Transcript Document

Ck positive cells in draining pulmonary
veins of patients with non-small cell
lung cancer: the impact of
intraoperative surgical manipolation
on the detection of tumour cells and
its relation to CXCR4 expression and
Microvascular Density
G.Liguori,G.Pirozzi^, I. Forte, G.Botti, R.Franco, A.La Rocca*, G.Rocco*
Istituto Nazionale Tumori Napoli
Dip.Anatomia Patologica; Dip.Onc.Sperimentale^;
Dip.Toraco-Polmonare*
INTRODUCTION
•
Cancer cell dissemination in cancer is an
essential
event
for
the
hematogenous
metastasis of solid tumors.
•
High frequency of cancer cells could be detected
in the bloodstream during surgery.
•
Tumor cell migration could be critically
regulated by chemokines and their receptors,
mainly CXCR4.
•
Micro Vasculature Density (MVD), represent a
measuring factor of metastatic potential.
PURPOSE
-Evaluation of CXCR4 and CD31 expression in 39 patients
with non-small cell lung cancer
-Relation between CXCR4 and CD31 expression
( Microvascular Density)
- To confirm CD31 and CXCR4 expression as a potential high
risk for metastasis and poor prognosis.
MATERIAL and METHODS
39 paraffin specimens from completely resected primary
non-small cell lung cancer (pT1-4 pN0-2), texted by
CXCR4 and CD31 immunohistochemistry.
Blood samples obtained in theatre from pulmonary veins
after lobectomy or pneumonectomy were examined for
occult tumour cells by immunocytochemical staining of
cytospins using the pancytokeratin antibody A45-B/B3 that
binds to the cytokeratins 8, 18 and 19.
HIGH AND LOW MVD
High expression CD31
Low expression CD31
Table
Patient characteristics and distribution of disseminated tumour cells
Variable
No Patients
Total
Tumour extension
pT1-pT2
pT3-pT4
Lymph node involvement
pN0
pN1-pN2
Tumour Histology
Adenocarcinoma
Squamous cell carcinoma
Large cell
Neuroendocrino
Age
≤60
>60
Sex
Female
Male
Expression of CD31
Low
High
39
No of Patients with positive blood samples
P Value
10 (22%)
35
4
7 (20%)
3 (75%)
0.04
34
5
8 (23,.5%)
2 (40%)
0.38
13
22
3
1
2 (15%)
7 (31%)
1 (33%)
14
25
4 (28%)
6 (24%)
0.51
12
27
3 (25)
7 (33%)
0.63
26
13
1 (3%)
9 (69%)
2.9x10-5
0.25
RESULTS
1) Cancer cells in pulmonary venous blood in 9 out of 39
patients (23,7%).
2) 31,8% in patients affected by squamous cells
carcinoma; 33,3% in patients with large cell carcinoma;
7,6% in patients with adenocarcinoma.
3) All the patients with N2-lymph node involvement were
not positive for the presence of cancer cells in the
venous blood.
4) No evidence of venous dissemination was found in
patients affected by the other histological types.
CONCLUSION
Occult cancer cells in the pulmonary venous blood are
detectable in about 23.7% of the patients with resectable
non-small cell lung cancer. Larger series are needed to
verify :
a. the extent by which surgical manipolation can contribute to
cancer cell dissemination in the pulmonary veins;
b. the detection of such cells might be useful for the
identification of patients who may benefit from adjuvant
therapy.
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