预示尿路上皮癌短期内复发分子指标的研究  

Study of the effect of molecular factors on the short-time recurrence of urothelial carcinoma

作　　者：杨新宇[1] 夏同礼[1] 何群[1] 李峻[1] 李文[1] 苏晋伟[1] 王静华[1] 那彦群[1] 

机构地区：[1]北京大学第一医院泌尿外科北京大学泌尿外科研究所,100034

出　　处：《中华泌尿外科杂志》2007年第5期338-341,共4页Chinese Journal of Urology

摘　　要：目的探讨p53、视网膜母细胞瘤基因蛋白（Rb）及增殖细胞核抗原（PCNA）的异常表达与尿路上皮癌短期内复发的关系。方法初诊为膀胱尿路上皮癌患者544例。男406例,女138例。年龄33～81岁,平均66岁。术前临床分期T1 486例、T2 58例。患者均行经尿道肿瘤电切术。术后病理诊断均为膀胱尿路上皮癌,其中G3 77例、G2 371例、G1 96例。统计1～3年内的复发情况及复发率。对患者进行组织形态学及p53、Rb、PCNA免疫组化染色研究,并分析其与尿路上皮癌1～3年内复发率的相关性。结果544例患者术后1～3年内复发者110例,其中1年内复发者82例,1～2年间复发者18例,2～3年间复发者10例。复发者中肿瘤多发者25例（22．7％）,复发后病理分级提高者30例（27．3％）,分期提高者8例（7．3％）。复发者中,初诊为尿路上皮癌G3者57例,短期复发率为74．0％;G2 49例,短期复发率为13．2％;G1 4例,短期复发率为4．2％。复发者中,分期为Ta～T1者87例短期复发率为17．9％,T2 23例短期复发率为39．7％。544例中Rb或p53或PCNA强阳性者194例,占35．7％;短期内复发者中Rb或p53或PCNA强阳性者89例（占80．9％）。单因素分析显示,病理分级（P〈0．001）、分期（P=0．031）、p53（P=0．002）及PCNA（P〈0．001）的表达情况是肿瘤短期内复发的影响因素。多因素分析表明,p53、Rb、PCNA作为整体,3者中有任一强阳性表达是肿瘤短期（1～3年）内复发的独立危险因素,肿瘤分级（P〈0．001）亦是肿瘤短期内复发的独立危险因素。结论p53或Rb或PCNA强阳性表达可作为预示尿路上皮癌短期内复发的重要参考指征,参考价值与肿瘤分级相似。Objective To investigate the expression patterns of p53, Rb and PCNA in urothelial carcinoma and their correlation with the recurrence of urothelial carcinoma. Methods A total of 544 patients who were first time diagnosed as urothelial carcinoma of bladder were included in present study. 406 patients were male and 138 patients were female and the ages were 33-81 years （mean, 66）. The preoperative clinical stage of the tumours was T1 in 486 cases and T2 in 58 cases. All the tisue samples were from transurethral resection. The pathological diagnosis was urothelial carcinoma, among which 77 cases were G3, 371 cases were G2 and 96 cases were G1. The recurrence parameters were recorded and analyzed. The morphologic characters and the expression pattern of p53,Rb and PCNA of all cases were studied and their relationship with the recurrence were evaluated. Results Among the 544 cases, 110 cases recurred within 1-3 years. In this group, which 82 cases recurred within 1 year, 18 cases recurred during 1-2 years and 10 cases recurred during 2-3 years. Also, 25 （22.7%） were multiple cancers. After recurrence, 30 cases（27.3%） had elevated pathological grades and 8 cases（7.30%） had advanced stages. The short-time recurrence rate was 57 in 77 grade G3 cases （74.0%）, 49 in 371 grade G2 cases（13.2%）, 4 in 96 grade G1 csses（4.2%） ; 87 in 486 stage Ta-Tj cases（17.9%） and 23 in 58 stage T2 （39.7%） ,respectively. 194 cases （35.7%） of all cases and 89 cases（80.9%） of short-time recurred cases overexpressed p53, Rb or PCNA. In ehi square test, the grading of tumor （P〈0. 001）, the staging of tumor （P=0. 031）, and the expression patterns of p53 （P=0. 002） and PCNA （P〈0. 001） is the influencing factors of the short-time recurrence of the tumor. In multivariate analysis, the over expression of p53, Rb, PCNA （P〈0. 001） and the grading of tumour（P〈0. 001） were the independent risk factors of recurrence. Conclusions The overexpression of p53,Rb, PCNA （P〈0. 001）

关 键 词：尿路上皮肿瘤 复发 P53 视网膜母细胞瘤基因蛋白 增殖细胞核抗原 

分 类 号：R686[医药卫生—骨科学]