Optimizing The Vascular Interventional Outcome For Patients With Primary Pulmonary Carcinoma: Results Of 5-year Follow-up

Objective:1 To ascertain tumor vascularity and its supplied arteries of primary pulmonary carcinoma(PPC) further by results of 5-year vascular interventional follow-up.2 To assess sensitivity and correlations of CTA versus DSA in detecting tumor vascularity and its supplied artery in PPC.3 To discuss interrelation of tumor vascularity and stein versus cellular pathology of PPC, and its interference with prognosis of vascular interventional management.4 To optimize the vascular interventional outcome for patients with PPC by results of 5-year vascular interventional follow-up. Materials and Methods:Ninety-three patients with PLC received 219 vascular interventional therapies during last 5 years. The common and enhancement scan technique of high-speed helical CT was adopted before every treatment firstly, including CT angiography (CTA) The superiority arteries of PLC were observed through thoracic aortiography. Meanwhile, the corresponding pulmonary arterial angiography was held on according to tumor in lung segment. Afterthen, micocatheter-inserted was used for further tumor angiography from superiority arteries. Statistics analysis was undertaken by SPSS 10 software.Forty cases with pathological diagnoses of PPC (central type, n = 17 ; peripheral type, n=23) , aged from 32 to 85 yrs with a mean of 67.6+/-11.45 yrs), had a total of 116 vascular interventional management; Thoracic aortiography were undertaken for supplied artery of tumor in all patients, and supper-selective bronchial angiography followed, meanwhile pulmonary angiography of relevant segment had been undertaken. Lastly micocatheter was inserted for angiography of supplied arteries of focus.Data were inputted into SPSS12.0 software as patient's age, sex, size and location of focus, pathology, supplied artery, tumor vascularity and stein, interventional regime, treated times,time of first interventional treatment, survival time, statistical analyses were carried out forrelations of each others.Results:The vascularity of PLC with central gross type in CTA and image- reconstructed showed that 31 cases occurred in arterial phase, 6 cases in metaphase. Of peripheral gross type showed that 40 cases occurred in arterial phase, 11 cases in metaphase. The supplied arteries to tumor in central gross type showed that 19 cases from bronchi cal artery (BA), 13 cases from non-bronchi cal system arteries (NBA), 7 cases part from pulmonary artery (PA), in peripheral gross type showed that 33 cases from BA, 3 cases from NBA, 19 cases part from PA.The vascularity of PLC with central gross type in DSA angiography showed that 26 cases occurred in arterial phase, 6 cases in metaphase, 7 cases in venous phase. Of peripheral gross type showed that 39 cases occurred in arterial phase, 6 cases in metaphase, 9cases in venous phase. The supplied arteries to tumor in central gross type showed that 28 cases from BA, 2 cases from NBA, 9 cases part from PA, in peripheral gross type showed that 38 cases from BA, 9 cases from NBA, 11 cases part from PA.The coincidence of tumor vascularity and steins is 94.56% CTA and image- reconstructed vs. DSA angiography. The focus with obvious evidences of tumor vascularity and stein had 13 with any evidence in DSA angiography. Conversely, the focus with obvious in DSA angiography had 15 with any evidences in CT image. Sensitivity comparison of two methods showed no statistics significances (P>0.05). But for the bronchial artery-pulmonary veins fistula (APVS) and bronchial artery-pulmonary artery fistula (APAS), CT did not detected any evidence about it.On first angiogarms of 40 cases, obvious tumor stein occurred in 27 cases, and the less or no stein in 13 cases. On the last angiogarms, the obvious occurred in 9 cases, the less or no stein in 31 cases. Changes of tumor vascularity and stein showed obviously statistical differences (P<0.01) between first and last interventional treatment. The relations of tumor vascularity and stein vs. pathological diagnosis and its classification of PPC showed that the main supplying arteries of PPC were bronchial arteriesC BA, 35/40,87.5%), meantime, only four cases also supplied by pulmonary arteries C PA, 10% ) ;Adenocarcinoma and squamous cellcarcinoma mainly supplied by BA (n=32,80%) .Interrelations of tumor vascularity and stein versus pathology showed obvious statistical difference (P<0.01) .By survival statistical results of 5-year vascular interventional follow-up, it should be depending on supplied- arterial and vascularity, for optimizing the vascular interventional outcome for patients with PPC.BAI+BAE is frist choice for rich vascularity in PPC. Conclusion:The supplied- arterial and vascularity of PLC could be evaluated effectively by common CTA, which was very helpful to making interventional therapy regime, and effective to avoid missing blood vessel during interventional management probably leading the treatment effect decrease. But the detection coincidences of APVS and APAS in CTA and image-reconstructed is much lower than in DSA angiography.BA is main supplied artery of PPC. No statistical relations demonstrated tumor vascularity and stein vs. pathology, but negative relations showed pathological cellular grading vs. tumor vascularity and stein, namely, lower level of differentiation of PPC cell, tumor vascularity and stein should be more rich and generous. Vascular interventional treatment should obviously reduce tumor vascularity and stein.