联合CK5和CK20免疫染色分析鉴别膀胱癌亚型  

Combination of CK5 and CK20 immunostaining analysis for identifying subtypes of bladder cancer

作　　者：张静琦 周晓洲 石家仲[2] 丁华 王力伟 刘沙[2] 杨劲[2] 陈志文 ZHANG Jingqi;ZHOU Xiaozhou;SHI Jiazhong;DING Hua;WANG Liwei;LIU Sha;YANG Jin;CHEN Zhiwen(Institute of Urology,Department of Urology,First Affiliated Hospital,Army Medical University,Third Military Medical University,Chongqing,400038,China;Department of Cell Biology,College of Basic Medical Sciences,Army Medical University,Third Military Medical University)

机构地区：[1]陆军军医大学(第三军医大学)第一附属医院泌尿外科全军泌尿外科研究所,重庆400038 [2]陆军军医大学(第三军医大学)基础医学院细胞生物学教研室

出　　处：《临床泌尿外科杂志》2020年第4期257-263,共7页Journal of Clinical Urology

摘　　要：目的:探讨联合CK5和CK20的表达与膀胱癌临床病理特征及预后的关系,从而鉴别膀胱癌亚型。方法:收集2012年1月~2018年9月于我院泌尿外科行膀胱癌根治术的患者149例,制备了包含149例膀胱癌组织及62例癌旁组织的组织芯片,采用免疫组化方法检测CK5、CK20及CD44的表达,采用χ~2检验比较各分子的表达与临床病理特征的关系,采用Spearman分析进行分子表达的相关性分析,采用Kaplan-Meier生存分析及多因素Cox回归模型进行预后分析。结果:联合CK5和CK20表达形成CK5^+CK20^+、CK5^+CK20^-、CK5^-CK20^+及CK5^-CK20^-4个亚型;①针对所有膀胱癌患者:149例膀胱癌组织中85例CK5^+(57.0%),82例CK20^+(55.0%)及96例CD44^+(64.4%);62例癌旁组织中56例CK5^+(90.3%),32例CK20^+(51.6%)及36例CD44^+(58.1%);癌与癌旁中CK5表达差异有统计学意义(P<0.001),而CK20和CD44差异无统计学意义(分别为P=0.650和P=0.384);CK5与CK20的表达呈负相关(r=-0.294,P<0.001),CK5与CD44的表达呈正相关(r=0.488,P<0.001);Kaplan-Meier结果表明CK5^-CK20^+亚型的无进展生存期(progression-free survival,PFS)、肿瘤特异性生存期(cancer-specific survival,CSS)、总生存期(overall survival,OS)均差于其他3种亚型;多因素Cox分析结果表明病理分期、淋巴结阳性、CK5^-CK20^+亚型是影响预后的独立危险因素;②针对化疗膀胱癌患者:4个亚型与临床病理特征及预后均无统计学意义。结论:联合CK5与CK20的表达可鉴别膀胱癌亚型,其中CK5^-CK20^+亚型预后最差;亚型与化疗耐药的关系仍需进一步扩大样本进行分析。Objective: To explore the relationship between the combination expression of CK5 and CK20 and the clinicopathologic features and prognosis of bladder cancer to identify the subtypes of bladder cancer. Method: From January 2012 to September 2018, 149 cases undergoing radical cystectomy in department of urology of First Affiliated Hospital of Army Medical University were collected retrospectively, and tissue microarray containing 149 cases of bladder cancer tissue and 62 cases of para-cancer tissue was prepared. The expression of CK5, CK20 and CD44 were detected by immunohistochemistry. The clinical and pathological characteristics of these molecules were compared by chi-square test, and the correlation of molecular expression was analyzed by Spearman analysis. Kaplan-Meier survival analysis and multivariate Cox regression were used for prognosis analysis. Result: CK5^+CK20^+ subtype, CK5^+CK20^-subtype, CK5^-CK20^+ subtype and CK5^-CK20^-subtype were defined by combining CK5 and CK20 expressions.(1) For all bladder cancer patients: among the 149 bladder cancer tissues, 85(57.0%) were CK5 positive, 82(55.0%) were CK20 positive, 96(64.4%) were CD44 positive, and 56(90.3%), 32(51.6%) and 36(58.1%) were positive in para-cancer tissues respectively. There was statistically significant difference in CK5 expression between cancer and para-cancer(P<0.001), while there was no statistically significant difference in CK20 or CD44(P=0.650 and P=0.384, respectively). A negative correlation was found between CK5 and CK20 expression(r=-0.294, P<0.001), while CK5 and CD44 were positively correlated(r=0.488, P<0.001). Kaplan-Meier results showed that the prognosis of CK5^-CK20^+ subtype was worse than other three subtypes. Multivariate Cox analysis showed that pathological stage, positive lymph node and CK5^-CK20^+ subtype were independent risk factors for prognosis.(2) For bladder cancer patients with chemotherapy: there was no statistical correlation between the four subtypes and clinicopathological features and prognosis. Concl

关 键 词：膀胱癌 CK5 CK20 CD44 

分 类 号：R737.14[医药卫生—肿瘤]