非浸润性膀胱尿路上皮肿瘤中Ki-67、c-erbB-2的表达及意义

Expression of Ki-67 and c-erbB-2 in non-invasive urothelial tumours of bladder and their significances

目的探讨非浸润性膀胱尿路上皮肿瘤的组织学形态及Ki-67、c-erbB-2表达的意义。方法依据WHO（2004）泌尿系统肿瘤中ISUP分类标准进行组织学观察及分类。应用免疫组化方法检测70例膀胱尿路上皮肿瘤标本中Ki-67、c-erbB-2的表达水平，并对其进行3～60个月随访。结果在尿路上皮乳头状瘤（UP）、乳头状肿瘤低恶性潜能（PUNLMP）、低级别乳头状尿路细胞癌（LGPUC）和高级别乳头状尿路细胞癌（HGPUC）中，Ki-67（L）分别为4．05±2．3、13．8±6．9、30．1±4．4和59．5±6．8;c-erbB-2与组织学分级有关（P〈0．01）。UP患者随访无复发；PUNLMP复发率为15％（3／20），LGPUC复发率为65％（13／20），HGPUC复发率为70％（7／10）。结论Ki-67和c-erbB-2可作为膀胱尿路上皮肿瘤细胞增殖程度及组织学诊断的参考指标。

Objective To explore the correlation between histologic appearance or Ki-67.c-erbB-2 expression and superficial non-invasive urothelial tumours of bladder. Methods The histological morphology was reviewed according to the WHO/ISUP Classification （2004）. The staining was used to evaluate the expression of Ki-67 and c-erbB-2 in 70 cases of urothelial tumotrrs of bladder. Follow-ups were obtained in 70 cases and the durationa ranged from 3 to 60 months. Results The Ki-67 labeling index （ Ki-67 LI） in urothelial papilloma （UP）, papillary urothelial neoplasm of low malignant potential （PUNLMP）, papillary urothelial earainoma, low grade （LGPUC） and papillary urothelial carainoma, high grade （HGPUC） were 4.05 ± 2.3, 13.8 ± 6.9, 30.1 ± 4.4, and 59.5 ± 6.8, respectively. The expression of c-erbB-2 was correlated with grades of the tumors （P 〈 0.01, P 〈 0.05）. In urothelial papillome no recurrence was found. The recurrence rate was 15% （3/20） in PUNLMP, 65% （13/20） in LGPUC and 70% （7/10） in HGPUC. Conclusions The results suggest that Ki-67 and c-erbB-2 are sensitive and specific markers and have a great significance in differential diagnosis of urothelial tumours of bladder. Detection of both Ki-67 and c-erbB-2 can improve the accuracy of diagnosis in papillary urothelial tumours.