NCAM And NGF Expression In Cholangiocarcinoma And Significance

Cholangiocarcinoma is derived from epithelial cells of malignant bile duct system, nearlytwenty years, the incidence of cholangiocarcinoma tended to increase significantly. Mortalityin male patients with cholangiocarcinoma has increased to1972in1992to3.3/105.3/10WanWan, Wan women rose from the3.5/105.3/10million. Cholangiocarcinoma poor prognosis,the current laboratory tests for early diagnosis of malignant biliary system of little help. Bilecytology or histological examination can confirm the nature of disease, but the positive rate isnot high; imaging studies is difficult to detect early cancer, but it can help clear the site oflesion, size, scope and lymph node invasion and distant metastasis.Surgery is the only cure, iscurrently cholangiocarcinoma surgical methods are:①hilar bile duct, common bile duct andgallbladder removal, biliary-enteric anastomosis. Applicable to non-invasive liver substanceof the hepatic duct cancer.②liver side or add some leaves right anterior lobe liver bile duct,extrahepatic bile duct resection, biliary-enteric anastomosis. For cancer or hepatic ductconfluence of cholangiocarcinoma.③side lobe or left lobe of liver resection and hepatic bileduct, extrahepatic bile duct resection, biliary-enteric anastomosis. For the left hepatic duct andliver cancer Explorer.④side lobe or right lobe of liver resection and liver bile duct,extrahepatic bile duct resection, biliary-enteric anastomosis. Explorer for right hepatic ductand liver cancer.⑤over half of the liver or third hepatectomy liver bile duct, extrahepaticbile duct, part of the caudate lobe resection, biliary-enteric anastomosis. For left or righthepatic duct cancer invasion and two above the hepatic duct and caudate lobe hepatic duct.⑥palliative resection. Side lobe of liver and hepatic bile duct, extrahepatic bile duct resection,biliary-enteric anastomosis, and the remaining part of the cancer organizations such as thecaudate lobe hepatic duct or portal vein wall.⑦portal vein, confluence of the Department orby the offender about dry wall removal of the affected part of the vein wall re-reconstructionof vascular repair, adjuvant brachytherapy.⑧rate for hilar cholangiocarcinoma so surgery:biliary drainage is the preferred method of palliative surgery. According to the differentsurgical site and bile duct resection rate from32%to51%range,3years after radical surgerysurvival rate was40%-60%,5-year survival rate is less than20%. The vast majority of bileduct cancer recurrence after surgical resection easier, hilar metastases after resection of aclinical recurrence rate was73.9%annual,3-year recurrence rate of100%, the averagerecurrence time of9.6months after surgery, no metastasis after resection of arecurrence rate was13.3%,3-year recurrence rate was71.4%, the average recurrence time of17.5monthsafter surgery, the main reason for the recurrence of liver portal areas of livermetastasis. Expand the scope of surgical resection and lymph node dissection has not beenable to determine the therapeutic effect. Without resection, only through the PTCD catheterdrainage or endoscopic means to alleviate their symptoms, survival between6and12months.Cholangiocarcinoma of radiotherapy, chemotherapy is not sensitive, is not yet astandard treatment. With the development of molecular biology, if you can understand theneural cell adhesion molecule (NCAM) and nerve growth factor (NGF) and bile duct invasionof peripheral nerve mechanisms, from the mechanism, to interfere with the peripheral nerveinfiltration, bile duct cancer will be bring breakthrough targeted therapy can improve theunderstanding of the bile duct to help improve the treatment of effective preventive measures,thereby improving the prognosis of cholangiocarcinoma.Methods: Select the Affiliated Hospital of Hebei Medical University, General Surgeryand First Central Hospital of Baoding. Malignant group (experimental group):20patientsunderwent surgical treatment and pathological diagnosis of bile duct cancer havecancer. Benign group (control group):10cases, including the bile duct, extrahepatic bile ductstricture, benign bile duct dilation of extrahepatic bile duct benign lesions. All cases wereconfirmed by surgery and diagnosed cases, after preoperative chemotherapy, clinical datadocumented. Whole-slice scanning technique to observe the local tumor growth andinfiltration pattern of nerve; of20patients with hilar cholangiocarcinoma cases of tissuesections for immunohistochemical staining NCAM and NGF, respectively, with benign bileduct tissue biopsy contrast, the tumor infiltration of nerve and the relationship betweenNCAM and NGF. All data SPSS13.0package for statistical analysis between groupscompared using the chi-square test.Results:1. NGF and NCAM expression in the cell membrane, cytoplasm, brownish yellow orbrown particles. NGF and NCAM is highly expressed in cholangiocarcinoma, benign diseasein the lower bile duct tissue expression, NGF and NCAM in benign bile duct tissues thepercentage of positive rate of less than20%. The positive expression in thecholangiocarcinoma group rate greater than83%, significantly higher than its benign groupwere significantly different (P <0.05). This experiment shows that, NGF and NCAMexpression in the cholangiocarcinoma was significantly higher than in benign biliary tractdisease, the organization, after examination by immunohistochemical indicators of NGF and NCAM in the diagnosis of cholangiocarcinoma have a great meaning.2. NGF and NCAM expression in cholangiocarcinoma and perineural invasion of tumorwas positively correlated, NGF and NCAM expression in the cell membrane, cytoplasm,brownish yellow or brown particles. NGF and NCAM is highly expressed in the bile duct,nerve infiltration rate is increased, the percentage of positive cells in the nerve infiltrationwere greater than92.3%,96.15%, higher than the non-invasive group,25%,50%positiveexpression (P <0.05). This experiment shows that, after immunohistochemical examination ofNGF and the higher the value of NCAM-positive, the diagnosis of cholangiocarcinomawithout perineural invasion was significant. To provide a strong basis for targeted therapyafter surgery.3. Bismuth-Corlette staging in clinical stage: Ⅰ type: tumor in the hepatic duct,non-infringement of confluence of the Department; Ⅱ type: tumor spread to the left hepaticduct, left hepatic duct is not violated; Ⅲ type: has violated the right hepatic duct (Ⅲ a) orviolation of the left hepatic duct (Ⅲ b); Ⅳ type: left and right have been violated bilateralhepatic duct.Ⅰ, Ⅱ period of NGF expression in cholangiocarcinoma and NCAM-positiverates were47.6%,42.8%,, Ⅲ, Ⅳ period of NGF expression in cholangiocarcinoma andNCAM-positive rates were88.8%, The significant difference between the period (P <0.05).This experiment showed that the higher stages of cholangiocarcinoma, NGF and NCAMexpression in cholangiocarcinoma higher, which in the diagnosis of cholangiocarcinomadevelopment and provide a theoretical basis.4. Well-differentiated cholangiocarcinoma expression of NGF and NCAM-positive rateswere50%,66.6%in poorly differentiated cholangiocarcinoma expression of NGF andNCAM-positive rate greater than88.8%,94.4%, significant levels of differentiation betweenthe difference (P <0.05). This experiment showed that the lower bile duct differentiation,perineural invasion faster the higher the degree of malignancy.5. Well-differentiated cholangiocarcinoma: in cholangiocarcinoma up, could account for2/3or more, can be found in any part. Cancer growth both in the wall infiltration, around theentire wall. Infiltration of cancer tissue were different sizes, shapes, irregular glandularstructure, and some showed a cavity can be expanded. In poorly differentiatedcholangiocarcinoma: a poorly differentiated adenocarcinoma, glandular cancer showed somestructure, some of the irregular solid pieces, also diffuse infiltrative growth in the wall.NGFand NCAM expression in cholangiocarcinoma and cholangiocarcinoma patients with gender, pathological type has nothing to do, there is no significant difference (P>0.05). NGF andNCAM expression in the same types of cholangiocarcinoma, with no significant relationshipbetween the type of patients, no significant meaning. This experiment shows that, bydetecting cholangiocarcinoma NCAM indicators of NGF and its not clear that patients withgender, pathological type of relationship.Conclusion：1. NCAM may be one of the characteristics molecules ofcholangiocarcinoma. It can lead cholangiocarcinoma cell to nerve fibers chemotaxis andadhesion, that is, the "Navigation" and "park" effect;2. NGF expression in a variety of tumor cell and tumor proliferation and infiltration withan important relationship, particularly in an important relationship exists with neural invasion.Also has enhanced the ability of cholangiocarcinoma tumor cells into the role of nerve growthfactor expression of cholangiocarcinoma tumor cells into fast, high incidence of distantmetastasis, and tumor prognosis.