错配修复蛋白在上尿路癌与膀胱尿路上皮癌组织中的表达差异及临床意义  

Difference of expression and clinical significance of mismatch repair proteins in upper tract urothelial carcinoma and bladder urthelial carcinoma tissues

作　　者：田伟 殷喜雀 杨旭 李妍 王辉 田子元 张冠军[4] TIAN Wei;YIN Xique;YANG Xu;LI Yan;WANG Hui;TIAN Ziyuan;ZHANG Guanjun(Department of Pathology;Department of Urology,No.215 Hospital of Shaanxi Nuclear Industry,Shaanxi Xianyang 712035,China;Grade 2022,Eight-year Program Student of Stomatology,Air Force Medical University,Shaanxi Xi'an 710038,China;Department of Pathology,the First Affiliated Hospital of Xi'an Jiaotong University,Shaanxi Xi'an 710061,China)

机构地区：[1]陕西省核工业二一五医院病理科 [2]陕西省核工业二一五医院泌尿外科,陕西咸阳712035 [3]空军军医大学,陕西西安710038 [4]西安交通大学第一附属医院病理科,陕西西安710061

出　　处：《现代肿瘤医学》2024年第23期4497-4503,共7页Journal of Modern Oncology

基　　金：陕西省核工业二一五医院2023年院级科研课题项目(编号:215KYJJ-202309)。

摘　　要：目的:对比分析上尿路尿路上皮癌(upper tract urothelial carcinoma,UTUC)和膀胱尿路上皮癌(bladder urthelial carcinoma,BUC)之间错配修复蛋白(mismatch repair protein,MMR)表达的差异及意义。方法:回顾性分析2010年12月至2022年12月陕西省核工业二一五医院病理诊断的UTUC和BUC共309例患者临床病理资料,行免疫组化染色,抗体选择MLH1、PMS2、MSH2、MSH6,观察UTUC和BUC两组间错配修复蛋白功能缺陷(mismatch repair-deficient,dMMR)情况并统计分析。结果:309例UC中dMMR有11例,表达缺失率为3.6%(11/309)。单因素分析结果显示,在UTUC和BUC之间dMMR发生率有显著性差异(P<0.05),UTUC组中dMMR为7.3%,BUC组中为1.5%;另外性别、肿瘤最大径、组织学级别、肿瘤单发或多发、T分期、N分期及癌栓在UTUC和UCB间存在统计学差异(均P<0.05)。进一步Logistic回归多因素分析:性别、肿瘤单发或多发、T分期、N分期、dMMR为UTUC的独立相关因素(均P<0.05)。Kaplan-Meier生存分析显示,UTUC中dMMR患者的OS显著高于错配修复蛋白表达正常(mismatch repair-proficient,pMMR)患者(P=0.048),但在整体UC和BUC中dMMR患者与pMMR患者的OS无显著性差异(P值分别为0.182、0.682)。进一步研究发现在UTUC中,dMMR患者与pMMR患者在复发或转移方面差异显著(P=0.036)。结论:UTUC中dMMR发病率显著高于BUC中dMMR发病率,且在UTUC中dMMR提示较好的预后,而在BUC中无预后提示意义。Objective:To analyse the difference and significance of mismatch repair protein(MMR)expression between UTUC and BUC.Methods:From December 2010 to December 2022,the clinicopathological data of 309 cases of UTUC and BUC diagnosed in the 215 hospital of Shaanxi Nuclear Industry were analyzed retrospectively.MLH1,PMS2,MSH2 and MSH6 were selected by immunohistochemical staining.The mismatch repair-defective(dMMR)between UTUC and BUC groups was investigated and analyzed statistically.Results:The dMMR occurred in 11 of 309 urothelial carcinoma patients,the rate was 3.6%(11/309).The results of single factor analysis showed that the incidence of dMMR in UTUC and BUC was significantly different(P<0.05).The expression rate of dMMR in UTUC group was 7.3%,in BUC group was 1.5%.In addition,there were statistical differences in gender maximun,tumor diameter,histological grade,number of tumors,T stage,N stage and cancer embolus(all P<0.05).Logistic multivariate analysis found that gender,number of tumors,T stage,N stage and dMMR were independent factors related to UTUC(all P<0.05).Kaplan-Meier survival analysis showed that the OS of the dMMR patients in the UTUC group was significantly higher than that of mismatch repair-proficient(pMMR)patients(P=0.048),but in all UC and in the BUC group,there was no significant difference in OS between dMMR patients and pMMR patients(P=0.182,P=0.682 respectively).Further research found that there was a significant difference in recurrence or metastasis between dMMR and pMMR patients in UTUC(P=0.036).Conclusion:The incidence of dMMR in UTUC is significantly higher than that in BUC,and it only suggests a better prognostic effect in UTUC,but no prognostic indicator in BUC.

关 键 词：上尿路尿路上皮癌 膀胱尿路上皮癌 错配修复蛋白 免疫组化 预后 回顾性研究 

分 类 号：R737.15[医药卫生—肿瘤]