathological types,thoracic lymphadenectasis(p＞0.05).There were positive correlations between the uncomplete lumen MVD,the surrounding area LMVD and expression of VEGF,PCNA,respectively(p＜0.05).There were positive correlations between degree of differentiation and PCNA expression,lymph node metastasis,VEGF expression(p＜0.05).There were significantly positive correlations between lymph node metastasis and P-TNM stage,degree of differentiation,expression of PCNA(p＜0.01),positive correlations between lymph node metastasis and expression of VEGF(p＜0.05)(2)There were no significant differences in the MVD or LMVD of adenocarcinoma and squamous cell carcinoma(p＞0.05)(3)The microvascular basement membrane have a worse integrity with decreasing differentiation ofNSCLC(p＜0.01),and have no relation with pathological types(p＞0.05).There were positive correlations between integrity of microvascular basement membrane and lymph node metastasis(p＜0.05)3.The relationship between CTP parameters and TMAP.(1)The multivariate correlation analysis of CTP and TMAP showed that:there were significantly negative correlations between BF,PEI and the uncomplete lumen MVD(p＜0.01),negative correlations between BV and the uncomplete lumen MVD(p＜0.05),positive correlations between PEI and the total MVD(p＜0.05),no correlations between the total MVD and other CTP parameters,degree of differentiation(p＞0.05). There were negative correlations between expression of PCNA and BV or PEI(p＜0.05),significantly negative correlations between expression of PCNA and BF(p＜0.01)(2)There were negative correlations between BF and integrity of the microvascular basement membrane(p＜0.05)(3)There were no correlations between BF,BV,PEI,TTP and all LMVD(p＞0.05)Conclusion:(1)Perfusion parameters reflects the density difference of vascular with the mature functional lumen and integrity of microvascular basement membrane,exactly evaluates the differences of blood flow pattern in pulmonary space-occupying lesions,then to identify the degree of NSCLC differentiation; (2)The BF,BV,PEI,decreased with decreasing differentiation of NSCLC;The BF was the best CTP parameter of evaluating the degree of lung cancer differentiation because it had the best correlation with differentiation and didn't been influenced by body weight,cardiac output, blood volume.(3)The risk of NSCLC metastasis and recurrence increased with decreasing BF,it's mechanism was BF indirectly reflect regulation of a mesh structure of TMAP on microangiogenesis and lymphangiogenesis by evaluating the differentiation.(4)The CTP can provided useful information of tumor microangiogenesis and indirectly reflect lymphangiogenesis for evaluating the risk of metastasis and recurrence in NSCLC,so can help to establish the best chemotherapy project and improve the prognosis.