浅表性膀胱癌组织学形态及Ki-67、p53表达与肿瘤复发的关系

The correlation between recurrence of superficial bladder cancer and histology manifestation or Ki-67, p53 expression

目的探讨浅表性膀胱癌组织学形态以及Ki67、p53表达与肿瘤复发的关系。方法将54例浅表性膀胱癌分为复发组和无复发组。复习肿瘤组织学形态并根据1998年WHO/ISUP分类标准进行重新分类。免疫组化法检测Ki67和p53的表达并比较复发组与无复发组的差异。结果在平均32个月的随访中,28例复发,占52%,其中5例为低度恶性潜能的乳头状移行细胞瘤,14例为低级别乳头状瘤,9例为高级别乳头状瘤。而26例无复发肿瘤中4例为乳头状瘤,12例为低度恶性潜能的乳头状移行细胞瘤,8例为低别乳头状瘤,2例为高级别乳头状瘤。低度恶性潜能肿瘤复发率为29.4%(5/17),低级别和高级别乳头状瘤术后复发率分别为63.6%(14/22)和81.8%(9/11),而乳头状瘤无一例复发。Ki67和p53阳性率在两组之间有明显差别,复发组均明显高于无复发组(P<0.05)。在乳头状瘤病例中,Ki67和p53联合表达的病例复发率明显高于无联合表达者(P<0.01)。结论浅表性膀胱癌术后复发与组织学有关,Ki67、p53阳性表达尤其是联合阳性表达对判断膀胱癌复发具有重要意义。

Objective To approach the correlation between histology manifestation or Ki-67, p53 expression and superficial bladder cancer. Methods 54 cases of superficial bladder cancer were classified into two groups（with and without recurrence）. The histological morphology was reviewed according to the 1998 WHO/ISUP classification. The expression of both Ki-67 and p53 was detected with immunohistochemical method, and a comparison was made between withand without recurrence group. Results The average duration of follow-up survey for the patients was 32 months. Among the 54 patients, 28 got recurrence. Of the recurred cases, 5 were papillary urothelial neoplasm of low malignant potential （PUNLMP）, 14 were low grade papillary urothelial carcinoma （LGPUC）, and 9 were high grade urothelial papillary carcinoma （HGPUC）. While among the 26 cases without recurrence, 4 were papilloma, 12 were PUTLMP, 8 were LGPUC, and 2 were HGPUC. The recurrence rate was 29. 4% （5/17） in PUTLMP, 63. 6% （14/22） and 81.8% （9/11） in LGPUC and HGPUC, respectively. There was a significant difference in Ki-67 and p53 expression between the recurrence and non-recurrence groups, the positive rate in recurrence group was significantly higher than that in non-recurrence group （P〈0.05）. Among the cases of papillary carcinoma, the recurrence rate in the cases with combined Ki-67 and p53 expression was significantly higher than that in the cases with only Ki-67 or p53 expression alone. Conclusion The recurrence of superficial bladder cancer is closely correlated with its histological manifestation. The expression of Ki-67 and p53, especially the positive combined expression played an important role in the judgment of recurrence.