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결직장암 환자의 예후평가에서 종양 맥관신생이 가지는 의의에 대한 연구

Tumor Angiogenesis as a Prognostic Assay for Patients with Colorectal Carcinoma

대한대장항문학회지 1997년 13권 2호 p.161 ~ 173
현문수 ( Hyun Moon-Soo ) - 동아대학교 의과대학 외과학교실

최홍조 ( Choi Hong-Jo ) - 동아대학교 의과대학 외과학교실
정갑중 ( Jung Ghap-Joong ) - 동아대학교 의과대학 외과학교실
김상순 ( Kim Sang-Sun ) - 동아대학교 의과대학 외과학교실
홍숙희 ( Hong Sook-Hee ) - 동아대학교 의과대학 병리학교실

Abstract


The growth and maintenance of solid tumors are dependent on new capillary ingrowth: a process called "angiogenesis." Thus, after a new tumor has attained a small size of a few millimeters in diameter(about 106 cells), further expansion of the tumor-cell population requires the induction of new capillary blood vessels. These new vessels also increase the opportunity for hematogenous or lymph node metastasis. Thus this study was designed to examine the microvessel count at the invasive margin in colorectal carcinoma to determine how angiogenesis correlates with clinicopathologic factors and prognosis. Paraffinembedded tissues from 127 patients with primary colorectal carcinomas that had been completely removed were retrieved and analyzed for angiogenesis. Vessels were immunostained with anti-factor VIII polyclonal antibody, and areas with the most discrete microvessels were counted in a 200×field, which were
defined as angiogenesis score(AS). The mean AS for anti-factor VIII antibody in this study was 55±08; therefore, cases
were classified into two subgroups : AS high group(n=67), for which AS was greater than 55 and AS low group(n=60), for which AS was equal to 55 or less. There were no significant intergroup difference regarding sex ratio, histologic grade, depth of invasion, or lymphatic invasion. AS was, however, significantly related to tumor size, venous invasion, lymph node metastasis, and liver metastasis(P=0.000, P=0.001, P=0.021, and P=0.004, respectively). The incidence of high AS group in Antler-Coller D was significantly greater than that in Antler-Coller A and B, and Antler-Coller C(P<0.05,
respectively). The recurrence rate in high AS group was 32.0%, which was, though statistically insignificant, higher than that in low AS group(17.2%). The 3 year survival rates of high AS group were significantly (P=0.004 both for overall cases and curatively-resected ones) worse than those of low AS group. This study suggests that the growth of colorectal carcinoma is dependent on ingrowth of new blood vessels, and that angiogenesis assessed by the microvessel count using immunohistochemical stains is an important predictor of tumor behavior and may identify patients at higher risk for recurrence and early death.

키워드

Angiogenesis;Colorectal Neoplasms
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