E2F1超声靶向造影及弹性成像评价肾癌合并瘤栓侵犯静脉壁机制研究

Renal cell carcinoma with venous tumor thrombus is the highest mortality of perioperative mortality in Department of urology. Up to 40%, a reasonable surgical strategy based on tumor thrombus characteristics is the basis for reducing perioperative mortality. Tumor invasion of inferior vena cava wall is considered to be the independent risk factors of renal cell carcinoma, tumor thrombus in the inferior vena cava wall invasion is important clinical significance: on the one hand, tumor thrombus invading inferior vena cava wall and intraoperative tumor thrombus were stripped clean of patients with a poor prognosis, on the other hand, tumor thrombus is an infringement of the inferior vena cava wall you can decide operation way. At present, in domestic and foreign lacking of diagnostic criteria for thrombosis involving venous wall imaging, our previous abnormal activation of E2F1 in malignant progression of renal cell carcinoma invasion, tumor thrombus in the vein wall event is the key factor, targeting contrast and elastic imaging is two new technology rapid development of ultrasonic field in recent years, this project intends to use ultrasound combined with E2F1 targeted imaging and elastography. Compared with histopathology and molecular pathology, explore the ultrasound features of tumor thrombus invasion of the venous wall, through experimental study in vitro and in vivo and verify its molecular mechanism, occurrence regularity on tumor embolus in vessel wall invasion, establishing early warning system of renal cell carcinoma with tumor thrombus invasion of the venous wall. To find clues and methods for solving clinical problems in order to improve the level of comprehensive diagnosis and treatment of renal carcinoma with venous tumor thrombus.

肾癌伴静脉瘤栓是泌尿外科围手术期死亡率最高疾病，高达40%，根据瘤栓特征制定合理的手术策略是降低围手术期死亡率基础。瘤栓侵犯下腔静脉壁被认为是肾癌的独立危险因素，瘤栓是否侵犯下腔静脉管壁在临床具有重要意义：一方面，瘤栓侵犯下腔静脉管壁以及术中瘤栓未剥离干净患者预后较差，另一方面，瘤栓是否侵犯下腔静脉管壁可以决定手术方式。目前，国内外缺乏瘤栓侵犯静脉壁的影像学诊断标准，本课题组前期发现E2F1的异常激活在肾癌恶性进展、瘤栓侵犯静脉壁事件中是关键因素，靶向造影和弹性成像是近年来超声领域迅猛发展的两项新技术，本课题拟运用超声结合E2F1靶向造影和弹性成像技术，与组织病理和分子病理对照研究，探索瘤栓侵犯静脉壁的超声影像特征，通过体外和体内实验研究并验证其分子机制，阐述瘤栓侵犯血管壁的发生规律，建立肾癌合并瘤栓侵犯静脉壁的预警系统。为临床问题的解决寻找线索和方法，以期提高肾癌伴静脉瘤栓综合诊疗水平。

肾癌伴静脉瘤栓是泌尿外科围手术期死亡率最高的疾病，高达40%，根据瘤栓的特征制定合理的手术策略是降低围手术期死亡率的基础。瘤栓侵犯下腔静脉壁被认为是肾癌的独立危险因素，瘤栓是否侵犯下腔静脉管壁在临床具有重要意义：一方面，瘤栓侵犯下腔静脉管壁以及术中瘤栓未剥离干净的患者预后较差，另一方面，癌栓是否侵犯下腔静脉管壁可以决定手术的方式。目前，国内外缺乏对瘤栓侵犯下腔静脉壁的影像学诊断标准，本课题组前期发现E2F1的异常激活在肾癌恶性进展、瘤栓侵犯静脉壁事件中是关键因素，靶向造影和弹性成像是近年来超声领域迅猛发展的两项新技术，本课题运用超声结合E2F1靶向造影和弹性成像技术，与组织病理和分子病理对照研究，探索瘤栓侵犯静脉壁的超声影像特征，通过体外和体内实验研究并验证其分子机制，阐述瘤栓侵犯血管壁的发生规律，建立肾癌合并瘤栓侵犯静脉壁的预警系统。为临床问题的解决寻找线索和方法，提高肾癌伴静脉瘤栓综合诊疗水平。.构建携载E2F1抗体的纳米微泡，利用超声分子影像与超声弹性成像研究E2F1阳性与阴性表达的肾癌合并瘤栓超声功能成像特征，并结合高分辨率超声对肾癌合并瘤栓显影特征，建立肾癌合并静脉瘤栓，瘤栓侵犯静脉壁的预警系统，为临床治疗方法的选择提供理论依据。课题组自2017年1月至今已采用术中超声，在保证将癌栓及血栓完全切除的同时，保护主要的侧支循环血管，患者术后下肢肿胀症状明显减轻，缩短了术后恢复时间，降低了平均住院日。根据临床及病理结果，术中超声造影诊断癌栓侵犯腔静脉壁的敏感性93.1%、特异性93.5%、准确性93.3%、阳性预告值93.1%、阴性预告值为93.5%。术中超声在推动肾癌合并静脉癌栓手术策略的制定在机器人手术时代具有重要意义，目前，围手术期的死亡率降低到1%。