肾损伤因子-1在肾上皮性肿瘤中的表达及临床意义  

Expression and clinical significance of kidney injury molecule-1 in renal epithelial neoplasms

作　　者：董迎春[1] 吴波[1] 王建东[1] 饶秋[1] 马恒辉[1] 章如松[1] 周航波[1] 陆珍凤[1] 周晓军[1] 

机构地区：[1]南京大学医学院临床学院南京军区南京总医院病理科,210002

出　　处：《中华病理学杂志》2010年第1期35-39,共5页Chinese Journal of Pathology

基　　金：基金项目：国家自然科学基金（30970813）;南京军区医学科学技术研究“十一五”计划（06Z37）

摘　　要：目的探讨肾损伤因子-1（KIM-1）在原发性和转移性肾上皮性肿瘤中的表达和意义。方法选取136例肾脏肿瘤，包括原发性肾透明细胞癌63例，乳头状肾细胞癌22例，肾嫌色细胞癌13例，肾嗜酸细胞腺瘤7例，Xp11．2易位／TFE3基因融合相关性肾癌7例和转移性肾透明细胞癌24例，用KIM-1和肾特异性钙黏蛋白抗体进行免疫组织化学EnVision法染色，并分析其表达与透明细胞癌分级和分期关系。结果KIM-1在原发性肾透明细胞癌、乳头状肾细胞癌、肾嫌色细胞癌、Xp11．2易位／TFE3基因融合相关性肾癌和转移性透明细胞癌中的表达率分别是77．8％（49／63）、90．9％（20／22）、1／13、7／7和87．5％（21／24），7例嗜酸细胞腺瘤均阴性。在原发性’肾透明细胞癌中，KIM-1弥漫阳性表达更易发生于Furhman细胞核Ⅲ／Ⅳ级的病例（P=0．010）。肾特异性钙黏蛋白主要表达于嫌色细胞癌和嗜酸细胞腺瘤。结论KIM-1仅表达于损伤的近曲小管和由其起源的肿瘤，对原发性和转移性肾透明细胞癌、乳头状肾细胞癌及Xp11．2易位／TFE3基因融合相关性肾癌具有高度的特异性和敏感性，与肾特异性钙黏蛋白合用可以提高原发性肾脏上皮性肿瘤组织学分类的准确性和转移性肾透明细胞癌的诊断率。Objective To study the expression and clinical significance of kidney injury molecule-1 （KIM-1） in primary and metastatic renal epithelial neoplasms. Methods A total of 136 cases of kidney neoplasms were retrospectively reviewed including 63 primary clear cell renal cell carcinomas （RCCs）, 22 papillary RCCs, 13 ehrornophobe RCCs, 7 oncocytomas, 7 RCCs associated with Xpll. 2 transloeation/ TFE3 gene fusions and 24 metastatic clear cell RCCs. Immunostaining for KIM-1 and kidney-specific-protein （Ksp）-eadherin were performed and the relationship to tumor stage and grade in clear cell RCCs was investigated. Results Expression of KIM-1 was detected in 77.8% （49/63） of clear cell RCCs, 90. 9% （20/22） of papillary RCCs, 1/13 of ehromophobe RCCs, 7/7 of RCCs associated with Xp11. 2 translocation/TFE3 gene fusions and 87.5% （21/24） of the metastatic RCCs, but not detected in 7 cases of oncoeytomas. A diffuse expression of KIM-I was more frequently observed in Furhrnan nuclear grade Ⅲ/Ⅳ clear cell RCCs （P = 0. 010）. Ksp-eadherin expression was mainly observed in ehromophobe RCCs and oncocytomas. Conclusions KIM-1 is a specific biomarker for injuried kidney proximal tubules and the corresponding neoplasms, and has a high specificity and sensitivity for primary or metastatic clear cell RCCs, papillary RCCs and RCCs associated with Xpl 1.2 translocation/TFE3 gene fusions. Combination of KIM-1 and Ksp-cadherin irnrnunostaining can lead to a more precise histological classification of primary kidney epithelial neoplasms and improve the diagnostic accuracy of metastatic RCCs.

关 键 词：肾肿瘤 肿瘤 腺和上皮 肿瘤 多原发性 肿瘤转移 

分 类 号：R737.11[医药卫生—肿瘤] R318.01[医药卫生—临床医学]