多灶性复发性表浅性膀胱移行细胞癌的克隆起源

Clonal origin of multifocal and recurrent low-grade superficial transitional cell carcinoma of bladder

目的探究多灶性、复发性、表浅性膀胱移行细胞癌的克隆起源。方法收集山西医科大学第一医院2000年1月至2004年12月经手术切除或膀胱镜活检并经病理证实的20例患者的多灶性膀胱癌、原发癌及复发癌,病理分级G1或G2的以10%甲醛液固定后石蜡包埋的组织标本66块。采用免疫组织化学染色SP法检测p16,Rb,cyclin D1基因表达。采用二项式分布法对结果进行统计分析。结果16例患者多发、原发和复发膀胱癌p16,Rb,cyclin D1表达完全一致;4例表达不一致。二项式分布计算分析认为,此16例膀胱移行细胞癌均为单克隆起源,其余4例为多克隆起源。结论多灶性、复发性、表浅性膀胱癌以单克隆起源为主,也可为多克隆起源。

Objective To investigate the clonal origin of malignant cell in muhifocal and recurrent low-grade superficial bladder cancer. Methods There were a series of 20 cases of synchronous and/or metchronous multifocal low-grade superficial transition cell carcinoma of bladder and 66 multiple bladder carcinomas from them. The expression of p16, Rb and cyclin D1 were compared by immunohistochemical method in all tumors. If the tumor was monoclonal, all tumors of a given patient should have the same immunoperoxidase staining. The probability for monoclonality was calculated using binomial distribution. Result Sixteen patients had identical expression in the multiple carcinomas ,suggesting that the carcinomas had a common origin, and the probability for monoclonality was ≥0.984. Four patients, however, had discordant expression, a fact that suggested independent origin. Conclusion These results demonstrate that multiple bladder carcinomas seem to be either common or independent origin, but the common origin plays the main role.