Relationship Between VEGF-C, E-carherin, TSH, NLR And Lymph Node Metastasis In Human Tumour In Papillary Thyroid Carcinoma

Objective:To investigate the relationships between lymph node metastasis(LNM) and expression of vascular endothelial growth factors-C(VEGF-C),E-cadherin,lymphatic vessel density(LVD) measured by D2-40,preoperative serum thyroid stimulating hormone(TSH) levels and neutrophil-to-lymphocyte count ratio(NLR) in patients with papillary thyroid cancer(PTC). Analyse the intratumoral and peritumoral lymphatic vessel density(ILD and PLD) but also the expression of VEGF-C,E-cadherin and TSH to their correlation.Methods : A total of 100 patients with PTC were divided into 3 groups by their postoperative LNM staging. Vascular endothelial growth factor-C(VEGF-C),E-cadherin levels and lymphatic vessel density(LVD) measured by D2-40 staining were examined by immunohistochemistry on paraffin-embedded tumor specimens. Collect the preoperative serum thyroid stimulating hormone(TSH) levels and neutrophil-to-lymphocyte count ratio(NLR)Results:(1) The expression of VEGF-C and E-cadherrin correlate with lymph node metastasis and lymphatic vessel density in PTC patients.(2)There was a significant difference of lymphatic vessel density between the N0,N1 a and N1 b groups(F=239.45 P=0.00). Moreover the peritumoral lymphatic vessel density was significantly higher than intratumoral lymphatic vessel density in N1 b group( Z=-5.32,P=0.00)(3)the levels of preoperative serum thyroid stimulating hormone(TSH) and neutrophil-to-lymphocyte count ratio(NLR) were significantly lower in patients without LNM(NO) comparing to the N1 a and N1 b group However,there was no significant difference between N1 a and N1 b.(4) Patients with a greater number of central lymph node metastasis(>2)showed higher rates of lateral cervical lymph node metastasis( ≤ 2 vs 3 ~ 5 vs>5=17% vs 54% vs52%)(5)Multivatiate analysis showed that the extracapsular extension, VEGF-C,LVD was an indenpenent risk factor of cervical lymph node metastasis in PTC.Conclusion:VEGF-C, E-cadherin, TSH, NRL was influence factors of LNM and associated with lymphangiogenesis in PTC.The number of peritumoral lymphatic vessel was significantly higher than the intratumoral lymphatic vessel, so we guess that peritumoral lymphatic vessel maybe the vital part for the lymph node metastasis.When CLNM > 2,there is a high risk of lateral neck lymph node metastasis,which can help to the decision of the extent of thyroid surgery at some degree. Extracapsular extension, VEGF-C and LVD were independent risk factors of cervical lymph node metastasis of PTC by multivariate analysis.